Diabetes affects more than 22 million people in the United States and Foot wounds are a common complication associated with diabetes mellitus (DM) and often impose significant economic, health, and quality of life. Diabetic Foot Ulcers (DFUs) can cause enormous personal hardships to patients, such as higher rates of depression, lack of mobility, and increased tensions with caregivers. Treatment of DFUs focuses on pressure offloading, local wound care (standard of care [SOC]), infection control, and surgical intervention when necessary. Peripheral neuropathy commonly associated with DM decreases protective sensation of the foot. Peripheral vascular disease can lead to ischemia of the distal lower extremity, which compromises native wound healing ability. The Wound Healing Society (WHS) 2013 DFU treatment guidelines promote pressure offloading, reduction of bacterial and cellular burden through adequate debridement, local wound care with moist dressings that also absorb wound exudate, topical and systemic antibiotic therapy when needed, and treatment of osteomyelitis. This study aimed to provide an updated search of the literature examining local wound care versus treatment with a human-derived acellular dermal matrices (H-ADM) for neuropathic, nonischemic DFUs.
The studies included in this meta-analysis investigated 3 subtypes of H-ADM: AlloPatch Pliable (H-ADM Product A; MTF Biologics, Edison, NJ), DermACELL (H-ADM Product B; Stryker, Kalamazoo, MI), and GRAFTJACKET (H-ADM Product C; Wright Medical Group, Memphis, TN). The following combinations of search terms were employed: “Diabetic foot, Foot Ulcer, Acellular Dermis,” “Diabetic Foot Ulcer, Acellular,” “Acellular Dermis,” and “Acellular Matrix, Diabetic.” The combinations returned 176 titles. Reference lists also were searched, yielding an additional 5 relevant titles. After removing 18 duplicates, 163 abstracts were screened for inclusion, using the criteria.
All included articles focused on neuropathic, nonischemic DFUs treated with debridement and placement of H-ADMs versus debridement and standard of care.
Data from 312 DFUs in total were included in the meta-analysis. The results show H-ADMs are more effective in healing patients within a 12-week (3.14; range, 2.04–4.83) and 16-week period (2.35; range, 1.25–4.43) in comparison with standard of care.
The overall effect of the data on 160 included ulcers significantly favored use of H-ADM over SOC and the present findings suggest the use of H-ADM may be more effective than typical SOC for DFU management This study shows H-ADMs are associated with a higher likelihood of complete healing and fewer days to complete healing within a 12-week and 16-week periods when compared with SOC.
Authors: Margaret Luthringer and coll.
Newspaper: Wounds. 2020 Feb;32(2):57-65.