Wound Bed Preparation of the Diabetic Foot Ulcer

Falanga, Vincent; Iwamoto, Satori

doi:10.1007/978-1-61779-791-0_13

Cited by 4 publications

(9 citation statements)

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“…The generally accepted immediate goal of debridement is the removal of debris and nonviable tissue as a means to the end goal of unleashing the capacity of the wound to heal itself. Depending on the method, debridement may also permit thorough evaluation of wound extent; reduce contamination by pathogens and biofilm-forming bacteria; and create a wound edge composed of cells that have the ability to respond to molecular signals [ 18 , 19 ]. Serial sharp debridement (SSD) is generally considered the “gold standard” method for wound debridement [ 2 , 16 , 17 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the method, debridement may also permit thorough evaluation of wound extent; reduce contamination by pathogens and biofilm-forming bacteria; and create a wound edge composed of cells that have the ability to respond to molecular signals [ 18 , 19 ]. Serial sharp debridement (SSD) is generally considered the “gold standard” method for wound debridement [ 2 , 16 , 17 , 19 ]. However, SSD is generally acknowledged to be a relatively nonselective method of debriding a wound because normal tissue is also unavoidably removed.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: economic analysis of results from a multicenter, randomized, open‐label trial

Motley

Gilligan

Lange

et al. 2015

Journal of Foot and Ankle Research

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BackgroundApproximately 10%–15% of people with diabetes develop at least one foot ulcer during their lifetime. Treatment of diabetic foot ulcers (DFUs) represents a significant economic burden. Enzymatic debridement with clostridial collagenase ointment (CCO) can be used to remove necrotic tissue from wounds. This study examined the impact of CCO as an effective adjunct therapy to serial sharp debridement (SSD) and assessed the cost-effectiveness of CCO compared with standard DFU treatments over 1 year.MethodsAdults 18 years or older with a diagnosis of type 1 or type 2 diabetes who had a neuropathic DFU were enrolled in a 12-week, randomized, open-label trial. Patients were randomly assigned to either treatment with CCO + SSD or to investigator-selected supportive care + SSD (Control). A 3-state Markov model with a 1-week cycle length was developed using wound-closure rates from the trial to estimate the number of healed-wound weeks and the expected DFU cost per patient. The 3 states included unhealed, healed, and death. Results were extrapolated to 1 year to estimate the number of healed-wound weeks per treatment and the average cost to achieve epithelialization. The perspective of the analysis was that of the payer, specifically, the third party payer.ResultsThe study sample included 55 patients (28 in CCO group; 27 Control). The majority were men (74.5%) with a mean age of 57.9 years. Projected healing rates were greater for the CCO + SSD group compared to Control (89% vs. 80%, respectively). The expected number of epithelialized weeks accumulated over 1 year was 25% greater in the CCO + SSD group than for Control (35 vs. 28 weeks, respectively). Over a 1-year time horizon, the expected cost per DFU was greater in the Control group than the CCO group ($2,376 vs. $2,099, respectively). The estimated cost per ulcer-free week was 40% higher for Control ($85/closed-wound week) than for CCO + SSD ($61/closed-wound week).ConclusionsCCO + SSD therapy is a cost-effective method of debridement in the management of patients with DFUs, providing better outcomes at a lower cost. Further high quality trials are needed to confirm this finding.Trial registrationThis study was registered at ClinicalTrials.gov as NCT01408277.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0065-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: economic analysis of results from a multicenter, randomized, open‐label trial

Motley

Gilligan

Lange

et al. 2015

Journal of Foot and Ankle Research

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“…Although these BMSC-laden hydrogels have achieved success in the wound healing of healthy skin 7 13 14 , they may not be suitable for treating diabetic ulcers. High concentrations of inflammatory cytokines are present in the inflammatory microenvironment of the ulcer, which leads to increased protease secretion, thereby resulting in the degradation or loss of growth factors secreted by the BMSCs or other effector cells 15 16 ; moreover, this chronic inflammatory microenvironment also can impair the activity of BMSCs. We believe that if BMSC delivery strategies are to reach their full potential, the ideal hydrogel for diabetic ulcers, in addition to having good biocompatibility, should suppress the inflammatory response or inhibit protease activity.…”

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confidence: 99%

Mesenchymal stem cell-laden anti-inflammatory hydrogel enhances diabetic wound healing

Chen

Shi

Zhang

et al. 2015

Sci Rep

150

110

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The purpose of this study was to permit bone marrow mesenchymal stem cells (BMSCs) to reach their full potential in the treatment of chronic wounds. A biocompatible multifunctional crosslinker based temperature sensitive hydrogel was developed to deliver BMSCs, which improve the chronic inflammation microenvironments of wounds. A detailed in vitro investigation found that the hydrogel is suitable for BMSC encapsulation and can promote BMSC secretion of TGF-β1 and bFGF. In vivo, full-thickness skin defects were made on the backs of db/db mice to mimic diabetic ulcers. It was revealed that the hydrogel can inhibit pro-inflammatory M1 macrophage expression. After hydrogel association with BMSCs treated the wound, significantly greater wound contraction was observed in the hydrogel + BMSCs group. Histology and immunohistochemistry results confirmed that this treatment contributed to the rapid healing of diabetic skin wounds by promoting granulation tissue formation, angiogenesis, extracellular matrix secretion, wound contraction, and re-epithelialization. These results show that a hydrogel laden with BMSCs may be a promising therapeutic strategy for the management of diabetic ulcers.

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“…The immediate goal of debridement is the removal of debris and nonviable tissue as a means to the end goal of the wound epithelialization. Depending on the method, debridement may permit thorough evaluation of wound extent, reduce contamination by pathogens and biofilm‐forming bacteria, and generate a wound edge composed of cells that have the ability to respond to molecular signals …”

mentioning

confidence: 99%

“…Sharp debridement is generally considered the “gold standard” method for wound debridement and is often used when devitalized tissue is present . However, sharp debridement is acknowledged to be a relatively nonselective method of debriding a wound because healthy tissue also is unavoidably removed.…”

mentioning

confidence: 99%

Treating pressure ulcers with clostridial collagenase ointment: Results from the US Wound Registry

Carter

Gilligan

Waycaster

et al. 2016

Wound Repair Regeneration

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We assessed the clinical effectiveness of clostridial collagenase ointment (CCO) as an adjunct to selective debridement compared with selective debridement alone for the management of stage IV pressure ulcers (PU) in the hospital outpatient department setting. Outcome data were derived from retrospective de-identified electronic medical records from 2007 to 2013 using the US Wound Registry. A propensity score method was used to adjust for selection bias and to test for treatment effect between PU treated with CCO plus selective debridement vs. selective debridement alone. A total of 337 CCO and 336 non-CCO stage IV PU were identified. The proportion of wounds closed at any time (e.g., at 1 or 2 years) was two times greater for stage IV PU treated with CCO compared with those not treated with CCO. Kaplan-Meier analysis showed that time to wound closure at 1 year was significantly faster for PU treated with CCO vs. PU not treated with CCO. Among those with five or more CCO applications or selective debridement treatments, significantly more CCO-treated PU were closed at 1 or 2 years than non-CCO-treated PU. CCO as an adjunct to selective debridement improved clinical outcomes and provided faster rates of closure of stage IV PU relative to selective debridement alone.

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Wound Bed Preparation of the Diabetic Foot Ulcer

Cited by 4 publications

References 133 publications

Cost‐effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: economic analysis of results from a multicenter, randomized, open‐label trial

Cost‐effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: economic analysis of results from a multicenter, randomized, open‐label trial

Mesenchymal stem cell-laden anti-inflammatory hydrogel enhances diabetic wound healing

Treating pressure ulcers with clostridial collagenase ointment: Results from the US Wound Registry

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