Cellular Tissue Product Is there a difference ? Brock Liden DPM

Cellular Tissue Product What are they Advanced modalities Single layer / Bi-layer No side orientation / side specific Cellular or A-cellular tissue products Apligraf, DermaGraft / GraftJacket, Oasis, Primatrix, Kerasis, Made from almost anything Human, Porcine, Bovine, Ovine, Amniotic, Fish, Modified Blood Product Storage varies Room temp to Bone Freezer Dry to Wet

Cellular Tissue Product When can you use them (guidelines) Diabetic - post 4 weeks conservative care Venous - post 6-8 weeks conservative care Burn - once wound bed prepared Atypical - per event and per insurance Insurance Companies Autonomy typically follow CMS however never assume ALWAYS PRE-CERT

Cellular Tissue Product How to Prep of application Appropriate vascular, antimicrobial, and wound bed prep weeks application Week before aggressive debridement with both edge and base preparation Day of application debridemnt

Cellular Tissue Product How to apply them Per the product guidelines Every product has a specific application process (some simple / some complex) Review the process one week pre application Utilize the Rep Make sure you have what you need Physician only Side appropriate (make sure some one different up and down) Surgically affixed (STERIS strips / staples / suture / NPWT ) Appropriate moisture level dressing selection (product specific) Re-dressed at appropriate intervals to optimize the product

Cellular Tissue Product How to dress them Know the goal – Wet  Ideally moist  Dry Contact layer Foam Hydrogel petroleum based product Absorptive Compression Off load (wasted product if not off loaded) Any combination needed to achieve the goal

Cellular Tissue Product When to re-apply Per product guidelines Per insurance coverage Till closed As long as making progress When to stop Pt non compliance Wound non- responsive

Cellular Tissue Product Billing Location determined Wound clinic HOPPS high / low bracket product specific Pass through #sq cm² Q code Office #sq cm² Q code Operating Room

Cellular Tissue Product What is next Stem cell 3 -D printing Cell regenerating There seems to be no limit except for gaining reinbursment