Meta-analysis on the clinical effects of allogenic acellular dermal matrix treatment for diabetic foot ulcer

Abstract

Objective: To analyze the clinical effects of allogenic acellular dermal matrix (ADM) treatment for diabetic foot ulcer (DFU) with meta-analysis. Methods: Databases including PubMed, Cochrance Library, Embase, and OVID EBM Reviews were searched using key words " diabetic foot, diabetic ulcer, diabetic wound, acellular dermal matrix, acellular dermal regenerative tissue matrix, acellular regenerative tissue matrix, AlloDerm, SureDerm, KaroDerm, Graftjacket, Hyalomatrix PA, and Hyalograft 3D" , and Chinese Biological Abstracts, Chinese Journals Full-text Database, VIP Database, and Wanfang Database were searched using key words in Chinese version ",,," to obtain the published trials of allogenic ADM treatment for DFU from January 1990 to July 2015, and then meta-analysis was used to analyze the trials. The measurement indexes were wound contraction rate, wound healing rate, complete epithelization time of wound, and complication rate. Meta-analysis was conducted by RevMan 5.2 statistical software. Results: A total of 5 trials involving 426 DFU patients were included, with 224 patients in group ADM who received allogenic ADM treatment and 202 patients in conventional treatment group (CT) who received conventional moist treatment. There was no statistically significant difference between group ADM and group CT in wound contraction rate, with mean difference 20.34 (with 95% confidence interval -25.27-65.94, P=0.38). The wound healing rate of patients in group ADM was higher than that in group CT, with relative risk (RR) 1.90 (with 95% confidence interval 1.29-2.80, P<0.01). There was no statistically significant difference between group ADM and group CT in complete epithelization time of wound, with mean difference 1.20 (with 95% confidence interval -2.93-0.52, P=0.17). The complication rate of patients in group ADM was lower than that in group CT, RR=0.54 (with 95% confidence interval 0.38-0.76, P<0.001). Publication bias might exist in wound contraction rate, wound healing rate, complete epithelization time of wound, and complication rate. Conclusions: Compared with conventional moist treatment, allogenic ADM treatment can accelerate wound healing and reduce complication rate in patients with DFU.