Allogeneic Skin Substitutes Versus Human Placental Membrane Products in the Management of Diabetic Foot Ulcers: A Narrative Comparative Evaluation of the Literature

Abstract

Diabetic foot ulcers (DFUs) occur in up to 25% of patients with diabetes mellitus. 1 These complex, chronic wounds are associated with increased patient morbidity 2 and decreased health-related quality of life. 3 Approximately 15% of DFUs result in lower extremity amputations, 4 and the presence of foot ulceration is an independent predictor of excess all-cause mortality among patients with diabetes. 5 Despite the global burden of DFU and its adverse sequelae, 6 outcomes following standard wound care (SWC) measures remain suboptimal. 7 As a result, a number of novel interventions and treatment approaches have been trialed with varying success. 8 One particularly promising strategy is based on the use of tissue engineered advanced wound therapy products. Cellular advanced wound therapies may be broadly categorized into either "living" skin substitutes (containing theoretically viable cells) or placental membrane allografts (containing theoretically viable or nonviable cells). Separately, both bioengineered skin substitutes 9 and human placental membrane products 2,10 have been shown to improve DFU wound healing outcomes. However, it is unclear which tissue engineered approach is superior and, as yet, there has been no comparative evaluation of the available evidence. Furthermore, previous studies of bioengineered skin substitutes in the context of DFU made no

Effectiveness and safety of human amnion/chorion membrane therapy for diabetic foot ulcers: An updated meta‐analysis of randomized clinical trials

“…One such promising treatment is human amnion/chorion membrane (HACM) transplantation 11,12 . These tissues are typically obtained from healthy female donors during cesarean section deliveries and then are processed in different methods, such as dehydration, cryopreservation, and decellularization 13,14 . In the middle of 20th century, HACM began to be used in the treatment of burns, venous ulcers, DFUs, and other types of chronic wounds 14,15 .…”

Efficacy of Recombinant Human Epidermal Growth Factor (Regen-D 150) in Healing Diabetic Foot Ulcers: A Hospital-Based Randomized Controlled Trial

“…14 The use of tissue-engineered allogeneic cellular wound therapies represents an emerging treatment strategy. 15 The present study highlighted the hEGF Regen-D 150 cream-based treatment was better in treating the DFUs when compared with placebo treatment. The postmarketing surveillance multicenter study of Regen-D 150 has shown significant results where we had found healthy granulation and stimulated epithelization in chronic DFUs.…”

Progress in Wound Healing: Wisdom Not Consumed in Confidence?

“…Among others, Holmes et al 12 report favorable results with dynamic optical coherence tomography in the evaluation of chronic ulcers. Luck et al 13 summarize the evidence from 11 randomized controlled trials on the utility of allogeneic skin substitutes compared with human placental membrane products for diabetic foot ulcers. Elbarbary et al 14 provide evidence that add-on hyperbaric oxygen enhances healing of diabetic foot ulcers in limbs with adequate blood flow.…”