Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

Santema, T.B.; Poyck, P; Ubbink, Dirk T.

doi:10.1002/14651858.cd011255.pub2

Cited by 57 publications

(49 citation statements)

References 65 publications

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“…The value of ADM in increasing healing rates in both acute and chronic wounds has been reflected over numerous trials (24). Similar conclusions have been drawn from a recent systematic review in the context of DFUs (40). Despite the handful of RCTs completed, notable bias was observed due to the difficulty of assessor blinding in the presence of a dermal substitute.…”

Section: Fiberglass Castssupporting

confidence: 80%

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Slow to heel: a literature review on the management of diabetic calcaneal ulceration

Khoo

Jansen

2018

International Wound Journal

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The diabetic heel ulcer (DHU) represents a reconstructive challenge to clinicians and the multidisciplinary team alike. It is traditionally viewed as a condition that is inherently difficult to treat due to the intrinsic anatomical vulnerabilities of the heel. In addition to this, several factors are associated with poorer end outcomes - namely, that of major amputation. These include peripheral vascular disease, infection/osteomyelitis and the size of the ulcer itself. In light of the significant morbidity, economic burden and mortality seen in this cohort of patients, this review aims to explore current treatment modalities that have been undertaken. Literature in this field has mostly been confined to a handful of small case studies, some of which reflect novel, multimodal approaches, and promising results. Management with osteotomy, flap reconstruction and acellular dermal matrices, amongst other options, is covered within this review.

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Section: Fiberglass Castssupporting

confidence: 80%

“…The aforementioned systematic review was published in the Cochrane Library in 2016 (40). Its aim was to determine the therapeutic benefits of skin grafting and tissue replacement therapy over the routine standard of care in patients with DFUs.…”

Section: Fiberglass Castsmentioning

confidence: 99%

Slow to heel: a literature review on the management of diabetic calcaneal ulceration

Khoo

Jansen

2018

International Wound Journal

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“…Diabetic ulcer is a complex clinical problem requiring a multifaceted treatment plan with standard therapeutic components, including debridement of necrotic tissue, offloading, infection control, surgical revascularization, and limb elevation/compression (Ayello, 2005; Alexiadou and Doupis, 2012; Andrews et al, 2015). Skin grafts, including bioengineered or artificial skin, autografts, allografts, or xenografts from animal tissue, have produced promising results in clinical trials for diabetic foot ulceration (Santema et al, 2016). While many bioactive approaches have been explored to improve wound care in diabetic patients (Calderini et al, 2014), many of these have been found to be ineffective in clinical trials, and these non-healing wounds remain a major clinical challenge (Steed et al, 1992; Richard et al, 1995; Wieman et al, 1998; Steed, 2006; Uchi et al, 2009; Marti-Carvajal et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

Baker

2016

Front. Bioeng. Biotechnol.

254

196

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Wound healing is an intricate process that requires complex coordination between many cell types and an appropriate extracellular microenvironment. Chronic wounds often suffer from high protease activity, persistent infection, excess inflammation, and hypoxia. While there has been intense investigation to find new methods to improve cutaneous wound care, the management of chronic wounds, burns, and skin wound infection remain challenging clinical problems. Ideally, advanced wound dressings can provide enhanced healing and bridge the gaps in the healing processes that prevent chronic wounds from healing. These technologies have great potential for improving outcomes in patients with poorly healing wounds but face significant barriers in addressing the heterogeneity and clinical complexity of chronic or severe wounds. Active wound dressings aim to enhance the natural healing process and work to counter many aspects that plague poorly healing wounds, including excessive inflammation, ischemia, scarring, and wound infection. This review paper discusses recent advances in the development of biomaterials and nanoparticle therapeutics to enhance wound healing. In particular, this review focuses on the novel cutaneous wound treatments that have undergone significant preclinical development or are currently used in clinical practice.

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“…After performing a TMA, wound closure is a pivotal element that must be tailored according to the wound's and the patient's conditions, and when appropriate, adjuvant local treatments must be considered (skin grafting, NPWT, application of PG) in order to speed up and maintain wound healing (58)(59)(60)(66)(67)(68)71).…”

Section: Discussionmentioning

confidence: 99%

“…Local flaps, characterised by skin without the presence of local necrosis and infection, and the transposition of neighbouring vascularised soft tissue allow coverage of a large defect (34,57). The split-thickness skin graft may be used with meshing that allows coverage of a larger area and decreases complications, such as a seroma or haematoma (58)(59)(60). Sometimes, delayed primary closure is a valid option (61); diabetic post-amputation wounds, in fact, tend to heal often by second intention, and the main disadvantage is the high complication rates in wound healing that range from approximately 40% to 70% (38,43,62,63).…”

Section: Postoperative Management Of Tmamentioning

confidence: 99%

The care of transmetatarsal amputation in diabetic foot gangrene

Ammendola

Sacco

Butrico

et al. 2016

International Wound Journal

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Diabetic foot ulcerations may determine minor or major amputation, with a high impact on patients' life expectation and quality of life and on economic burden. Among minor amputations, transmetatarsal amputation (TMA) appears to be the most effective in terms of limb salvage rates and in maintaining foot and ankle biomechanics. In spite of this, TMA needs particular pre- and postoperative management in order to avoid the frequent failure rates. A systematic review was undertaken of studies concerning TMA and its care in diabetic foot gangrene. Studies were identified by searching the MEDLINE, Scopus and Science Direct databases until 13 January 2016. All studies were assessed using the Downs and Black quality checklist. Of the 348 records found, 86 matched our inclusion criteria. After reading the full-text articles, we decided to exclude 35 manuscripts because of the following reasons: (1) no innovative or important content, (2) no multivariable analysis, (3) insufficient data, (4) no clear potential biases or strategies to solve them, (5) no clear endpoints and (6) inconsistent or arbitrary conclusions. The final set included 51 articles. In the current literature, there are less data about TMA, indication for the selection of patients, outcomes and complications. Generally, the judgment of an experienced physician is one of the best indicators of subsequent healing. Ankle brachial indices, toe pressures, laser Doppler skin perfusion pressures, angiography and Doppler assessment of foot vasculature may help physicians in this decision. In any case, despite the presumed lower healing rate, it is reasonable to pursue a TMA in a patient with a higher likelihood of continued ambulation. Furthermore, tailored wound closure, adjuvant local treatments and the choice of the most appropriate antibiotic therapy, when infection occurs, are pivotal elements for the success of TMA procedures. TMA is a valuable option for diabetic foot gangrene that can prevent major limb loss and minimise loss of function, thus improving the quality of life for diabetic patients.

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Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

Cited by 57 publications

References 65 publications

Slow to heel: a literature review on the management of diabetic calcaneal ulceration

Slow to heel: a literature review on the management of diabetic calcaneal ulceration

Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing

The care of transmetatarsal amputation in diabetic foot gangrene

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