Conference Coverage

Cost-effective wound healing described with fetal bovine collagen matrix


 

EXPERT ANALYSIS FROM THE ACMS ANNUAL MEETING

– A novel, commercially available fetal bovine collagen matrix provides “an ideal wound healing environment” for outpatient treatment of partial and full thickness wounds, ulcers, burns, and surgical wounds, Katarina R. Kesty, MD, declared at the annual meeting of the American College of Mohs Surgery.

Fetal bovine collagen matrix is an effective alternative to secondary intention healing and skin grafting for many challenging Mohs surgical patients. We applied this product to 46 patients over 10 months and have observed favorable healing times and good cosmesis,” said Dr. Kesty, a dermatology resident at Wake Forest University, Winston-Salem, N.C.

She shared the clinical experience she and her colleagues have accrued with this product, which is called PriMatrix and is manufactured by Integra LifeSciences. She also explained how to successfully code and bill for its use.

“In-office application of this product is cost-effective when compared to similar products applied in the operating room by plastic surgeons and other specialists,” Dr. Kesty noted.

How cost-effective? She provided one example of a patient with a 12.6-cm2 defect on the scalp repaired with fetal bovine collagen matrix. Upon application of the appropriate billing codes, this repair was reimbursed by Medicare to the tune of $1,208. In contrast, another patient at Wake Forest had a 16.6-cm2 Mohs defect on the scalp repaired in the operating room by an oculoplastic surgeon who used split thickness skin grafts. For this procedure, Medicare was billed $30,805.11, and the medical center received $9,241.53 in reimbursement.

“An office repair using this fetal bovine collagen matrix is much more cost-effective,” she observed. “It also saves the patient from the risks of general anesthesia or conscious sedation.”

PriMatrix is a porous acellular collagen matrix derived from fetal bovine dermis. It contains type I and type III collagen, with the latter being particularly effective at attracting growth factors, blood, and angiogenic cytokines in support of dermal regeneration and revascularization. The product is available in solid sheets, mesh, and fenestrated forms in a variety of sizes. It needs to be rehydrated for 1 minute in room temperature saline. It can then be cut to the size of the wound and secured to the wound bed, periosteum, fascia, or cartilage with sutures or staples. The site is then covered with a thick layer of petrolatum and a tie-over bolster.

Dr. Kesty and her dermatology colleagues have applied the matrix to surgical defects ranging in size from 0.2 cm2 to 70 cm2, with an average area of 19 cm2. They have utilized the mesh format most often in order to allow drainage. They found the average healing time when the matrix was applied to exposed bone, periosteum, or perichondrium was 13.8 weeks, compared with 10.8 weeks for subcutaneous wounds.

With the use of the fetal bovine collagen matrix, wounds less than 10 cm2 in size healed in an average of 9.3 weeks, those from 10 cm2 to 25 cm2 in size healed in an average of 10.4 weeks, and wounds larger than 25 cm2 healed in an average of 15.7 weeks.

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