Healing of Diabetic Foot Ulcers and Pressure Ulcers With Human Skin Equivalent

Abstract

In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds. Design: In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds. Setting: A single university teaching hospital and tertiary care center. Patients and Methods: Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses. Main Outcome Measure: Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site. Results: Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE. Conclusions: In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.

Cellular and molecular basis of wound healing in diabetes

“…These FDA-approved treatments are clinically efficacious and include PDGF-BB (23), fibroblasts delivered in an absorbable mesh (24), and fibroblasts and keratinocytes delivered in type 1 collagen (25). If simultaneously combined with current therapies, potential treatments targeting eNOS activation and EPC recruitment might further stimulate healing.…”

The Role of Vascular Endothelial Growth Factor in Wound Healing

“…27 . Purified growth factors 28 and cultured human cells [29][30][31] have both been approved by the Food and Drug Administration to accelerate closure of non-healing wounds. This has transformed the field of wound healing by establishing the efficacy of a topical growth factor and cell therapy.…”

Retrospective Cohort Study Evaluating Clinical Outcomes in Lower Extremity Ulcers Treated with a Bi-layered Bioengineered Skin Substitute (BBSS) as Compared to Standard Therapy

“…We compared our results with two RCTs [4,11]. An RCT with BBSS treatment for diabetic foot ulcers (DFU) on 208 patients with non-ischemic, chronic plantar diabetic foot ulcers done by Veves et al, showed that, at 12 weeks, 56% of the BBSS treated patients achieved complete wound healing in comparison with 38% of the control group, with the median time to complete closure being 65 days for the BBSS treated group and 90 days in the control group.…”