Skin Replacement Therapies for Diabetic Foot Ulcers

Abstract

Diabetic ulcer complications are a leading cause of hospitalization and amputation. Of the 20 million individuals with diabetes, 10–15% are at risk for developing diabetic ulcers. Standard therapy involves the use of dressings to protect the wound bed from trauma and to absorb exsudate; offloading high pressure from the wound bed, e.g., by prescribing protective footwear; and wound bed preparation to accelerate endogenous healing and facilitate the effectiveness of topically applied substances. But these measures are often deficient in healing all diabetic ulcers when the patient's own intrinsic wound-healing system is insufficient. In such patients, skin replacement therapies are second-line treatment options; however, the effectiveness of skin replacement therapies in treatment of diabetic ulcers is unclear. The objective of this study is to assess their effectiveness using evidence from randomized trials in diabetic leg and foot ulceration. We searched the Cochrane Controlled Trials Register (1970–2006), MEDLINE (1966–2006), EMBASE (1980–2006), and CINAHL (1982–2006) using a combination of text and keywords in addition to a filter for controlled clinical trials. The last update of searches was performed on 30 September 2007. We included trials if the allocation of participants was described as randomized, with participants of any age and in any care setting having diabetic leg or foot ulceration. We included studies that compared the following types of grafts with any other intervention: 1 ) autografts (pinch, split or full-thickness skin grafts, cultured keratinocytes, or fibroblasts), 2 ) allografts (cultured keratinocytes or fibroblasts), 3 ) xerografts, and 4 ) bioengineered skin. Two reviewers independently evaluated …