Patient with Charcot deformity of left foot. Diabetic with peripheral vascular disease, chronic renal failure, hypothyroidism. Ulcer present for greater than 4 years, with previous amputation of 4th and 5th toes and portions of metatarsals. Two Apligraf units were applied to ulcer at bedside, one week after initial encounter with patient. Ulcer was healed at 5 months. Strict non-weight bearing was achieved with total contact cast (one application, discontinued due to claustrophobia), then wheelchair and soft cast/Unna boot.

Patient with Type 1 diabetes, neuropathy. Ulcer present for 3 months, initial onset secondary to golf ball inside shoe. Patient unaware of presence of golf ball in shoe through first nine holes of round. Patient developed osteomyelitis and was recommended for below knee amputation by other surgeon. Our treatment included partial resection of 5th metatarsal, and VAC (Vacuum Assisted Closure) prior to Apligraf (2 units) application. Ulcer healed after 6 months of treatment.

First post Apligraf dressing change

~50% Improvement

Continued improvement

Ulcer resolving

Ulcer healed

Patient with Type 1 diabetes and lymphedema, who developed ulcer of heel, the result of blister formation after wearing new shoes. Patient referred to us after ulcer worsened, cellulitis present. Antiobiotic therapy, VAC (applied twice weekly in office) and Apligraf (also applied in office) were utilized. Entire course of treatment was performed as outpatient, despite severity of wound.

Patient referred after 7 month history of ulcer, secondary to spider bite. Previous incision and drainage of abscess from site. Patient in exquisite pain at inital evaluation. Office vascular evaluation suspicious for presence of arterial insufficiency to right lower extremity greater than left. Patient hospitalized for surgical debridement, vascular studies, antibiotic therapy and pain management. Aorta-iliac level of occlusion found, patient refused any vascular intervention (angioplasty or by-pass). VAC therapy started with application of Apligraf two weeks later. Patient with significant decrease in pain, discharged to home. Ulcer healed at four months.

Patient presented on 11/30/01 with history of venous ulcer of greater than 20 years. Patient was receiving "topical" hyperbarric oxygen therapy in home and home nursing dressing changes at time of first encounter. Compression therapy (Unna boot) initiated with moderate improvement over approximately 6 weeks. Patient then hospitalized for VAC, antibiotic therapy and Apligraf application. Additional Apligraf application in office when healing rate slowed. Ulcer resolved at 10 months.