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Open AccessJournal ArticleDOI

The Efficacy and Safety of Dermagraft in Improving the Healing of Chronic Diabetic Foot Ulcers: Results of a prospective randomized trial

TLDR
The results demonstrated that patients with chronic diabetic foot ulcers of >6 weeks duration experienced a significant clinical benefit when treated with Dermagraft versus patients treated with conventional therapy alone.
Abstract
OBJECTIVE —To determine if a human fibroblast–derived dermal substitute could promote the healing of diabetic foot ulcers. RESEARCH DESIGN AND METHODS —A randomized, controlled, multicenter study was undertaken at 35 centers throughout the U.S. and enrolled 314 patients to evaluate complete wound closure by 12 weeks. Patients were randomized to either the Dermagraft treatment group or control (conventional therapy). Except for the application of Dermagraft, treatment of study ulcers was identical for patients in both groups. All patients received pressure-reducing footwear and were allowed to be ambulatory during the study. RESULTS —The results demonstrated that patients with chronic diabetic foot ulcers of >6 weeks duration experienced a significant clinical benefit when treated with Dermagraft versus patients treated with conventional therapy alone. With regard to complete wound closure by week 12, 30.0% (39 of 130) of Dermagraft patients healed compared with 18.3% (21 of 115) of control patients ( P = 0.023). The overall incidence of adverse events was similar for both the Dermagraft and control groups, but the Dermagraft group experienced significantly fewer ulcer-related adverse events. CONCLUSIONS —The data from this study show that Dermagraft is a safe and effective treatment for chronic diabetic foot ulcers.

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Citations
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Wound healing and its impairment in the diabetic foot

TL;DR: Enhanced understanding and correction of pathogenic factors, combined with stricter adherence to standards of care and with technological breakthroughs in biological agents, is giving new hope to the problem of impaired healing.
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Cellular and molecular basis of wound healing in diabetes

TL;DR: In this issue of the JCI, Gallagher and colleagues demonstrate that in diabetic mice, hyperoxia enhances the mobilization of circulating endothelial progenitor cells (EPCs) from the bone marrow to the peripheral circulation, resulting in accelerated wound healing.
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Challenges in the Treatment of Chronic Wounds.

TL;DR: The pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients are discussed, with a focus on diabetic foot ulcers.
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Chronic Wound Healing: A Review of Current Management and Treatments

TL;DR: Wound healing physiology is reviewed and current approaches for treating a wound are discussed, showing how the healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably.
References
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Journal ArticleDOI

Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers : A Prospective Randomized Multicenter Clinical Trial

TL;DR: Application of Graftskin for a maximum of 4 weeks results in a higher healing rate when compared with state-of-the-art currently available treatment and is not associated with any significant side effects.
Journal ArticleDOI

Definitions and Guidelines for Assessment of Wounds and Evaluation of Healing

TL;DR: The report that follows defines wound, acute wound, chronic wound, healing and forms of healing, wound assessment, wound extent, wound burden, and wound severity, broadly applicable to all wounds.
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Clinical evaluation of recombinant human platelet – derived growth factor for the treatment of lower extremity diabetic ulcers

TL;DR: Once-daily topical application of rhPDGF-BB is safe and effective in stimulating the healing of chronic, full-thickness, lower-extremity diabetic neurotrophic ulcers.
Journal ArticleDOI

Differences in cellular infiltrate and extracellular matrix of chronic diabetic and venous ulcers versus acute wounds

TL;DR: Data indicate that important differences exist in the cellular infiltrate and ECM expression patterns of acute, healing versus chronic wounds, which may be related to the nonhealing status of chronic wounds.
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