Skin substitute protocol
CTP/CAMP Graft Success
Wound Bed Preparation Fundamentals
This comprehensive guide explores the essential principles of wound bed preparation and their direct impact on cellular and tissue-based product outcomes.
Clinicians will learn systematic approaches to assess wound readiness, manage bioburden, control moisture, and optimize the healing environment.
Through evidence-based protocols and practical techniques, this resource provides the critical knowledge needed to maximize graft adherence, vascularization, and successful integration of CTPs/CAMPs across various wound types.
Classification of Persistent Tissue Injuries
Types of Chronic Wounds
This overview identifies the primary categories of chronic wounds seen in clinical practice, each with distinct pathophysiology and treatment requirements.
Understanding these classifications is essential for targeted assessment and effective management strategies.
- Venous Leg Ulcers (VLU)
- Arterial
- Diabetic Foot Ulcers (DFU)
- Pressure
- Trauma
Wound Healing
Phases of Wound Healing
Acute Process
Body advances through healing phases in orderly and timely manner
Chronic Status
Wound does not progress as expected, becoming classified as chronic
Systemic Factors
Age, chronic disease and poor nutrition impede normal healing
Local Factors
Pressure, trauma, edema, excessive bacteria and decreased oxygen delay healing
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- Primarily Diabetic Foot Ulcers (DFUs) & Venous Leg Ulcers (VLUs)
Other Wound Applications
- Chronic Pressure Ulcers
- Post-Surgical Wounds
- Disease-State Wounds
- And more...
Diabetic Foot
Ulcers (DFUs)
Venous Stasis,
Chronic Scalp
Ulcers (VLUs)
Other Factors Affecting Wound Healing
Other Factors Affecting Wound Healing
- Certain factors may affect the quantity, timing, and activity of the cytokines, growth factors, and MMPs that play a role in wound healing
- MMP (Matrix Metalloproteinase): enzymes that break down proteins in the wound bed
- In addition, bacteria found in chronic wounds
- In some cases, these substances may be present, but not available to the wound for healing
- Growth factors known as Cytokines are proteins that control the signaling properties of the wound bed.
- Growth factors are mediators that tell cells how to behave, affecting migration, reproduction, and cell death.
- Growth factors bind to ECM in order to be activated. Therefore, organized ECM plays a critical role in regeneration.
- Certain growth factors, including PDGF, EGF, and TGFb, are found in decreased levels in chronic wounds compared to acute wounds.
- In some cases, these substances may be present, but not available to the wound for healing.
Categories of Grafts
Categories of Grafts
- Chronic Pressure Ulcers
- Post-Surgical Wounds
- Disease-State Wounds
- And more...
Categories of Grafts
T.I.M.E Management Approach to Graft Prep
T
- Manage Tissue Quality ensuring it is viable.
I
- Manage the bacterial balance to Infection.
M
- Control the Moisture and exudate.
E
- Manage the cooperation of the wound Edges.
The Policies Focus on Two Main Conditions
The Policies Focus on Two Main Conditions
Diabetic Foot Ulcer (DFU) and Venous Leg Ulcer (VLU) since that is the majority of use for skin subs. Therefore, this influences other applications:
Chronic wounds always need to show treatments tried and failed at least 30 days SOC as per definition of “chronic”
Adequate blood flow (typically ABI above 0.65 in the last 60 days, however any form documenting blood flow to the wound is acceptable)
Controlled diabetes (gold standard is A1C levels under 12% in the last 90 days), however any adequate medical management of the condition is acceptable
Presence of a venous stasis ulcer for at least 3 months
Unresponsive to appropriate wound care for at least 30 days with documented compliance
Adequate blood flow and diabetic, controlled diabetes
Additional Considerations for Skin Substitute Use
Additional Considerations for Skin Substitute Use
This overview identifies the primary categories of chronic wounds seen in clinical practice, each with distinct pathophysiology and treatment requirements.
This information must be updated in the medical record throughout treatment.
Measurements pre- and post-debridement of the wound bed should be documented.
Wound description must also be documented pre- and post-treatment with the skin substitute graft being used.
If obvious signs of worsening or lack of treatment response are noted, continuing treatment with the skin substitute would not be considered medically reasonable and necessary without documentation of a reasonable rationale for doing so.
This overview identifies the primary categories of chronic wounds seen in clinical practice, each with distinct pathophysiology and treatment requirements.
Date, time, and location of the ulcer treated
Name of the skin substitute and how the product was supplied
Amount of product unit used
Amount of product unit discarded with the reason for wastage
Manufacturer’s serial/lot/batch or other unit identification number of the graft material. If the manufacturer does not supply unit identification, the record must still document such. Consider including pictures of graft packaging.
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