Systematic review on the rational use of amniotic membrane allografts in diabetic foot ulcer treatment

Kasun Lakmal,D Hettiarachchi,Oshan Basnayake

doi:10.1186/s12893-021-01084-8

Abstract

BackgroundDiabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients’ lives and costs to the healthcare system. The potential of human amniotic membrane to act as an allograft has been studied in relation to this condition. Aim of this study is to evaluate the current scientific evidence on its effectiveness in healing diabetic foot ulcers.MethodsPubmed, Cochrane library, and Google scholar were searched using the search terms, “Amnion” OR “Placenta” AND “Diabetic foot”. (MeSH terms) in the title or the abstract field from 1st of January 2000 to 30th March 2020. The quality of published reports was assessed using standard methods. We searched for experimental and observational studies in terms of randomized control trials, prospective cohort, retrospective cohort studies and case series.ResultsWhen searched with Mesh terms, 12 citations in PubMed, 22 citations in Cochrane library and 30 in other data bases were found. After screening the studies and their reference lists, 12 studies met the inclusion criteria and the others were excluded. There were 8 randomized control trials (RCTs), 2 prospective studies and 2 retrospective studies employing different preparation methods of the amniotic membranes. A wide variation in study end points were noted. Majority of the RCTs (n = 7) were concluded with significantly higher wound closure rate compared to the conventional treatment groups. In prospective and retrospective studies, it was shown that large chronic ulcers which were resistant to closure with standard therapy achieved wound closure with amniotic membrane allografts. A meta-analysis could not be performed due to study heterogeneity, and publication bias was not assessed due to the small number of available studies which was not sufficient for accurate comparison.ConclusionEven though, the studies had some inherent heterogeneity due to different preparation methods, different study end points and outcome measurements. According to our review the current studies using amniotic membrane allografts give reliable evidence of reduction in healing time over conventional methods.

Highlights

Diabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients’ lives and costs to the healthcare system
Complications of diabetic foot ulcers maybe related to its chronicity, osteomyelitis, re-ulceration, gangrene and amputation which might be aggravated by concomitant co-morbidities such as peripheral vascular disease, sub-optimal blood glucose control and neuropathy to name a few [5]
We sought to investigate the rational use of amniotic membrane allografts in the management of diabetic foot ulcers by conducting a systemic review through published studies

Summary

Introduction

Diabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients’ lives and costs to the healthcare system. Some clinicians recommend advanced treatment such as biological dressings, collagen, platelet-derived growth factors (PDGF), and platelet-rich plasma (PRP) for non-healing ulcers after a\standard wound care [1]. In this light natural amniotic membrane wound dressings have been used for over a century as it contains a single epithelial cell layer, a thick basement membrane and an avascular stroma making it an ideal biological graft. We sought to investigate the rational use of amniotic membrane allografts in the management of diabetic foot ulcers by conducting a systemic review through published studies. Objective of the study was to assess the impact on wound closure rates by the use of amniotic membrane in diabetic foot ulcers

Objectives

Methods

Results

Conclusion