Utilization of living bilayered cell therapy (Apligraf) for heel ulcers

Among lower extremity chronic wounds, heel ulcers present one of the greatest challenges to the wound care provider. The potential for these ulcers to progress to osteomyelitis of the calcaneus is well known. The concept of "what to take off the wound" is a known clinical axiom; however, extensive debridement or surgical reconstruction including a partial calcanectomy can significantly impair the patient's ambulation, balance, and overall functional mobility. Critical to the wound healing process is the need to replace damaged cells. The use of cellular therapy to achieve wound closure has added to the armamentarium of the wound care specialist. Among several commercially available advanced wound products, the Food and Drug Administration has approved only 1 living bilayered cell therapy (Apligraf) for use with standard therapy in the treatment of venous ulcers, as well as for full-thickness neuropathic diabetic foot ulcers. Apligraf has the capability to express multiple growth factors found in normal skin, thus potentially providing a biologically active matrix in the wound. This case review summarizes the use of living bilayered cell therapy in 10 heel ulcerations. The use of Apligraf with appropriate pressure offloading resulted in effective wound closure, leading to an alternative care plan for patients with heel ulcers.