Treatment of Pressure Injuries with CAMPs:

An Evidence-Based Approach‍

Venture Medical LLC  |  March 2026

‍

The Pressure Injury Crisis in Post-Acute Care

Pressure injuries (PIs) represent a profound clinical and economic burden, concentrated disproportionately in post-acute care. Over 2.5 million Americans develop PIs annually, and NPIAP data reveal a 20–30% incidence in skilled nursing facilities. The annual US treatment cost is estimated at $26.8 billion. Patients who develop PIs face a 3.6-fold increase in mortality; for PIs involving deeper structures, mortality can reach 70% at 180 days. The post-acute population—older adults with reduced mobility, impaired perfusion, polypharmacy, and malnutrition—is especially vulnerable, and standard of care alone is often insufficient for full-thickness wounds in this setting.

Cellular, acellular, and matrix-like products (CAMPs) offer an effective approach to resetting the stalled healing trajectory of these wounds. Clinical experience and real world evidence have shown that CAMPs are extremely beneficial for these patients.  

In a real world study recently published in the International Journal of Tissue Repair, Tettelbach et al. analyzed matched Medicare claims data (2016–2024) for Stage 3 PI episodes managed in hospital outpatient settings (n=7,223 matched episodes per group) and found that CAMP use was associated with lower rates of sepsis (26.1% vs. 36.1%), major amputation (2.2% vs. 3.1%), ED visits, inpatient admissions, and mortality (17.8% vs. 22.3%) compared to SOC with sharp debridement alone.

Establishing a Clinical Protocol

The first suggested step in the appropriate treatment of PI patients with CAMPs is the development of an appropriate clinical treatment protocol. However, without an applicable LCD, there was previously limited available guidance on the use of CAMPs for these patients. Providers were left to develop their own approaches.

This is no longer the case. A 2025 international consensus document published in the Journal of Wound Care provides a comprehensive framework for CAMP use in PIs and offers a defensible evidentiary basis for providers to rely on. The JWC consensus panel established that CAMPs should be integrated into standardized, protocol-driven treatment plans. CAMPs are indicated for full-thickness PIs that have failed to respond to standard of care after comorbidities and risk factors have been addressed, and the panel endorsed early application in patients with complex wounds, multiple comorbidities, or impaired healing capacity. Accurate differential diagnosis—ruling out atypical wounds, skin failure, and osteomyelitis—is a prerequisite.

The consensus outlines a step-down/step-up timeline: aggressive multimodal intervention in Days 1–4 (debridement, antiseptics, etiology management), therapy optimization in Days 5–7, de-escalation in Weeks 1–4 as the wound improves, and evaluation for advanced therapies including CAMPs if healing stalls beyond Week 4.

‍

Patient and Wound Bed Optimization

The biological reset facilitated by CAMPs must occur within an optimized systemic environment. Key domains include comorbidity management, nicotine cessation, location-specific offloading, nutritional assessment, medication review, tissue perfusion evaluation, microclimate management, and psychosocial support. Wound bed preparation per the TIMERS framework—tissue debridement, inflammation/infection control, moisture balance, edge management, and readiness for repair—is likewise mandatory before CAMP application. Products like UltraMist, XsonX and Histologics can make wound bed preparation both more tolerable for patients and more effective.

‍

CAMPs Product Selecting

Flat reimbursement for CAMPs does not mean all CAMPs are the same. Far from it CAMPs differ greatly in composition, mechanisms of action, regulatory classification, and evidentiary support. Product selection should reflect wound depth and complexity, healing trajectory, comorbidity profile, and the clinical setting. Published clinical evidence in PI treatment is also extremely beneficial in justifying the selection and use of a particular product.

Among available options, ProgenaMatrix® human keratin matrix (HKM) is one of the few CAMPs with an FDA-cleared indication specifically for Stage I-IV pressure injuries. Recent peer-reviewed evidence has highlighted the benefits of HKM in PI treatment. A March 2026 study in the International Journal of Tissue Repair (Tunyiswa et al.) provides an effectiveness analysis of HKM in real-world PIs in post-acute settings.  . Using data from a national database capturing longitudinal PI data from multiple LTACHs and SNFs, the authors applied Bayesian propensity score matching to compare 81 HKM-treated and 80 SOC-only PIs. HKM was associated with an approximately 60% greater probability of healing (posterior mean RR ≈ 1.6, 95% HDI 1.0–2.1), with a 99.4% posterior probability of benefit. The treatment effect was consistent across all PI stages including the most severe Grade III, Grade IV and unstageable wounds, and no HKM-related complications were identified.

Full open-access article: https://doi.org/10.63676/vt5yx857

Using the appropriate CAMPs product in the appropriate patient at the appropriate time is the key to unlock what the consensus panel described as “one of the most effective solutions” for pressure injuries not responding to standard care.

‍

References

1. Tettelbach WH, Armstrong DG, Oropallo A, et al. Real-world outcomes of cellular, acellular, and matrix-like products (CAMPs) in Stage 3 pressure injury ulcers: A matched Medicare claims analysis (2016–2024). Int J Tissue Repair. 2026. https://doi.org/10.63676/dj8g4218

2. Desvigne M, Tettelbach WH, Dirks R, et al. CAMPs in pressure injuries: International consensus document. J Wound Care. 2025;34(12 Sup D):S1–S18.

3. Tunyiswa Z, Frade S, Dirks R, Walthall H. Human keratin matrix use and wound healing outcomes in post-acute care of pressure ulcers: Evidence from a Bayesian real-world study. Int J Tissue Repair. 2026. doi:10.63676/vt5yx857

‍

‍