Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group.
OBJECTIVE
To test the safety, efficacy, and immunological impact of a cultured allogeneic human skin equivalent (HSE) in the treatment of venous ulcers.


METHODS
Prospective, randomized study.


METHODS
Multicenter study in the outpatient setting.


METHODS
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.


RESULTS
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.
Falanga
V
V
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Fla 33136, USA.
Margolis
D
D
Alvarez
O
O
Auletta
M
M
Maggiacomo
F
F
Altman
M
M
Jensen
J
J
Sabolinski
M
M
Hardin-Young
J
J
D000368:Aged; D000818:Animals; D000906:Antibodies / Q000032:analysis; D001458:Bandages; D002417:Cattle; D003094:Collagen / Q000276:immunology; D003602:Cytotoxicity, Immunologic; D005260:Female; D005347:Fibroblasts / Q000637:transplantation*; D006084:Graft Rejection; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D015603:Keratinocytes / Q000637:transplantation*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D017768:Skin, Artificial; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing
D000906:Antibodies; D006680:HLA Antigens; D003094:Collagen