Graftskin Treatment of Difficult to Heal Diabetic Foot Ulcers: One Center's Experience

Sams, Hunter H.; Chen, June; King, Lloyd E.

doi:10.1046/j.1524-4725.2002.02019.x

Cited by 25 publications

(14 citation statements)

References 8 publications

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“…In this more complex population, 86% of wounds were healed by 6 months 20. Sams and colleagues22 conducted a randomized controlled trial of 17 patients with nonhealing DFUs. In this study, 20 patients went through a 1-week screening process following debridement, offloading, and saline wet-to-dry dressings.…”

Section: Discussionmentioning

confidence: 99%

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

Holmes¹,

Wrobel²,

MacEachern³

et al. 2013

DMSO

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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.

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Section: Discussionmentioning

confidence: 99%

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

Holmes¹,

Wrobel²,

MacEachern³

et al. 2013

DMSO

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“…Combinations of growth factors may be more effective, including the use of platelet‐derived materials [69,70,76,78]. Various dermal equivalent products have been used in ulcer studies [79–82], which would allow for sustained and timed release of growth factors from cells attached to the matrix/membrane in response to in vivo signals. A recent development is gene therapy using viral vectors containing a growth factor gene [65,66,83].…”

Section: Growth Factorsmentioning

confidence: 99%

The molecular biology of chronic wounds and delayed healing in diabetes

2006

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Wound healing is a complicated and integrated process. Although there is some tolerance in terms of redundancy and interrelated control mechanisms, pushing beyond such limits may contribute to delayed wound healing, and in extreme cases lead to chronic wounds/ulcers and thus potentially to lower extremity amputation. Diabetes is associated with such disruption in wound healing. Research in humans and in animal models has identified a large number of changes associated with diabetes at the molecular level in delayed wound healing and to a lesser extent in chronic diabetic ulcers. Better overall understanding of these changes and how they are interrelated would allow for specifically targeted treatment, thus ensuring improved quality of life for patients and providing savings to the high costs that are associated with all aspects of chronic diabetic ulcers. This review examines the work done at the molecular level on chronic diabetic ulcers, as well as considering changes seen in diabetes in general, both in humans and animal models, that may in turn contribute to ulcer formation.

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“…1,2,8 There is considerable interest in the treatment of diabetic ulcers with grafts of cultured keratinocytes and/or fibroblasts. [9][10][11][12][13] These technologies, some of which are commercially available, are capable of adjusting a wound's environment and providing the desired growth factors and other substances that may be lacking in a diabetic wound, therefore representing an exciting development and a major advance. However, the effect was generally not very drastic.…”

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confidence: 99%

The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: A pilot study

Han

Kim

2010

Wound Repair Regeneration

111

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Human processed lipoaspirate (PLA) cells are relatively easy to obtain in large quantities without cell culture. The purpose of this study was to present the possibility of using uncultured PLA cell autografts for the treatment of diabetic ulcers. An in vitro study was designed initially to determine the effect of PLA cell autografts on the proliferation and collagen synthesis of diabetic fibroblasts (n=4). In a subsequent clinical study, 26 patients with diabetic foot ulcers were treated using PLA cell autografts. Control treatment was also performed in 26 patients. Eight weeks after treatment, the percentages of complete healing and mean healing times were compared. Cell proliferation and collagen synthesis in the PLA cell treatment group were 28 and 44% higher than that in the control group in vitro, respectively. Our clinical study showed that 100% of the PLA cell-treated group and 62% of the control group achieved complete healing. The PLA cell treatment was also superior to the conventional method in terms of the healing time. No adverse events related to the study treatment occurred. Uncultured PLA cell autografts stimulate the activity of diabetic fibroblasts and may offer a simple and effective treatment for diabetic ulcers.

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Graftskin Treatment of Difficult to Heal Diabetic Foot Ulcers: One Center's Experience

Abstract: Graftskin as an adjunct to aggressive debridement and standardized wound care appears to be a valuable treatment adjunct in patients with difficult to heal diabetes-related neuropathic foot ulcers. The application learning curve was steep and the ease of application exceptional.

Cited by 25 publications

References 8 publications

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

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

The molecular biology of chronic wounds and delayed healing in diabetes

The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: A pilot study

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