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.read more
Citations
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Wound healing and its impairment in the diabetic foot
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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
Harold Brem,Marjana Tomic-Canic +1 more
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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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2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections
Benjamin A. Lipsky,Anthony R. Berendt,Paul B. Cornia,James C. Pile,Edgar J G Peters,David G. Armstrong,H. Gunner Deery,John M. Embil,Warren S. Joseph,Adolf W. Karchmer,Michael S. Pinzur,Eric Senneville +11 more
TL;DR: Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs, and Employing multidisciplinary foot teams improves outcomes.
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Chronic Wound Healing: A Review of Current Management and Treatments
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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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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.
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Definitions and Guidelines for Assessment of Wounds and Evaluation of Healing
Gerald S. Lazarus,Diane M. Cooper,David R. Knighton,David J. Margolis,Roger E. Pecoraro,George T. Rodeheaver,Martin C. Robson +6 more
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.
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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.