Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

Abstract

BackgroundDiabetic foot ulcers are a major source of morbidity, limb loss, and mortality. A prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence have all been hypothesized as major contributing factors in the delayed healing of diabetic wounds. Collagen components such as fibroblast and keratinocytes are fundamental to the process of wound healing and skin formation. Wound dressings that contain collagen products create a biological scaffold matrix that supports the regulation of extracellular components and promotes wound healing.MethodsA systematic review of studies reporting collagen wound dressings used in the treatment of Diabetic foot ulcers was conducted. Comprehensive searches were run in Ovid MEDLINE, PubMed, EMBASE, and ISI Web of Science to capture citations pertaining to the use of collagen wound dressings in the treatment of diabetic foot ulcers. The searches were limited to human studies reported in English.ResultsUsing our search strategy, 26 papers were discussed, and included 13 randomized designs, twelve prospective cohorts, and one retrospective cohort, representing 2386 patients with diabetic foot ulcers. Our design was not a formal meta-analysis. In those studies where complete epithelialization, 58% of collagen-treated wounds completely healed (weighted mean 67%). Only 23% of studies reported control group healing with 29% healing (weighted mean 11%) described for controls.ConclusionCollagen-based wound dressings can be an effective tool in the healing of diabetic foot wounds. The current studies show an overall increase in healing rates despite limitations in study designs. This study suggests that future works focus on biofilms and extracellular regulation, and include high risk patients.

Downregulation of miRNAs during Delayed Wound Healing in Diabetes: Role of Dicer

“…It is a secreted serine protease that converts the proenzyme plasminogen to plasmin and plays a critical role in cell migration and tissue remodeling. Keratinocytes use plasmin activated by plasminogen activators for paving their way through phase of the wound-healing process (47), and its inhibition, as seen in our study and also reported by others (34,48), is one of the main reason for the delay in wound closure. Ctgf and transforming growth factor b1 (Tgfb1) were significantly upregulated.…”

“…Dicer knockout (KO) mice show follicular epithelial progenitors evaginating into the epidermal surface instead of into the dermis (40,41). Notch and sonic hedgehog and epithelial are thought to be effective for delayed wound closure (34). Wnt5a and Itgav, components of the Wnt signaling and Integrin signaling pathways, respectively, also depicted multiple interactions with the miRNA predicted regulators.…”

Nano-Engineered Biomaterials for Tissue Regeneration: What Has Been Achieved So Far?

“…Both are contraindicated in wounds with signs of infection. In addition, they are recommended for limbs with good blood supply, and in some cases several applications of the scaffold are required (Veves et al, 2001;Marston et al, 2003;O'Loughlin et al, 2010;Holmes et al, 2013). Other therapies, such as hyperbaric oxygen and negative pressure, have emerged also as potential non-surgical alternatives for treating DFU; however, clinical evidence does not fully support their use (Londahl et al, 2010;Dumville et al, 2013;Ma et al, 2013;Rhee et al, 2014;Cychosz et al, 2015).…”

Collagen membrane for reconstruction of soft tissue defects after surgery of oral cancer and precancer: a brief review

“…In the early 1970's, John F. Burke and Ioannas Yannas developed a bio-compatible collagen matrix to improve wound healing. It is commonly used in the management of burns, [6] diabetic foot ulcer, [7,8] toxic epidermal necrolysis, [9] chronic wounds, etc. [10][11][12] This versatile material also finds its application in the field of plastic surgery, oral and maxillofacial surgery and dentistry for various purposes e.g.…”