Skin Substitutes for Foot Ulcers

A chronic foot wound that refuses to close needs more than simply another bandage. When a diabetic foot ulcer or other difficult-to-heal wound has not made enough progress with appropriate standard wound care, a skin substitute may be considered as part of an advanced wound treatment plan.

At Annapolis Foot & Ankle Center, our experienced podiatrists provide advanced foot wound care for patients with diabetic foot ulcers and other complex or nonhealing wounds. Skin substitutes are one of several advanced treatment options we may use to provide coverage and structural support to a properly prepared wound while the patient's own tissue continues the healing process.

A skin substitute is not appropriate for every wound, and it does not replace important treatments such as debridement, infection management, pressure offloading, circulation assessment, or diabetes control. The first step is determining why the wound has stopped healing and whether an advanced wound product is appropriate for that specific situation.

What Is a Skin Substitute for a Foot Wound?

Skin substitutes are advanced wound care products designed to cover, protect, or provide structural support to a wound while healing takes place. They are sometimes also described as advanced tissue products, skin substitute grafts, or cellular and tissue-based wound products.

The term "skin substitute" covers many different products. Depending on the specific product, it may be made from:

• Donated human tissue
• Animal-derived tissue
• Extracellular matrix materials
• Bioengineered materials
• Cellular or acellular components
• Combinations of structural proteins and other wound-supporting materials

Because these products differ significantly, they should not all be treated as interchangeable. Our podiatrists select an advanced wound product based on the type of wound, its condition, the patient's health, and the intended use of the specific product.

How Do Skin Substitutes Help a Chronic Foot Wound?

A chronic wound can become stuck in the healing process. Instead of steadily progressing toward closure, the wound may remain open for weeks or months.

Depending on the product being used, a skin substitute may help by:

• Providing a protective covering over the wound
• Creating a structural scaffold that supports tissue growth
• Helping maintain an environment favorable for healing
• Providing extracellular matrix components that support wound repair
• Supporting the patient's own tissue as it progresses toward wound closure

A skin substitute does not simply "turn into new skin," and applying one does not guarantee that a wound will heal. The underlying factors that caused the wound or prevented it from closing must still be addressed.

What Types of Foot Wounds May Be Treated With Skin Substitutes?

Skin substitutes are most often considered for selected chronic wounds that have not responded adequately to appropriate conventional wound care.

Diabetic Foot Ulcers

Diabetic foot ulcers are among the most common foot wounds treated with advanced tissue products.

Diabetes can make wounds more difficult to heal because of several overlapping problems. Peripheral neuropathy may prevent a patient from feeling repeated injury or pressure. Poor circulation can limit the oxygen and nutrients reaching the wound. Elevated blood sugar can interfere with immune function and tissue repair.

For selected diabetic foot ulcers that are not healing sufficiently despite appropriate wound care, a skin substitute may be added to the treatment plan.

Chronic Nonhealing Foot Wounds

A wound that remains open despite consistent treatment requires reevaluation. Sometimes the issue is continued pressure. In other cases, infection, reduced blood flow, dead tissue, swelling, or another medical problem is preventing healing.

Skin substitutes may be considered for certain chronic wounds once those underlying factors have been evaluated and managed as much as possible.

If you currently have a wound that seems to have stopped improving, read what to do when a foot wound is not healing.

When Is a Skin Substitute Recommended?

A skin substitute is generally considered when a properly treated wound is not making enough progress with standard wound care and the wound is appropriate for the specific product being considered.

Before moving to an advanced graft or tissue product, our podiatrists evaluate whether important barriers to healing have been addressed.

This may include:

• Removing dead or unhealthy tissue when appropriate
• Treating infection
• Relieving pressure from the wound
• Using appropriate wound dressings
• Evaluating blood flow to the foot
• Managing swelling
• Improving diabetes management when applicable
• Addressing nutritional or other medical factors affecting healing

The goal is not to apply a skin substitute as quickly as possible. It is to create the conditions that give the wound the best opportunity to respond to advanced treatment.

For more detail about patient and wound selection, read When Is a Skin Substitute Recommended for a Nonhealing Foot Wound?

Why Do Some Diabetic Foot Ulcers Stop Healing?

There is rarely one reason why a diabetic foot ulcer becomes chronic. Several problems may be occurring at the same time.

Peripheral Neuropathy

Neuropathy can reduce the ability to feel pain, pressure, heat, or injury. A patient may continue walking on a wound without realizing that it is being repeatedly damaged.

Pressure on the Wound

Every step places pressure on the bottom of the foot. If an ulcer is located beneath a weight-bearing area, repeated pressure can prevent fragile new tissue from surviving.

Poor Circulation

Healing tissue requires oxygen and nutrients delivered through the bloodstream. Reduced circulation can substantially slow healing and may require evaluation or treatment by a vascular specialist.

Infection

Bacteria within a wound can damage healthy tissue and interfere with healing. More serious infections may spread deeper into the foot and potentially reach bone.

Elevated Blood Sugar

Poorly controlled diabetes can impair immune function and tissue repair. Blood glucose management is therefore an important part of treating diabetic foot ulcers.

Dead or Unhealthy Tissue

Necrotic tissue, heavy callus, or other unhealthy tissue may prevent the wound bed from progressing. Debridement may be needed to remove this material.

What Happens Before a Skin Substitute Is Applied?

Before application, our podiatrists evaluate both the wound and the patient's overall ability to heal.

The evaluation may include:

• Measuring wound length, width, and depth
• Examining the wound bed
• Assessing the surrounding skin
• Checking for drainage or infection
• Evaluating blood flow
• Assessing sensation and neuropathy
• Identifying pressure points
• Reviewing previous wound treatment
• Evaluating diabetes and other medical conditions

The wound may also require debridement before the skin substitute is applied.

What Is Wound Debridement?

Debridement is the removal of dead, damaged, infected, or unhealthy tissue from a wound. It may also include removal of thick callused tissue surrounding a diabetic foot ulcer.

A clean, viable wound bed is important because dead tissue can harbor bacteria and interfere with the body's ability to form healthy new tissue.

The type and extent of debridement depends on the wound and the patient's medical condition.

How Is a Skin Substitute Applied to a Foot Ulcer?

The specific technique depends on the product being used. In general, once the wound has been appropriately prepared, the skin substitute is positioned over or within the wound according to the product's instructions.

The product may be trimmed or shaped to match the wound and then secured with an appropriate dressing.

A secondary protective dressing may be placed over the area, and pressure on the wound may need to be reduced immediately following treatment.

For a step-by-step explanation of the procedure and aftercare, read What Happens During and After a Skin Substitute Is Applied to a Foot Ulcer?

Are Skin Substitutes the Same as Skin Grafts?

No. Although both may be used to help close difficult wounds, a skin substitute and a traditional skin graft are not the same procedure.

A traditional autologous skin graft generally involves removing a section of the patient's own skin from a donor site and surgically placing it over the wound.

A skin substitute is an advanced wound care product supplied separately and applied to the wound without creating a second donor wound on the patient's body.

The appropriate approach depends on the size and depth of the wound, the condition of surrounding tissue, circulation, infection, medical history, and other factors.

Learn more in our detailed comparison of skin substitutes vs. traditional skin grafts for foot ulcers.

Can I Walk After a Skin Substitute Is Applied?

That depends on where the wound is located and how much pressure the area experiences during walking.

Offloading is often one of the most important parts of diabetic foot ulcer treatment. Even the most advanced wound product can struggle to work if every step repeatedly damages the treatment area.

Depending on your wound, offloading may involve:

• A surgical shoe
• A removable walking boot
• Specialized padding
• Pressure-relieving insoles
• Custom orthotics
• Another device designed to reduce weight or pressure on the wound

Your podiatrist will tell you how much weight you can safely place on the foot and whether specific activities need to be limited.

How Many Skin Substitute Applications Will I Need?

There is no predetermined number of applications that is appropriate for every foot wound.

The number of treatments depends on factors such as:

• The specific skin substitute product
• Wound size and depth
• How long the wound has been present
• How quickly wound measurements are improving
• Blood flow to the foot
• Diabetes control
• Infection
• Pressure and offloading
• Other medical conditions that affect healing

A repeat application should be based on how the wound is responding and whether another application is appropriate for the particular product being used. More applications do not automatically produce better results.

Read How Many Skin Substitute Applications Might a Foot Wound Need? for a more detailed explanation.

How Do We Know Whether a Skin Substitute Is Working?

Our podiatrists monitor wound healing objectively rather than relying only on how the foot looks or feels.

Signs of progress may include:

• A reduction in wound surface area
• A decrease in wound depth
• Healthy granulation tissue
• New skin formation around the wound edges
• Reduced drainage
• Improvement in the overall wound bed
• Continued movement toward complete closure

Measuring and documenting the wound at follow-up visits allows us to determine whether treatment is working or whether the plan needs to change.

What If a Skin Substitute Is Not Helping?

If the wound is not making appropriate progress, simply repeating the same treatment indefinitely is not the answer.

Our podiatrists may reassess:

• Whether enough pressure is being removed from the wound
• Whether infection is present
• Whether circulation has worsened
• Whether additional debridement is required
• Whether blood sugar or another medical condition is interfering with healing
• Whether the wound is deeper than originally recognized
• Whether a different advanced treatment should be considered

A change in strategy may sometimes be more appropriate than another skin substitute application.

How Long Does a Diabetic Foot Ulcer Take to Heal?

There is no universal healing timeline for a diabetic foot ulcer. Some wounds make meaningful progress within weeks, while deeper or more complicated wounds may require months of care.

Healing time can be affected by:

• Wound size and depth
• Infection
• Blood flow
• Neuropathy
• Pressure on the wound
• Blood glucose control
• Overall health
• Consistency with offloading and wound care instructions

Learn more about how long diabetic foot ulcers may take to heal.

Can Skin Substitutes Prevent Amputation?

No single wound treatment can guarantee that an amputation will be avoided. However, helping a chronic wound progress toward closure can be one important part of a comprehensive limb-preservation strategy.

Preventing serious complications requires addressing the entire problem, including infection, blood flow, pressure, diabetes management, tissue loss, and the structural condition of the foot.

Patients with complex or limb-threatening wounds may benefit from the comprehensive approach available through our foot amputation prevention and limb-preservation services.

What Does Research Say About Skin Substitutes for Diabetic Foot Ulcers?

Clinical studies have found that certain skin substitute products can improve wound closure outcomes for selected diabetic foot ulcers when used in addition to appropriate standard wound care.

However, "skin substitutes" are not one single treatment. There are many products with different materials, manufacturing processes, indications, and levels of supporting evidence. Results from research on one product should not automatically be assumed to apply to every other product.

This is why we select advanced wound products based on the wound being treated and the available evidence and instructions for the specific product rather than assuming all skin substitutes work the same way.

Does Insurance Cover Skin Substitutes for Foot Ulcers?

Insurance coverage varies depending on the patient's plan, diagnosis, wound history, the specific skin substitute being used, previous treatment, and medical documentation.

Medicare and commercial insurance policies may also establish requirements regarding conservative wound care, wound measurements, treatment response, and the type or frequency of advanced wound products.

Because coverage policies and payment rules can change, patients should not assume that every skin substitute or every application will be covered. Coverage should be evaluated for the individual treatment being recommended.

What Other Advanced Foot Wound Treatments Are Available?

Skin substitutes are only one component of advanced wound management. Depending on the wound, our podiatrists may use or coordinate treatments such as:

• Wound debridement
• Advanced wound dressings
• Pressure offloading
• Infection management
• Vascular assessment
• Negative pressure wound therapy when appropriate
• Growth-factor or other advanced wound products when appropriate
• Hyperbaric oxygen therapy for selected wounds
• Surgical treatment when necessary

The best treatment plan is based on why the wound is not healing, not simply which advanced technology is available.

Why Choose Annapolis Foot & Ankle Center for Advanced Wound Care?

Annapolis Foot & Ankle Center provides comprehensive care for chronic and complex foot wounds throughout Central Maryland. Our approach combines advanced wound treatment with evaluation of the underlying factors that determine whether a wound can heal.

Our wound care services include:

• Evaluation and management of diabetic foot ulcers
• Care for chronic and nonhealing foot wounds
• Advanced skin substitutes and grafting products
• Wound debridement
• Pressure offloading
• Vascular assessment
• Advanced wound dressings
• Diabetic foot care
• Limb-preservation and amputation-prevention care
• Coordination with other medical specialists when necessary

Patients can receive care at our Annapolis and Chester, Maryland locations.

Frequently Asked Questions About Skin Substitutes

What Is a Skin Substitute?

A skin substitute is an advanced wound care product designed to provide coverage, structure, or other support to a wound while the patient's own tissue heals. Different products may contain human tissue, animal-derived materials, cellular components, acellular matrices, or other engineered materials.

When Is a Skin Substitute Recommended?

A skin substitute may be considered when a chronic wound is not making adequate progress despite appropriate wound care and the wound is suitable for the particular product. Read When Is a Skin Substitute Recommended for a Nonhealing Foot Wound? for more information.

Are Skin Substitutes Used for Diabetic Foot Ulcers?

Yes. Selected diabetic foot ulcers are among the chronic wounds for which skin substitutes may be used as an adjunct to standard wound care when appropriate.

Is a Skin Substitute the Same as a Skin Graft?

No. Traditional skin grafting generally involves transplanting the patient's own skin from a donor site. A skin substitute is a separately manufactured or processed wound product applied to support wound healing.

What Happens When a Skin Substitute Is Applied?

The wound is evaluated and prepared, the selected product is applied according to its specific instructions, and the area is covered with an appropriate dressing. Pressure on the wound may also need to be reduced. Read What Happens During and After a Skin Substitute Is Applied to a Foot Ulcer? for a detailed explanation.

How Many Skin Substitute Applications Will I Need?

There is no universal number. The treatment plan depends on the product being used, the wound, and how well it responds. Learn more in How Many Skin Substitute Applications Might a Foot Wound Need?

Can I Walk After a Skin Substitute Is Applied?

That depends on the wound location. Because pressure can interfere with healing, many foot ulcers require offloading with a boot, specialized shoe, padding, or another pressure-relieving device.

Does a Skin Substitute Guarantee That My Foot Ulcer Will Heal?

No. Skin substitutes may help selected wounds progress toward closure, but outcomes depend on many factors, including circulation, infection, pressure, diabetes control, wound severity, and adherence to the overall wound care plan.

Schedule a Wound Care Consultation

Could a Skin Substitute Help a Chronic Foot Wound Heal?

If a diabetic foot ulcer or another chronic foot wound has not healed with standard wound care, a skin substitute may be considered as part of an advanced treatment plan. Our experienced podiatrists use skin substitutes for selected patients to provide a protective wound covering and support the body's natural healing process when a wound needs additional help closing.

Our team can evaluate the wound, identify factors that may be delaying healing, and determine whether a skin substitute or another form of advanced foot wound care is appropriate. Whether you visit us in Annapolis or Chester, Maryland, we provide comprehensive care for chronic and complex foot wounds throughout Central Maryland. Contact Annapolis Foot & Ankle Center online or call 410.266.7666 to schedule an appointment.