In burn care, the time required to prepare a wound for grafting can have meaningful implications for both patients and providers. This webinar highlights Cohealyx®, a bovine dermal collagen matrix designed to optimize wound bed preparation and support progression to graft-readiness. Recorded date: June 17, 2026
The session features interim analysis results from the ongoing Cohealyx-I clinical trial, along with preliminary histology data that offer early insight into matrix integration and tissue remodeling. Attendees will gain perspective on how Cohealyx supports timely healing and its potential role in advancing wound reconstruction.
Presenter: Derek E. Bell, Professor of Plastic Surgery, Kessler Burn Director, University of Rochester Medical Center, NY
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Read the full transcript here:
Karen Winn, MSN, ACNP, RN
I’m happy to welcome today Dr. Derek E. Bell, who is going to present and share his experiences on Cohealyx Collagen Dermal Matrix, Faster Graft Readiness. Dr. Bell is a Professor of Surgery in the Division of Plastics and Reconstructive Surgery and the Professor of Orthopedic Surgery at the University of Rochester Medical Center. He serves as the Director of the Kessler Family Burn Center as well as the director of the burn unit, leading one of the region’s premier multidisciplinary burden care and reconstruction programs in the U.S. In addition, he serves as clinical instructor for the Rochester Institute of Technology for the Physician Assistant Program. Dr. Bell received his bachelor’s degree magna cum laude from the St. John Fisher’s Rochester College in Rochester, New York before he earned his doctor of medicine from SUNY Upstate Medical Center in Syracuse. He completed his general surgery residency at the State University of New York at Buffalo and subsequently completed a Plastics and Reconstructive Surgery Fellowship at the University of Virginia Medical Center. Since joining URMC in 2009, he’s established a national reputation in burn surgery, reconstructive plastic surgery, complex wound management, a focus on burn care and research and he continues with his interest in wound healing, skin substitutes, regenerative medicine, and clinical outcomes research. He has served as a principal investigator and collaborator on numerous clinical studies and has authored multiple book chapters as well as more than 100 peer-reviewed articles. Dr. Bell received numerous honors recognizing his contribution to surgical education, mentorship, research, and patient care. He is the faculty inductee of the Alpha Omega Alpha Honor Medical Society and a member of the American Association of Plastic Surgeons. Dr. Bell’s an active leader within the burn care and plastic surgery communities, serves on national committees in the American Burn Association, and has held leadership roles both regionally as well as nationally, disaster preparedness initiatives as well as participated in many surgical educational programs. Throughout his career, Dr. Bell has remained committed to advance in patient care, surgical education, and clinical research while mentoring the next generation of surgeons and healthcare professionals. Welcome, Dr. Bell, and I would like to turn it over to you.
Derek E. Bell, MD
Karen, thanks for that rather prestigious introduction. I don’t know where you got all that information from. That was a lot. Thank you, that was too generous. So I’d like to thank the audience for joining today. Again, Derek Bell from the University of Rochester. Happy to present today my experience with Cohealyx and give you a little bit of background on this coming to fruition and some of our clinical outcomes and some of the science behind its success. I’m a KOL for AVITA, it’s the only company I’m a KOL for. I have several research grants with Kerecis as well.
I’ve had more than seven years experience using AVITA products, primarily RECELL to start with, and now Cohealyx, as well as PermeaDerm, and I’ve had outstanding success with all of them. I do think that RECELL is a standard of care for definitive closure of appropriately selected burn patients and also complex wound patients. I tell people that since I started using RECELL, I haven’t had a single patient die. Granted, there may be some bias in that, some lag time bias, but I wish I had RECELL in itself 20 years ago, because I think that there would be more people alive today because of that. Our center has been involved in multi-center trials using both RECELL as well as Cohealyx and as well PermeaDerm. And again, I’m gonna talk to you about our experiences with Cohealyx today.
So first we have to prepare the wound, then we have rebuild the foundation and then restore the skin. I think that AVITA has been very proactive and thoughtful in acquiring the right products to do all of that. So the spectrum of products that they have really can take care of any of our wound needs. It’s a little bit of a busy slide, but this is very much how I think about taking care of a wound patient or a burn patient. My residents and medical students asked me about my thought processes. Behind what I’m going to do to a wound and why I’m doing that, but this is kind of how my brain works.
So looking at this, initially it’s a deep partial thickness or full thickness wound. If it’s deep partial thickness, this is something that I may want to RECELL, excise, spray, and then put a topical on top of. If it’s full thickness, this gets a little bit more complex. First I look at the wound, then I look at the patient. In terms of their potential donor sites, and also take in consideration different patient variables like the type of wound it is, whether it’s a burn or other wounds, whether it is nec fasc, or bulging injuries. Also the age of the patient and overall healthcare status of the patient as well as the appearance of the wound.
With these full thickness wounds, I excise them, then determine if they need temporary coverage. If they do, then PermeaDerm. Then we go on to graft them later on with or without Cohealyx and split thickness skin grafts. With those that are not ready, those are patients that I would use Cohealyx on. So this is a stage process by which we use the Cohealyx to optimize the wound bed while we are trying to prepare that for split thickness skin grafting plus or minus RECELL. So Cohealyx is a collagen dermal matrix.
Why do we use dermal matrices? This is a patient of one of my friends, Dr. Flores, who’s in Las Vegas. This is the patient that has a debrided wound, but I think that most of us would agree this is not ready for grafting. There are open areas where you have exposed tendons, potentially the bone over the lateral femur proximally exposed tendon distally and even the central aspect of the wound bed. In this circumstance I could get a graft to take on some of this but this is certainly not something that I would graft straight away because this is a wound that’s going to fail with that. I think that when we take into consideration how we’re treating the wounds, I want something that is going to optimize the wound bed and do so in a timely manner. I don’t want these patients lingering in the hospital, and I don’t want these patients having a prolonged hospital or out-of-hospital course and optimizing the wound bed before I can graft them reliably. And certainly, I don’t want to push the envelope and graft something that would have gone on to potentially fail, then I have to re-graft them.
Fortunately, in my practice, I’ve, knock on wood, I only have to re-graft one patient per year. I think part of that is selection, as well as utilization of products such as Cohealyx to optimize the wound bed. I’m going to tell you some data and show you some outcomes on how it does that. Because what I want to do is I want get these patients better. I want them out of the hospital. I want to get them on with their lives and take care of new acute patients. So this has an impact on time to healing. I’m gonna talk to you about this in detail.
First we optimize the wound bed by debriding it and then putting down the dermal matrix. The impacts of delay as I’ve alluded to to some degree is risk of wound infection with an open wound for an extended period of time, ongoing pain and discomfort. These are things that could prolong patient’s hospitalization, which is an additive cost… to the patient, to our healthcare system, as well as freeing up a hospital bed that could be utilized by a patient that is more acute. I want to use a product that is going to mitigate scarring and functional impairment. I am happy to not have to re-graft or do Z-plasties or flaps on patients. So that’s something I’m also taking into consideration when choosing an acellular dermal matrix. Of course, there’s extended wound care needs, even as an outpatient, this utilizes visiting their services or impacts family members or caregivers outside the hospital and provide an extended period of care to optimize wound bed before grafting. So this translates into unnecessary, potentially unnecessary utilization of our healthcare resources.
So what is it made out of? Cohealyx is designed for wound bed preparation. I think there’s a really smart design by utilizing type one and three collagen. It has an optimal pore structure to facilitate cell migration into the wound. I’m gonna show you some histological evidence of that. Also, I don’t want a product that’s gonna stick around forever.
It has a controlled 30-day reabsorption on purpose so it goes away. It does its job, optimizes the wound bed, then it goes away. It’s a single layer, and it’s extremely conformable. I think there’s a lot of rigidity with some of the products that we have on the market, which will lead to either tenting across a concavity or pleating of the product, which can lead to unsightly scarring on the patient or some permanency with pleating of some of products that have on market. It’s three millimeters thick. It comes as a dry structure, but then it’s hydrated to conform to the wound bed. And along the lines of the 30-day resorption, some products that are on the market stick around for an extended period of time. It’s a little bit harder for me to explain to a patient that this product is going to stay in your body. It’s a foreign material that’s going to stay in your body for a year or two, and eventually it will digest and go away. Some people are not super keen on that. So this supports balanced cell infiltration.
These are some smart slides. You can see from the bottom right, I think you guys can see my arrow, you can see the bottom, right, the gross appearance of these wounds with the utilization of three common products that are on the market.
I think most of us would agree that the Cohealyx at seven days is ready for an autograft. It’s integrating well, it’s granulating throughout, and it’s nice and beefy and red and robust. The Integra, however, you can see along the edge, there’s some biofilm in through those areas. Some of this is healing OK, but it’s certainly not optimal. And then the Kerecis has a very, very thick biofilm along the surface. And that’s not a wound that I would graft in seven days. So both the Integra and the Kerecis, in my hands, I would give that extended period of time to integrate better before grafting straight away. From each of these, there was a biopsy taken.
You can see from the Cohealyx, even at seven days, there’s evidence of new angiogenesis with capillary formation within the central aspects of the product itself. So the purple also represents a cell infiltration. There’s a lot of collagen in there, a little bit of cell infiltration. You can see with the Integra, there’s some cell infiltration, some collagen formation. However, you can see that there’s the thickness of the Integra is really, really pretty thin. So the central aspect, these are diposites. The actual thickness of the Integra is really thin compared to the Cohealyx. This is a concern to me because I prepared the wound bed by taking a Versajet or dermablades to the wound bed and removing the biofilm that may form on there. With Integra, I’m always concerned that I’m taking that product away. I think that this also demonstrates evidence that even with gentle versajetting, you can remove the product entirely. So that’s a concern to me, that it’s so thin. And the Kerecis, this is purple. And that’s because there’s a lot of cell infiltration there. Some people want that. I don’t want a hyperinflammatory wound bed. I don’t think that’s an optimal condition for autografting. So even though there’s cellular proliferation within the product itself, I don’t want inflammatory cells comprising much of the acellular dermal matrix.
Here’s a greater magnification with the same three products. Again, you can see the Cohealyx at seven days. There’s capillary formation. You can see capillaries in there with the red blood cells within the product itself. Integra, not much. Maybe a couple red blood cells in there, but not formation of capillaries. And again, with the Kerecis, there’s no capillary formation, extreme cellular infiltration with inflammatory cells, but no capillary formation. This demonstrates to me evidence that this integrates well and does do what it’s stated to do in optimizing the wound bed with capillary integration.
This is a different staining with CD31, so it stains specifically for blood vessels. So again, you can see with the Cohealyx on the left, there’s capillary formation throughout the entirety of the product with the Integra a little bit, but it’s not well organized and certainly not as robust as a Cohealyx. And then with Kerecis, you see some in through there, but again, there’s a lot of inflammatory cells throughout the Kerecis. Further magnification demonstrates more of the same. You can see the capillary channels formed within the Cohealyx. Again, this is at seven days. Integra not much, and Kerecis also very little. I talked about scarring a little bit. I don’t want an ADM to scar. I don’t want it to contract. I want it mitigate scarring.
This is a really, really smart slide. This looks at the Cohealyx versus no Cohealyx. So this is a prospective control. The blue line on the left is the Cohealyx. The dotted line is a wound bed without Cohealyx. Looking at the wound bed surface area over the course of six weeks, you can see the contracture rate is very, very low with Cohealyx. And without Cohealyx it contracts quite a bit. There’s almost a 30% reduction in the contraction with the utilization of Cohealyx. So again, this is going to mitigate scarring, which is going contribute to an unsightly wound bed after grafting, as well as potential pain and functional impairment. On the right, also this is really smart, staining for alpha smooth muscle actin. So why is there no contraction? With the Cohealyx, you can see that there’s a very, very little brown in that histological specimen. So there’s very little smooth muscle actin. Smooth muscle actine contracts the wound. Without the Cohealyx, there’s fair amount of that within the skin graft only. So there is a greater than twofold reduction in the surface area with smooth muscle, with percentage-wise with the smooth muscle actin.
I was fortunate to be involved with some of my esteemed colleagues and friends throughout the country in the Cohealyx multi-center trial, looking at a lot of data points with its utilization. So this is a prospective randomized control. What we did is we looked at patients that had acute full-thickness wounds that required staged surgical procedures. There was no limitation in the size of the wound bed, and then there was no limitations with burn patients with their TBSA. So first, we grafted these. Secondary endpoint is we looked at time to graft with a skin graft. First with the Cohealyx, and then time to graft with the split-thickness skin graft thereafter. We looked at wound healing, scar assessment, and of course safety events.
For a comparator group, we looked at a meta-analysis of published data. Those published articles, we found that there were 532. The research through October of 2024. We screened out patients that required a two-stage approach. They had to have full-thickness wounds, had to be human subjects, and we had to legitimate evidence with these studies. These studies also required patients to have sufficient safety and performance data. So of those, we found that there were 21 that included a BTM, Integra, Matriderm. From this, the average time to grafting was 33.2 days. Over a month was average time of grafting. So again, in the vertical column on the left, in the black, time to grafting was 33.2 days. We found that the average time of grafting with Cohealyx was 13.6 days. 11 days was the median time to grafting readiness, and five days was earliest in the study that we found with grafting. Again, I don’t want to have to do wound care on these patients for five weeks before I can graft them.
There may be some criticism that this was not a prospective randomized control going forward. However, I think that this solidifies the validity of what has been published previously in utilizing a meta analysis as a comparative group for this. So 25% of these patients were grafted within a week. Three quarters of these patients were grafted within 14 days. You can see there’s some outliers on the right, there’s two outliers in the right. This is honest data. Patients become unwell, they get lost to follow up. There’s a multitude of reasons why we have a couple outliers, but this is true data. Regardless, the vast majority were able to be grafted within 14 days. Again, compared to five weeks on average.
I think it was clever to include the satisfaction surveys of the providers. Of those that were included in the study, most were very satisfied or satisfied. Only 10% were either neutral or dissatisfied. So again, honest data showing that we are very satisfied with this product. I think that speaks to the reproducibility of its utilization because if we as providers are not happy with the product itself, we’re not going to use it. I think most of us would use it.
This is one of the patients that I had in the study. This is a 60 year old gentleman who had flame burns on his torso. This extends from his hip almost to the axillary region. You can see that the anterior thorax is along the superior extent of the slide. What is not seen in this is his patient’s rather cachectic. He has COPD. He’s a very, very heavy smoker. He’s not great nutritionally. You can also see the scar on his hemithorax from his prior thoracotomy for his lobectomy for lung cancer. Not the best surgical candidate to straightaway put an autologous graft on. Could I do that? Yes. I would not put a graft on this patient because I’d be concerned that straightaway I’d lose part of the graft for the multitude of reasons. It doesn’t make him an optimal candidate for straightaway autografting.
So I took him to the operating room to debride the wound bed. Nice, healthy-appearing wound bed, nice, robust bleeding throughout. You can see that the [inaudible] has been mitigated with epinephrine [inaudible]. You can this blanching show on the perimeter from the epinepherine solution. So again, I applied the product dry. You can see the central aspect in the product itself is there’s a red dot there, that’s from the biopsy. So we apply it dry, staple it sparingly, and then apply saline to the product. So it’s dry, it’s like felt. It handles nicely, it’s like felt, it’s nice, light, and fluffy. And then you hydrate. Once you get in place, you hydate, and once it’s hydrated, it can conform to all the nooks and crannies, if you will, in a multi-convoluted surface. I like to use negative pressure therapy a lot. I think it helps to control fluid egress. I think helps to mitigate hematoma and seroma formation. We actually have publications demonstrating that as well as mitigating any friction or loss of graft from shearing forces. So we put a negative pressure wound dressing on this patient. So essentially treat it how I would other any other ADM.
Here he is in a week, it’s integrating nicely. You can see the staples are still in place. It’s integrating very nicely. It’s healing well. So I take him 11 days. I think this is over Thanksgiving. So I think that I probably would have grafted him sooner if I didn’t have a lag time bias from the Thanksgiving holiday. I applied split thickness skin graft. People ask why it says up. It’s because the grafts are very, very thin. I take about four one-thousandths of an inch and I don’t want the residents putting them on upside down. So I write up on the grafts. I use the non-mesh sheet graft in this patient to, again, optimize cosmesis, staple this in, put a negative pressure dressing back on the patient. But here you can see them in 11 days.
So I bring him back at a week, so seven days post-op. Everything’s integrating very, very nicely, still stays up. 14 days, he’s on the moisturizer, and eight weeks post-up, everything’s healing very, very well. He has a little bit of an area that’s a little hyper-pigmented, but what’s not appreciated from this, I wish I had a video, is that this is extremely soft, supple, tender, and well-integrated. It’s another one of my colleague’s patients. It’s not a patient of mine. 55-Year-old patient that had a soft tissue infection or necrotizing fasciitis.
You can see the patient at presentation, excision, and then application of the Cohealyx in the right. Patient’s not well. They have heart failure, cirrhosis, obesity, hypoventilation syndrome. Not an optimal candidate by any regard. There’s some undermining along the perimeter. I’ll show you how this has influenced the undermining. Generally, this is a patient I would have taken, I would’ve skived the edges and actually made the wound bigger and doing so to create a general transition into the base of the wound bed by excising the perimeter of this. But. They need to do that. So this is after six days of application of the Cohealyx and then after 13 days. This was pretty impressive. I think that we’d all agree that this is nice, healthy granulation tissue throughout.
And from this, there was a biopsy obtained. We looked at the blood vessel density, the inflammatory infiltrates, collagen profile. The amount of granulation tissue and engraftment to the tissue. We used different stains to demonstrate that. So again, there’s a biopsy site. What do we find from this? The blue indicates mature collagen. So it’s 13 days after application. There’s a lot of mature collagen throughout the biopsy specimen, which indicates that there’s integration of the Cohealyx into the wound bed.
You can also see from the dark purple, or almost black, these are these are cell nuclei. So we do have some cellular proliferation into the into the product as well, but not nearly as dense as what you saw with the with the Kerecis. So probably an optimal amount of cellular proliferation into the into the product. So here it is, 13 days after Cohealyx, application of split thickness skin graft. Again, this is not my patient. However, I think that 12 weeks post-graft, you can see that it’s got really great closure and it’s healing very, very nicely.
Something I’d like to point out also, as I mentioned, that there’s kind of a step off at the time of application at Cohealyx but that has totally been mitigated long term at a 12 week so it’s a nice smooth graft in that area with a nice high quality durable closure. So these are the histologic results, looking at the biopsy sites of the different patients or different periods of time. From the study, we looked at patients that were grafted within a week. Those were grafted between one and two weeks, and those greater than two weeks. So again, the vast majority of these patients, 72% of these patients were grafted within 14 days.
What do we find from that? We wanna look and see if there was any difference in these different… Assessments with the Cohealyx. So if you look at the inflammatory infiltrate that was pretty consistent across the consortium of the patient population. The blood vessel density is actually higher earlier on. It dips a bit at the 8 to 14 days and then goes up again those that were grafted a little bit later. Not surprisingly there’s more collagen as you delay the grafting, however, I think it’s important to note that there’s a fair amount of collagen as I demonstrated from that prior histologic specimen early within a week of application of the product. And more importantly, there’s consistency with the mature collagen throughout the course of the study population.
There’s excellent engraftment into the tissue, a little bit higher as you progress further out. And then the granulation tissue was a little bit higher earlier on. Amount of epithelial cells was pretty minimal throughout, so there may be some residual epithedial cells in the deep epidermal components of the skin or of the dermis, which is not surprising with any residual sebaceous or molecular components. But I think that overall, this demonstrates that even within a week or two weeks, there’s excellent deposition of collagen, blood vessel density, and there’s not a significant amount of hypergranulation tissue. This was assessed by several blinded pathologists. So again, there’s rapid matrix integration within two weeks. There’s excellent revascularization. There’s reliable skin grafting and there’s early definitive closure.
Again, we were able to do this on these patients within two weeks, not 33 and a half days. So the median graft readiness was 11 days compared to our literature derived benchmark of 33 days. Again, Cohealyx advances the readiness for closure, has a significant clinical impact as operational efficiency. And with that comes economic value. So I think that the time is money. Patients sitting around the hospital for a certain period of time waiting for a wound bed to become optimized is several thousand dollars a day. One application of that product mitigates that within a day comparatively. Again, this supports auto grafting as early as five days.
I showed you the slides, the histological slides with the smooth muscle actin. It reduces infection and contraction. This supports consistent graft take. We will look at the long-term data with these patients so that the trial’s not definitively over because we’re still collecting some data with these with these patients. But we will have that probably within the next couple of months. The three millimeter thickness is great for volumetric support. It’s conformable and very, very easy to apply, especially once you moisten it conforms to all the, uh, the concavities of the wound bed and it’s designed for economic pricing.
This is far cheaper than many other products that we have on the market. It is a very, very affordable and, I think again, really, part of the value is not just with the product itself, but also earlier time to grafting. That’s invaluable, and I’d like to see that study that comes out, looking at the cost of the product versus the time savings with that. I want to be on that study.
AVITA is great to work with. I have to say that they have the best clinical team and support services of any products that I’ve worked with thus far. They have great clinical support. They’re very, very good with scientific exchange and medical education. I know they’re very very proactive with setting up cadaver labs and also educating our staff. We have a burn boot camp and AVITA supports that in training our medical students, residents and the entire OR staff, so they’re great in that regard. And their clinical support services are absolutely outstanding. I talk to them almost every day. They have a market access team that is excellent with coding, coverage, and reimbursement. With these new products coming on the market, they have been actively involved with our billing and reimbursements here at the University of Rochester to ensure that we’re getting paid for the products that we are using. So they’re very, very proactive in ensuring that we get paid for what we’re doing.
They’re excellent with prior authorization, appeals, and setting up specific case inquiries. And then you can see the the code here on the right for your reimbursement guide. So with that, I thank you. I thank the ABA and AVITA for allowing me to talk about this product today. And I hope that it will change your practice as it has mine.