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Vincent Falanga, MD; David Margolis, MD; Oscar Alvarez, PhD; Michael Auletta, MD; Frank Maggiacomo, DO; Morton Altman, DPM; Jeff Jensen, DPM; Michael Sabolinski, MD; Jan Hardin-Young, PhD; and the Human Skin Equivalent Investigators Group

Arch Dermatol. 1998;134:293-300.

Objective  To test the safety, efficacy, and immunological impact of a cultured allogeneic human skin equivalent (HSE) in the treatment of venous ulcers.

Design  Prospective, randomized study.

Setting  Multicenter study in the outpatient setting.

Intervention  Each patient with a venous ulcer received either compression therapy alone or compression therapy and treatment with HSE. The patients were evaluated for HSE safety, complete (100%) ulcer healing, time to wound closure, wound recurrence, and immune response to the HSE.

Outcome  The study was completed as planned in 293 randomized patients.

Results  Treatment with HSE was more effective than compression therapy in the percentage of patients healed by 6 months (63% vs 49%; P=.02, Fisher exact test, 2-tailed) and the median time to complete wound closure (61 days vs 181 days; P=.003, log-rank test). Treatment with HSE was superior to compression therapy in healing larger (>1000 mm²; P=.02) and deeper ulcers (P=.003) and ulcers of more than 6 months' duration (P=.001). Occurrence of adverse events was similar in both groups. No symptoms or signs of rejection occurred in response to treatment with HSE, and no HSE-specific immune responses were detected in vitro to bovine collagen or to alloantigens expressed on keratinocytes or fibroblasts.

Conclusions  Treatment with HSE healed venous ulcers more rapidly and in more patients than compression therapy alone. There was no clinical or laboratory evidence of rejection or sensitization in response to HSE application. These data suggest that HSE represents a significant advance in the treatment of venous ulcers, particularly those that are difficult to heal.

From the Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Fla (Dr Falanga); the Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia (Dr Margolis); the University Wound Healing Clinic (Drs Alvarez and Auletta) and the Division of Dermatology, Robert Wood Johnson Medical School (Dr Auletta), New Brunswick, NJ; Silver Lake Medical Inc, Providence, RI (Dr Maggiacomo); the Diabetic Foot and Wound Healing Center, Denver, Colo (Dr Jensen); and Organogenesis Inc, Canton, Mass (Drs Sabolinski and Hardin-Young). Dr Altman is in private practice in Palm City, Fla. A complete list of the members of the Human Skin Equivalent Investigators Group is given in the Acknowledgments.

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