» What if you had a tool in your armamentarium that has repeatedly been shown to improve ...
… wound healing rates and patient quality of life? How would you use it?
Hard-to heal wounds – those that do not exhibit normal physiology or heal in an expected amount of time with standard wound care including debridement, compression, and off-loading – are a burden to the patient, clinician and the healthcare system. In the field of wound care, advanced therapies such as skin substitutes, also referred to as cellular tissue products (CTPs) with the updated nomenclature of CAMPs (cellular, acellular and matrix-like products), have been shown to improve healing rates, increase patient function and decrease amputations.
As of late, CAMPs product use has been in the spotlight, and not necessarily for all the good they can do for the at-risk patients we treat on a daily basis. Reports of overuse and abuse have led to increased scrutiny of CAMPs use, even prompting audits across the continuum of care. In November of 2024, all seven Medicare Administrative Contractors (MACs) finalized a change to their individual Local Coverage Determinations (LCDs) focusing on CAMPs use in diabetic foot and venous leg ulcers. After an evidentiary review of published literature and available medical evidence, the MACs have updated the LCD restricting coverage of CAMPs products, and limit applications to a total of eight per 16-week wound duration. With the date of adoption of these policies looming in February 2025, the ways that podiatrists and wound care clinicians use CAMPs may be substantially impacted.
In this edition of FAQ, we focus on the best practices around CAMPs use while highlighting key advancements made in the space of tissue engineering. In this publication, we cover a wide range of topics including the compliant use of CAMPs, pearls for appropriate charting for medical necessity, justification of product costs, advancements in tissue engineering, unique and emerging CAMP formulations, and promising research in alternative outcome measures such as tissue durability, cosmesis and bacterial modulation. After diving into the content of this issue, I sincerely hope that you leave with a strong foundation on how to best use CAMPs products in your practice, and a sense of excitement for the product innovations that are currently in the pipeline.
Windy Cole, DPM, CWSP
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Article Authors and Lecturers
Jaminelli Banks, (n.)
Desmond Bell (n.)
Nicholas R. Butler (n.)
Marissa J. Carter (n.)
Windy Cole (1. Data Trace Publishing Co.)
Martha R. Kelso (n.)
Eric J. Lullove (1. Data Trace Publishing Co.)
Andrew Rader (n.)
Richard A. Schilling (n.)
William H. Tettelbach (n.)
Emma Woodmansey (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Foot and Ankle Quarterly 35-3 Contributors
Guest Editor
Windy Cole, DPM, CWSP
Director of Wound Care Research, Kent State University College of Podiatric Medicine, Independence, OH; Board-Certified, American Board of Foot and Ankle Surgery and American Board of Wound Management
Contributors
Jaminelli Banks, DPM Adjunct Faculty, Midwestern University School of Podiatric Medicine, Glendale AZ; Fellow, American Board of Foot and Ankle Surgery; Fellow, American Board of Podiatric Medicine; Physician Owner, JBanks Medical, Phoenix and Scottsdale, AZ; Director of Podiatric Research, Perseverance Research Center; Scottsdale, AZ
Desmond Bell, DPM, CWS, FFPM, RCPS (Glasg) Founder, The Save a Leg, Save a Life Foundation; Chief Medical Officer, Omeza
Nicholas R. Butler, DPM, FASPS, FACPM Assistant Professor, Division of Clinical Medicine and Surgery, Kent State University College of Podiatric Medicine, Independence, OH
Martha R. Kelso, RN, CHWS, DAPWCA, HBOT Chief Executive Officer, Wound Care Plus, LLC; Board Member, American Professional Wound Care Association (APWCA); Board Member, Coalition for At-Risk Skin (CARS); Board Member, Post Acute Wound & Skin Integrity Council (PAWSIC); Peer Reviewer, International Wound Journal
Eric J. Lullove, DPM, CWS, FAPWH(c), FFPM, RCPS (Glasg) Chief Medical Officer, West Boca Center for Wound Healing, Coconut Creek, FL
Andrew Rader, DPM, FAENS, FACPM, FASPS, FAPWCAc, FAPWH Medical Director, Memorial Hospital Wound Center; Board of Trustees, Association of Extremity Nerve Surgeons
Richard A. Schilling, DPM, FACFAS Private practice, ABC Podiatry, Columbus, Ohio; Fellow American College of Foot and Ankle Surgeons; Chairman, Ohio Foot and Ankle Medical Association annual Wound Care Seminar
William H. Tettelbach, MD, FACP, FIDSA, MAPWCA, CWSP Chief Medical Officer, RestorixHealth, Metairie, LA; President, American Professional Wound Care Association; Chief Medical Officer, Onsite Advanced Care, Salt Lake City, UT; Adjunct Assistant Professor of Undersea and Hyperbaric Medicine, Duke University School of Medicine, Durham NC; Adjunct Professor of Podiatric Medicine and Surgery, Western University of Health Sciences, Pomona, CA
Emma Woodmansey, PhD Principal Consultant, Clinical & Scientific Solutions, York, UK; Honorary Senior Lecturer, School of Medicine, Cardiff University, Cardiff, Wales, UK
35-3 In this issue:
FEATURE ARTICLE: Updating the Reconstructive Ladder of Limb Salvage to Incorporate Advancements in Tissue Engineering
Windy Cole, DPM, CWSP
CONDENSATIONS and COMMENTARIES
Counting the Cost of Cellular and/or Tissue Based Products in Diabetic Foot Ulcers: Is There a Justifiable Price Limit Per cm2?
Commentary by Eric J. Lullove, DPM, CWSP, FFPM, RCPS (Glasg)
Angiogenesis and Re-Endothelialization in Decellularized Scaffolds: Recent Advances and Current Challenges in Tissue Engineering
Commentary by Willam H. Tettelbach, MD, FACP, FIDSA, FUHM, MAPWCA, CWSP
Systematic Review of Cellular, Acellular and Matrix-Like Products (CAMPs) and Indirect Treatment Comparison between Cellular/Acellular and Amniotic/Non-Amniotic Grafts in the Management of Diabetic Foot Ulcers
Commentary by Andrew Rader, DPM, FAENS, FACPM, FASPS, FAPWCAc, FAPWH
How to Select an Extracellular Matrix for Wound Repair: A Comprehensive Review
Commentary by Marissa J. Carter, PhD, MA, MAPWCA
Clinical Efficacy of Acellular Dermal Matrix Paste in Treating Diabetic Foot Ulcers
Commentary by Desmond Bell, DPM, CWS, FFPM, RCPS (Glasg)
Ready-to-Use Micronized Human Acellular Dermal Matrix to Accelerate Wound Healing in Diabetic Foot Ulcers: A Prospective Randomized Pilot Study
Commentary by Richard A. Schilling, DPM, FACFAS
Avoiding Scar Tissue Formation of Peripheral Nerves with the Help of an Acellular Collagen Matrix
Commentary by Nicholas R. Butler, DPM, FASPS, FACPM
The Applications of 3D Printing in Wound Healing: The External Delivery of Stem Cells and Antibiosis
Commentary by Emma Woodmansey, PhD
Delivery of Adipose-Derived Growth Factors from Heparinized Adipose Acellular Matrix Accelerates Wound Healing
Commentary by Martha R. Kelso, RN, CHWS, DAPWCA, HBOT
Human Acellular Dermal Matrix in Reconstructive Surgery: A Review
Commentary by Jaminelli Banks, DPM
AUDIO LECTURE 1: The Use of CAMPs in the Clinical Setting
Windy Cole, DPM, CWSP
AUDIO LECTURE 2: Documenting and Coding for Wound Care and Cellular Tissue and Matrix-Like Products
Eric J. Lullove, DPM, CWSP, FFPM, RCPS(Glasg)
