Application of Graftskin to Accelerate Healing of Ulcers in Diabetic Foot Syndrome

Binienko, M. A.; Kotslova, A. A.; Давыденко, В. В.; Власов, Т. Д.

doi:10.24884/0042-4625-2016-175-5-63-68

Cited by 5 publications

(9 citation statements)

References 10 publications

(12 reference statements)

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“…Six studies on cellular skin substitutes reported on reduction in ulcer area, one 166 with the bilayered skin substitute, four with the polymer scaffold/fibroblast skin substitute, [158][159][160][161] and one with the microvascular tissue structural allograft. 165 All of the 4 studies with the polymer scaffold/fibroblast skin substitute [158][159][160][161] and the single study of the microvascular tissue structural allograft 165 demonstrated greater wound area reduction with the use of cellular skin substitutes compared to standard of care.…”

Section: Outcome: Reduction In Ulcer Areamentioning

confidence: 99%

“…We included 19 studies comparing negative-pressure wound therapy to standard of care, 46,166,[255][256][257][258][259][260][261][262][263][264][265][266][267][268][269][270][271] which fitted our inclusion criteria, the majority of which were in post-surgical diabetes-related foot wounds. Two were in a mixed population comprising post-surgical and non-surgical wounds, 255,267 and only one in nonsurgical wounds alone.…”

Section: Intervention 8: Negative Pressure Wound Therapymentioning

confidence: 99%

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Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Chen,

Vilorio,

Dhatariya

et al. 2024

Diabetes Metabolism Res

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BackgroundIt is critical that interventions used to enhance the healing of chronic foot ulcers in diabetes are backed by high‐quality evidence and cost‐effectiveness. In previous years, the systematic review accompanying guidelines published by the International Working Group of the Diabetic Foot performed 4‐yearly updates of previous searches, including trials of prospective, cross‐sectional and case‐control design.AimsDue to a need to re‐evaluate older studies against newer standards of reporting and assessment of risk of bias, we performed a whole new search from conception, but limiting studies to randomised control trials only.Materials and MethodsFor this systematic review, we searched PubMed, Scopus and Web of Science databases for published studies on randomised control trials of interventions to enhance healing of diabetes‐related foot ulcers. We only included trials comparing interventions to standard of care. Two independent reviewers selected articles for inclusion and assessed relevant outcomes as well as methodological quality.ResultsThe literature search identified 22,250 articles, of which 262 were selected for full text review across 10 categories of interventions. Overall, the certainty of evidence for a majority of wound healing interventions was low or very low, with moderate evidence existing for two interventions (sucrose‐octasulfate and leucocyte, platelet and fibrin patch) and low quality evidence for a further four (hyperbaric oxygen, topical oxygen, placental derived products and negative pressure wound therapy). The majority of interventions had insufficient evidence.ConclusionOverall, the evidence to support any other intervention to enhance wound healing is lacking and further high‐quality randomised control trials are encouraged.

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Section: Outcome: Reduction In Ulcer Areamentioning

confidence: 99%

Section: Intervention 8: Negative Pressure Wound Therapymentioning

confidence: 99%

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Chen,

Vilorio,

Dhatariya

et al. 2024

Diabetes Metabolism Res

View full text Add to dashboard Cite

show abstract

“…241 Overall, the balance of effects was not thought to favour either Rationale: We identified 19 studies which fulfiled our inclusion criteria. 50,152,[244][245][246][247][248][249][250][251][252][253][254][255][256][257][258][259][260] All studies were thought to be at moderate to high risk of bias.…”

Section: Rationalementioning

confidence: 99%

“…Some examples of acellular skin substitutes would be products such as human acellular dermal matrix and bovine collagen dermal matrix where the cells have been removed and the support structure or matrix is left in place. For the systematic review, 7 we found 10 RCTs [146][147][148][149][150][151][152][153][154][155] on cellular products, 13 RCTs 150,156-167 on acellular products, and 5 RCTs [168][169][170][171][172] on autologous skin graft products. Rationale: Although evidence from 10 RCTs [146][147][148][149][150][151][152][153][154][155] suggest that cellular skin substitutes may improve healing and reduce the time to healing in patients with diabetes-related foot ulcers when provided in addition to standard of care, all studies were at high risk of bias due to non-blinding, had high dropout rates and per-protocol analyses.…”

Section: Intervention: Skin Substitutesmentioning

confidence: 99%

“…Rationale: Based on the review of the 13 RCTs 150,156–167 found on acellular skin substitutes, we concluded that these interventions may improve the incidence of healing and reduce the time to healing in patients with diabetes‐related foot ulcers, when provided in addition to standard of care. However, all of the studies were considered at high risk of bias with the majority having no blinding as part of the protocol and only three 158,160,166 being blinded for outcome assessment.…”

Section: Recommendationsmentioning

confidence: 99%

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Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)

Chen,

Vilorio,

Dhatariya

et al. 2023

Diabetes Metabolism Res

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AimsPrinciples of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes‐related foot ulcer. However, the rising incidence and costs of diabetes‐related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes‐related foot ulcers are supported by high‐quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold‐standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence‐based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.Materials and MethodsWe followed the GRADE approach by devising clinical questions and important outcomes in the Patient‐Intervention‐Control‐Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders.ResultsFrom the results of the systematic review and evidence‐to‐decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post‐operative wounds, the use of placental‐derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions.ConclusionsThese wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.

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Experience of outpatient treatment of trophic foot ulcers complicating the course of diabetes

Burleva

Бабушкина

2018

Stacionarozameshchayushchie tekhnologii: Ambulatornaya khirurgi

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The work was aimed at analysing the annual results of outpatient observation of patients with trophic ulcers (TU) on the background of diabetes mellitus while applying modern principles of general and differentiated local treatment in the Diabetic Foot Room (DFR) environment. The authors carried out a retrospective analysis in a cohort of patients with diabetic foot syndrome (DFS), who visited a practitioner to receive advice and treatment in the DFR in 2015–2017 (n = 570). Of which, only 308 people have been treated on an outpatient basis. Neuropathic form (n = 194): diabetic osteoarthropathy (DOAP) (A0) = 63, DOAP + TU = 34; TUs without DOAP = 131 (AI 105, BI 26). Neuroischemic form (n = 114), all had TUs (CI 107, D I 7). The patients received glucose-lowering therapy correction, feet relief and differentiated local effects on TUs in accordance with the wound process stages. All options of modern wound dressing were used for indications. As a result, out of 83 patients with neuropathic DFS form, who were regularly observed in DPT, 65 (78.3%) patients achieved healing within 1 year. Of 103 patients with the neuroischemic form regularly observed in DFR, 76 (73.8%) patients achieved epithelialization, 19 patients (18.4%) reported unhealed TUs, 3.9 and 3,9% of patients had small and high amputations, respectively. 96.1% of patients achieved preservation of the supporting limb. Differentiated treatment and dynamic observation in the DFR environment made it possible to reduce the number of high limb amputations in patients with diabetic TUs within 1 year of observation to the minimum.

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Application of Graftskin to Accelerate Healing of Ulcers in Diabetic Foot Syndrome

Cited by 5 publications

References 10 publications

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)

Experience of outpatient treatment of trophic foot ulcers complicating the course of diabetes

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