1. Cellular Tissue Product
Is there a difference ?
Brock Liden DPM

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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