Is ACApatch (Accelerated Cellular Attachment patch) contraindicated in surgical wounds with possible pre-cancerous lesions?

ACApatch Use in Surgical Wounds with Possible Pre-cancerous Lesions

ACApatch is contraindicated in surgical wounds with possible pre-cancerous lesions due to the risk of enhancing abnormal cell growth and potentially accelerating malignant transformation.

Rationale for Contraindication

• Surgical wounds with pre-cancerous lesions require careful management as these lesions have the potential to transform into invasive cancers if not properly treated 1
• Pre-cancerous lesions differ from normal tissue and have some, but not all, of the molecular and phenotypic properties that characterize cancer 1
• The application of growth-promoting products like ACApatch, which contains angiogenic and trophic factors (PGE2, WNT4, GDF-11), may stimulate not only normal tissue growth but potentially abnormal cell proliferation in pre-cancerous lesions 2

Management Considerations for Surgical Wounds with Pre-cancerous Lesions

• Surgical wounds in areas with pre-cancerous lesions require caution in the early stages of healing, as noted in cancer treatment guidelines 3
• The primary goal in managing pre-cancerous lesions is complete removal or destruction of the abnormal tissue to prevent progression to invasive cancer 4
• For surgical wounds in areas with pre-cancerous lesions, the following approach is recommended:
  • Complete excision with appropriate margins to ensure removal of all abnormal tissue 3
  • Histopathological examination of the excised tissue to confirm diagnosis and assess margins 3
  • Close monitoring for recurrence or new lesions 3

Specific Concerns with ACApatch in Pre-cancerous Wounds

• ACApatch contains growth factors that promote angiogenesis and tissue regeneration, which may potentially stimulate growth of any residual pre-cancerous cells 2
• Common pre-cancerous skin lesions such as actinic keratoses, Bowen's disease, and keratoacanthoma require specific treatment approaches focused on complete removal rather than accelerated healing 5
• The concentrated molecules in amniotic patches (PGE2, WNT4, GDF-11) that have angiogenic and trophic effects may potentially enhance not only normal wound healing but also abnormal cell proliferation 2

Alternative Approaches for Wound Management

• For wounds with possible pre-cancerous lesions, consider:
  • Mohs micrographic surgery for high-risk areas to ensure complete removal of abnormal tissue 3
  • Re-excision with appropriate margins if initial excision was incomplete 3
  • Close clinical and histological monitoring of the wound healing process 3
  • Standard wound care approaches without growth-promoting agents until complete removal of pre-cancerous tissue is confirmed 3

Monitoring and Follow-up

• Regular follow-up examinations are essential to monitor for:
  • Complete wound healing 6
  • Signs of recurrence of pre-cancerous lesions 3
  • Potential transformation to invasive cancer 1
• Documentation of wound appearance, size, and characteristics at each follow-up visit 2
• Consider repeat biopsy if there are any concerning features during the healing process 3

In conclusion, while ACApatch may be beneficial for enhancing healing in standard surgical wounds, its use should be avoided in wounds with possible pre-cancerous lesions until complete removal of all abnormal tissue is confirmed and the risk of malignant transformation is eliminated.