Learn more about skin substitutes for wound healing.

If you have a chronic wound that won’t heal, your doctor may refer you to a wound center for treatment with a cellular tissue-based product (CTP). CTPs closely resemble human skin in structure and function. They may be used to treat patients with certain types of nonhealing wounds.

Learn more about cellular tissue-based products and if you may be a candidate for this type of treatment.

What Are Cellular Tissue-Based Products?

Cellular tissue-based products (CTPs) are substitutes for human skin. Wound healing specialists may consider using them with patients who have high-risk wounds or other medical conditions that complicate skin grafting.

CTPs may be used to temporarily or permanently:

  • Close wounds.
  • Eliminate the need for surgical skin grafts.
  • Promote healing.
  • Reduce pain.

Where do cellular tissue-based products come from?

There are several types and sources of these tissue products:

  • The first type are products that come from a human or an animal. If it is human, the tissue has come from a deceased donor. If it is from an animal, it has come from a pig or a cow.
  • The second type is tissue that either contains living cells or does not. If there aren’t living cells, the tissue is a scaffold into which your own cells grow to stimulate wound healing. If there are living cells in it, sometimes it actually stimulates growth through the cells of whatever donated product it is.
  • The final type is synthetics. This includes tissue made out of absorbable material, but there’s no animal or human product in it.

Currently, there are more than 80 CTPs on the market.

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What Kind of Wounds Can Be Treated with Cellular Tissue-Based Products?

CTPs may be used to treat a variety of chronic and/or nonhealing wounds. These include:

A number of other conditions also may make CTPs become necessary or preferable to treat certain types of wounds, according to Brodie Parent, MD, UPMC Wound Healing Services.

“Cellular tissue-based products can be used for a variety of wounds, including complications of diabetic foot infections, venous ulcer disease in the lower leg, or surgery,” says Dr. Parent, a board-certified plastic surgeon. “And, then, sometimes, there’s a wound that just hasn’t healed by the usual methods.

“The most important thing I check for before initiating any treatment with a CTP is: Have the basics been covered? Things like nutrition: Does the person have good protein intake, good levels in their body? Is their wound care optimized? Has the wound been offloaded in terms of pressure?

“We try these simple things first. But when wound healing stalls out and things just aren’t progressing, CTPs can be a really nice adjunct.”

Dr. Parent says that there are several basic steps that must be taken first before CTPs can be considered:

  • Increase the patient’s protein intake. “These types of wounds actually leak quite a bit of protein over time,” he says. “It’s important that the person keeps up on their protein intake so their body can heal to begin building new skin.”
  • Remove dead tissue or bacteria. Dead tissue or bacteria that’s built up in the base of the wound must be removed. They are toxic to any migrating skin cells. “Cleaning the wound properly and keeping it moist and covered is really important for healing,” Dr. Parent says.
  • Ensure there’s no ongoing injury. “Sometimes these wounds have ongoing sheer injuries or pressure injuries,” Dr. Parent says. “Sometimes, we’ll send our patients for mapping to look at different pressure points on their body to make sure that there’s no ongoing sources of injury.”
  • Consider other potential reasons for the wound. “If those basic steps don’t work, I often go looking for more unusual things,” he says. “Like — could this be a cancer developing? Could this be an unusual reaction or an autoimmune condition? I try to find the reason before the treatment. And, then, most of the time, we can achieve success.”

CTPs should only be considered after covering these basics.

When Would a Cellular Tissue-Based Product Be Used?

CTPs may be an option for wounds that are healing at a very slow rate or that are painful and difficult to manage.

“CTPs have the benefit of helping to reduce the patient’s pain, keep the wound covered, and make dressing care much easier,” Dr. Parent says.

Dr. Parent related two patient stories where CTPs were particularly helpful.

One was an elderly man who had advanced skin cancer on his scalp that went down to the bone.

“He had many medical conditions and didn’t want a fancy surgery to rebuild his scalp,” Dr. Parent says. “He was entirely bald, so he didn’t care about any hair. We used a cellular tissue-based product to cover the bone. And within two stages of applications, we had it fully healed, and he didn’t need a skin graft. And this was a sizable defect: something in the range of 5 to 6 centimeters.”

The other patient story Dr. Parent related was of an older woman who was in a car crash. The accident took off most of the skin on the back of her forearm.

“It was a very tender wound, and she was in an enormous amount of pain,” Dr. Parent says. “She also had a lot of issues going on and was not interested in getting a skin graft to this area. We trialed one of these CTPs, and, again, within one application this time, she ended up healing this wound on her own.”

Special Considerations with CTPs

Dr. Parent says CTPs take a little bit more maintenance and additional wound care dressings, but they usually heal well.

“Once you put the skin substitute on, you actually need a little bit more dressing care to maintain it and keep it healthy,” he says. “Complications from CTPs have been few and minimal in scope.”

The main issues to watch for are:

  • Detachment from the skin. If the CTP becomes detached, you might have to try a different plan.
  • Infection underneath it. You’ll have to be on the lookout for spreading redness, an odor, or a discharge coming from the wound.
  • Blood accumulating underneath it. Your surgeon or wound care specialist will try to make sure that the surface is not bleeding when they put the CTP on.

Who Is a Good Candidate for a Cellular Tissue-Based Product?

Dr. Parent says the best candidate for a CTP is somebody who’s had a problematic wound that has stalled out on its healing by the usual methods. Other candidates are people with wounds that have failed to heal using simpler, less-expensive alternatives. CTPs are a more advanced technology and cost more, but they may speed up the healing process.

Who Is Not a Candidate for a CTP?

People who are not good candidates for CTPs include those who:

  • Still have an ongoing infection or dead tissue to be debrided.
  • Do not have good nutrition.
  • Have other chronic medical conditions.
  • Continue to smoke.
  • Have uncontrolled vascular disease.
  • Have uncontrolled diabetes.

To see if you are a candidate for a cellular tissue-based product for your wound, Dr. Parent recommends a consultation with a wound healing expert. The doctor can do a physical exam and discuss your treatment goals.

“That first visit is where we come up with the strategy of possibly using our wound dressing adjuncts or cellular tissue-based products,” he says. “I usually meet several times with patients who have chronic wounds. But we start with those basics that I’ve been talking about, making sure that they’re all covered and optimized. I would also examine the wound and take some measurements.

“We might give a numbing agent and actually debride it right there in the office. I tend to take every opportunity I can when I see a patient with a wound to take off the surface of it because there’s a bacterial burden that builds up on the surface. Again, that’s directly toxic to migration of skin cells into that area. So, we use every opportunity to take off the surface of it, get it down to clean, healthy tissue, before using the CTP.”

Why Wound Care at UPMC?

From a patient experience, the goal of UPMC Wound Healing Services is to assess patients from head to toe, looking at the whole patient.

“We try to optimize factors that influence wound healing,” Dr. Parent says. “And that can include multiple different things, such as diabetes control, smoking, blood vessel health, and vascular disease. I’ll talk with multiple different specialists trying to optimize care and making sure we’re hitting all the basics before we try anything that’s a little bit more advanced.

“I’m routinely consulting with podiatry experts, vascular surgeons, endocrinologists, and diabetic care experts about wound care. These are all people I talk to regularly about patients to try to optimize and come up with a consensus plan. So, at UPMC, you are getting the opinion of multiple people, not just one.”

Dr. Parent says the center’s “excellent wound care nurses” are also a key part of the multidisciplinary model.

“They work every day to optimize patient care, which can also include things like optimizing transportation and financial support,” he says.

For more information about UPMC Wound Healing Services, visit our website.

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.