What skin substitutes are

Skin substitutes are sheets or other forms of material that a clinician places on a prepared wound to support the body’s own healing. Some are made from donated human tissue, some from animal tissue and some from synthetic materials. You may also hear them called cellular and tissue-based products.

They are different from a skin graft taken from your own body, and they are not a first step. For people asking about skin substitutes for wounds in St. Louis and the Metro East, Gateway arranges an assessment with a partner clinician, who decides whether one is appropriate. Our guide to what a skin substitute is covers the basics.

Wounds where a skin substitute may be considered

Skin substitutes are most often discussed for:

  • Diabetic foot ulcers that stay open despite offloading and regular wound care
  • Venous leg ulcers that have stalled despite compression
  • Certain other chronic wounds, when the clinician judges that the person’s situation supports it

What comes before an advanced product

A skin substitute works on top of good basic care, not in place of it. In advanced wound care planning, a clinician usually wants to see that the essentials have been in place for a period of time, with the wound measured along the way:

  • The cause of the wound has been identified
  • Circulation has been checked
  • Dead tissue has been removed where appropriate
  • Pressure is off a foot wound, or compression is on a venous leg wound
  • Infection has been treated and drainage is under control
  • Blood sugar, nutrition and smoking have been raised with primary care

If the wound starts closing on those measures alone, an advanced product may not be needed. Gateway sends wound notes to your primary care clinician throughout, as our page on primary care and wound care together describes.

What the treating clinician may do

For a wound that might be a candidate, the treating clinician may:

  • Review earlier records, measurements and treatments, and examine the wound
  • Explain the options, including continuing current care
  • If a skin substitute is chosen, prepare the wound, apply the product at a visit and cover it with a dressing
  • Measure the wound at follow-up visits and decide whether another application is appropriate
  • Stop and rethink the plan if the wound is not responding

The treating clinician chooses the product and the treating practice obtains it. Gateway does not recommend products to patients.

How Gateway coordinates review and coverage questions

Coverage rules for skin substitutes are detailed, they differ from plan to plan, and they change. The treating provider’s office reviews eligibility, benefits and any prior authorization before treatment is arranged.

Around that review, Gateway:

  • Collects prior wound records so the clinician can see the history of care
  • Schedules the assessment at home or in a facility, where a partner clinician is available
  • Tells you what paperwork is still pending and who is working on it

Nothing is applied until the clinician has decided it is appropriate and you have had the chance to ask what it would cost you. Our insurance page lists general questions to ask.

Skin substitutes at home and in facilities

Whether a product can be applied in a private home, an assisted living apartment or a skilled nursing facility depends on the treating provider, the product and the plan’s rules for that setting. We confirm this for your location before a visit is planned.

After an application, the dressing over it is usually meant to stay in place until the clinician says otherwise. Gateway passes that instruction to whoever handles dressings between visits, whether a home health nurse, a facility nurse or a family caregiver.

What to report after an application

Contact the treating clinician if:

  • The outer dressing gets wet, loosens or comes off
  • Pain, redness, warmth or swelling increases around the wound
  • Drainage soaks through the dressing or develops a strong odor
  • You have a fever or chills

Gateway is not an emergency service. Call 911 for heavy bleeding, trouble breathing, or sudden confusion or weakness.

How to start

To ask about a review, request care or call 314-325-0126. The form collects a name and phone number only.

Clinicians and facilities can refer a patient or fax records to 314-786-7966. Serial wound measurements and notes on prior treatment are the most useful documents to send.

Common questions

Are skin substitutes covered by Medicare or my insurance?

We cannot tell you that a plan covers a skin substitute. Coverage depends on the plan, the type of wound, the product, the care setting and the record of earlier care, and the rules have been changing. The treating provider’s office checks benefits before treatment. Ask for your expected cost before you agree to anything.

Is a skin substitute made from real skin?

Some are and some are not. Products may come from donated human tissue, including placental tissue or skin, from animal sources such as pig or cow tissue, or from synthetic materials. If the source matters to you for religious, ethical or allergy reasons, tell the treating clinician before a product is chosen so alternatives can be discussed.

Does having a skin substitute applied hurt?

The product itself is laid on the wound and secured, which is usually not the uncomfortable part. Preparing the wound beforehand can be, especially if dead tissue needs to be removed. Tell the clinician ahead of time if dressing changes have been painful for you, so comfort can be planned for.

Why did the clinician say my wound is not ready for a skin substitute?

Usually because something else has to be dealt with first. Common reasons include infection, dead tissue in the wound, uncontrolled swelling, pressure that has not been relieved, or circulation that needs testing or treatment. It can also mean the wound is improving with standard care and should be given more time. Ask which reason applies and what would change the answer.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.