Two Cases of Traumatic Wounds in Patients With Ehlers-Danlos Syndrome Successfully Treated With a Bioengineered Skin Equivalent

Babak Abai, MD, Dena Thayer, DO, Paul M. Glat, MD


Wounds. 2003;15(6) 

In This Article

Abstract and Introduction


The authors present two cases in which traumatic wounds in patients with Ehlers-Danlos syndrome (EDS) were successfully treated with a bioengineered skin equivalent (BSE) (Apligraf®, Organogenesis, Canton, Massachusetts). Due to defects in collagen metabolism, it has been reported that patients with EDS have poor wound healing and unsightly scarring. Considering this, it is important to look into alternate ways to improve the healing process while avoiding donor site morbidity. The authors have demonstrated, in these two cases, the successful use of BSE as an option for use in the healing of wounds in patients with this syndrome.

Ehlers-Danlos syndrome (EDS) is a group of heritable disorders with an incidence of approximately 1 in 5000 births.[1] It is associated with a defect in collagen formation leading to skin fragility and hyperelasticity of skin, hypermobility of joints, and poor wound healing with scarring.[2,3] It has been subdivided into separate types according to the predominant areas affected and the degree of abnormality ( Table 1 ). Collagen plays an important part in the wound healing process, and patients with EDS have suboptimal wound healing and multiple complications following surgery secondary to defects in collagen

The authors treated two patients with traumatic wounds of the lower extremities with a bioengineered skin equivalent (BSE) (Apligraf®, Organogenesis, Canton, Massachusetts). Both of these patients failed to heal their wounds normally with standard wound care. BSE consists of bovine collagen and human fibroblasts and keratinocytes.[7] The fibroblasts and keratinocytes in BSE produce growth factors and antibiotic peptides creating a physiological microenvironment that can stimulate wound healing.[8]


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