The role of skin substitutes in the treatment of chronic wounds or in preventing surgical complicaitons is evolving. However, dermal sustitutes are expensive and it is no entirely clear how much benefit they provide in disparate settings in which they are being used. CMS recently regonfigured its payment structure to stop providing financial incentives for using specific types of skin substitutes. Unfortunately the different types of substitutes appeared so quickly that there ahd not been an opportunity to compare them with one anotehr and to select the best performers. This has led to individual plans approving specific but not all available dermal substitutes. A randomized study was performed by Romanelli for one substitute and in one type of woulnd only, mixed arterial/venous and venous ulcers.
BCBS, for example accepts Alloderm but not other dermal substitutes. In principle, this position is reasonable in the absence of comparative trials.