Graftskin (Apligraf®) in the Treatment of Venous Leg Ulcer: Optimal Application Techniques

The goal of therapy for venous leg ulcer (VLU) patients is to achieve rapid, complete healing of ulcers and prevent ulcer recurrence. Graftskin (Apligraf®), a bioengineered human skin construct, has been shown to provide significantly faster and more frequent ulcer closure than in patients treated with standard compression therapy alone. Clinical experience indicates that failure of VLUs to heal with Graftskin correlates with poor compliance, extended duration of ulceration prior to Graftskin placement, and suboptimal Graftskin application technique. A recent optimization trial suggests aggressive wound bed preparation, fenestration of Graftskin to permit fluid egress, overlapping the ulcer edge with Graftskin, and a nonslip compressive dressing are important for wound healing. Wound dressings should be changed weekly and reapplication of Graftskin, if needed, attempted only after six weeks from the first Graftskin placement. Use of these optimal techniques and attentive care should improve healing rates for VLUs.