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How to Select Cellular and/or Tissue Products

How to Select Cellular and/or Tissue Products

How to Select Cellular and/or Tissue Products

INTRODUCTION

Overview

This topic provides guidance on selection of Cellular and/or Tissue Products (CTPs). For an overview on CTPs from the clinical, coverage and reimbursement perspective, see "Cellular and/or Tissue Products". For decision support on CTP brands, see interactive feature matrices  “Human Skin Allografts”, “Allogeneic Matrix”, “Composite Matrix” and “Acellular Matrix”. For custom case discussions, send message to WoundReference advisory panel through Curbside Consult.<

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HOW TO SELECT AN APPROPRIATE PRODUCT

For successful outcomes, choice of CTPs for each case may be guided by criteria outlined in Algorithm 1 below.


Algorithm 1: Algorithm for Selection of Cellular and/or Tissue Products (click this link to enlarge) 

Criteria relevant for decision making is also itemized below: 

  • Evidence, as defined by availability of RCTs
  • Careful weighing of benefits and harms, appropriate product selection for the wound condition
    • CTP indications, contraindications and features 
    • Shelf-life: length until expiration date, storage requirements (room temperature, freezer, refrigerator), need for special equipment for application
  • Patient’s and clinician’s preference and familiarity with the product
    • Dietary beliefs, religious beliefs, moral beliefs
    • Compliance with post-application care
  • Availability of resources and cost-effectiveness
    • Reimbursement
      • See section ‘Coding, Coverage and Reimbursement’ in topic "Cellular and/or Tissue Products" 
      • Pre-authorization requirements
      • Patient co-pay
  • Adherence to standard of care [1] :
    • Meticulous wound bed preparation, including removal of exudate and necrotic tissue, infection control, nutritional support, pressure avoidance (e.g., offloading for diabetic foot ulcers and pressure ulcers) and edema control (e.g., compression for venous leg ulcers).
    • Diligent patient preparation and correction of systemic cofactors that impair healing;
    • Aggressive correction of the underlying wound etiology;
    • Proper CTP application; appropriate cover dressings;
    • Consistent, regular monitoring of both the cover dressings and the wound bed
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.
Topic 1080 Version 1.0