Document 6516462

Porcine Grafts
(xenografts)
xenografts) following
MOHS Surgery
Julio Hernandez, M.D
Ellecia Egloff,
Egloff, MS IV
All One Skin Cancer
Glendale, Arizona
MidWestern University
Glendale, Arizona
Types of Grafts
 Heterografts:
Heterografts:
tissues of any type that are
transferred from one species to an unrelated
species (also known as xenografts or zoografts)
zoografts)
 Homografts:
Homografts: tissues that are transferred from an
individual of one species to another individual of
the same species
 Autografts:
Autografts: harvested from a single individual
and placed elsewhere on the body of the same
individual (eg.
eg. FTSG, STSG, composite grafts)
What is a porcine graft?
A porcine graft
is a xenograft
Prepared from domestic swine sacrificed
at 6 months of age
Biological Advantages
 AntiAnti-bacterial
efficiency of split thickness
homografts and heterografts

Are splitsplit-thickness skin grafts
harvested
with a dermatome at 0.01 in thickness under
aseptic conditions (non(non-living tissue)
Some are soaked in antibiotic and bleach
solutions, followed by electron beam
irradiation for additional sterility
Others are saturated with antiseptic
solutions or aldehyde starches
Clinical Advantages
 Alleviates

 Protects

exposed vital structures
cartilage, tendons, bone or nerves
 Facilitates

pain
Provides nearly normal tissue environment for
nerve endings
early motion and mobility
Patients able to continue daily activities
 Helps
to avoid having to harvest a skin graft
from a donor site
 Readily available and inexpensive
 Unlimited Supply
Studies have shown porcine grafts augment the
host immunologic defense and decreases
bacterial count
 ReRe-establishment
of the vapor barrier
facilitates the management of associated
metabolic derangements


Prevents excessive loss of water and proteins
Seals wound and inhibits the loss of vital fluids
 Increases
 No

epithelialization
apparent immunologic stimulus
Rejection extremely rare in literature
Indications for a porcine graft
 Large wounds unable to close by primarily
 Areas difficult
to close
harvesting a skin graft
 Partial closure and granulation prior to
delayed repair (avascular
(avascular areas)
 Risks outweighs benefits of a flap or graft
 Work better in the head and neck region
 Avoidance of
Porcine Grafts do not do well in areas that
experience excessive movement.
1
Contraindications
 Patients with known sensitivity to porcine
products
Types of Porcine Grafts
Perforated
 Promotes wound drainage
 patients with histories of
multiple or serum
allergies
 Wounds with large amounts of eschar
Porcine Graft Placement
NonNon-perforated
 Cartilage exposed areas
•Minimizes exposure to air
resulting in decrease in
pain
Porcine Graft Placement
 Using
sterile instruments, the graft is removed
from the original packaging
Porcine Graft Placement
Porcine Graft Placement
2
Porcine Graft Placement
Porcine Graft Placement
 Using
sterile instruments, the graft is removed
from the original packaging
 Graft is placed over wound to cover entire
defect
 Cut graft to size if it extends beyond edges of
defect
Porcine Graft Placement
Porcine Graft Placement
 Using
sterile instruments, the graft is removed
from the original packaging
 Graft is placed over wound to cover entire
defect
 Cut graft to size if it extends beyond edges of
defect
 Lying graft flat on defect, the graft is sutured
into place using physician’
s suture
physician’
preference.

Simple interrupted or simple running is used
Porcine Graft Placement
Porcine Graft Placement
 Using
sterile instruments, the graft is removed
from the original packaging
 Graft is placed over wound to cover entire
defect
 Cut graft to size if it extends beyond edges of
defect
 Lying graft flat on defect, the graft is sutured
into place using physician’
s suture
physician’
preference.

Simple interrupted or simple running is used
 Some
surgeons do not suture graft with
similar outcomes
3
Wound Dressing
Wound Dressing
 Once graft
is adequately placed, apply a
think layer of polysporin
Wound Dressing
 Once graft
is adequately placed, apply a
think layer of polysporin
 Follow with telfa pad to absorb drainage
and to help protect the graft
 Bandage appropriately
Follow Up
 Graft

is left in place for 77-14 days
Depends on size and location of defect
 Grafts that
are not sutured are usually left
on until graft falls off on own
 Provides adequate time for granulation of
defect
Patient Home Care
 Patient
provided with verbal and written
instructions
Remove bandage and telfa every day
Clean with saline
 Apply thick layer of polysporin followed by
telfa and bandage until graft is removed
 After graft removed, continue same treatment
until healed


4
2 weeks post op
6 weeks post op
Before and After
PrePre-op
Defect
Porcine placement
5
PrePre-bandage
3 ½ months post op
Bandaged
Before and after
6
7
Where to buy Porcine grafts
2”x 2”
2”Ten Pak
EZ Derm
 porcine xenograft in which the collagen
has been crosslinked with and aldehyde
 Shelf Life: 18 months
 Room temperature storage
 Multiple sizes available
 Perforated 2”
pak”
2”x 2”
2”(EM(EM-202) ten “
pak”
$214.40
 Nonpak”
Non-perforated 2”
2”x 2”
2”(E(E-202) ten “
pak”
$198.00
Distributed by Brennen Medical
www.brennenmed.com
Single Unit
Where to buy Porcine grafts
Mediskin
 Frozen irradiated porcine xenograft with a
dermal and epidermal layer
 Shelf Life: 24 months
 Standard freezer storage required
 Multiple sizes available
 Perforated and NonNon-perforated
Distributed by Brennen Medical
www.brennenmed.com
Coding and Reimbursement of
Porcine Grafts
 CPT
defines a Xenograft as the
application of a nonnon-human skin graft or
biologic wound dressing (eg
(eg,, Porcine
tissue or pigskin) to a part of the
recipient’
s body following debridement of
recipient’
the burn wound or area of traumatic injury,
soft tissue infections and/or tissue
necrosis, or surgery.
surgery.
Coding and Reimbursement of
Porcine Grafts
15400 - Xenograft,
Xenograft, skin (dermal), for
temporary wound closure, trunk, arms,
legs;
legs; first 100 sq cm or less, or 1% of body
area of infants and children
Medicare payment:
•NonNon-facility: $343.10
•Facility: $310.66
8
Coding and Reimbursement of
Porcine Grafts
 15420 - Xenograft
skin (dermal), for
temporary wound closure, face, scalp,
eyelids, mouth, neck, ears, orbits,
genitalia, hands, feet, and/or multiple
digits;
digits; first 100 sq cm or less, or 1% of
body area of infants and children
 Medicare payment:


NonNon-facility: $386.80
Facility: $344.69
Conclusion
 Porcine grafts are
xenografts used as
temporary biological dressings to
accelerate granulation, neovascularization,
neovascularization,
and healing
 It shortens wound healing time, facilitates
wound care and provides better results
that second intention healing
 It’
s inexpensive, compared to other
It’
biological dressings
References
A Porcine Graft is not:
 Artz
CP, Rittenbury MS, and Yarbrough DR. An
Appraisal of Allografts and Xenografts as
Biological Dressings for Wounds and Burns. Ann
Surg 1972;175:9341972;175:934-7.
 Aronoff M, Fleishman P, and Simon DL.
Experience in the application of porcine
xenografts to splitsplit-graft donor sites. J Trauma
1976;16:2801976;16:280-3.
 Bromberg BE, Song IC, and Mohn MP. The
use of pig skin as a temporary biological
dressing.
dressing. Plast Reconstr Surg 1965;36:801965;36:80-90.
References
R and Eiseman B. Mechanisms of
Antibacterial Effect of Biologic Dressings.
Dressings. Ann
Surgery 1973;177:1811973;177:181-6.
 Davis DA and Arpey CJ. Porcine Heterographs
in Dermatologic Surgery and Reconstruction.
Reconstruction.
Dermotol Surg 2000;26:762000;26:76-80.
 Elliot RA and Hoehn JG Use of commercial
porcine skin for wound dressings.
dressings. Plast Reconstr
Surg 1973;52:4011973;52:401-5.
 Papp G. The use of porcine skin in partial and
fullfull-thickness skin loss.
loss. J Am Osteopath Assoc
1976; 75:95175:951-7.
Acknowledgments
 Burleson
We want to thank the staff of All One Skin
Cancer for their encouragement and
support, in particular, Claudia Quiroz, M.A.
for her invaluable help in the preparation
of this presentation
9
Contact Info:
Julio Hernandez, MD
All One Skin Cancer
6525 W Sack Dr Ste 307
Glendale, AZ 85308
[email protected]
10