Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers

Abstract

ABSTRACT Introduction The prevalence of diabetes has been rising sharply and the rise in chronic wounds parallels this trend. Lower extremity ulcers present a serious complication for people with diabetes. While debridement of necrotic tissue and off-loading plays an important role in wound healing, many patients with diabetic foot ulcers (DFUs) fail to heal with standard of care (SOC) alone. Unresolved ulcers can lead to complications, such as osteomyelitis and amputation. There continues to be a need for the evaluation of novel wound therapies that can accelerate wound healing and lower the cost of care associated with DFUs. This paper presents recent evidence for the use of cellular and/or tissue-based products (CTPs) and offers an approach for selecting an appropriate CTP. Materials and methods A systematic literature search was conducted using PubMed, Embase, Medline, Cochrane library, and NHS Economic Evaluation Database. Full-length articles in English were assessed for relevance to select studies on effectiveness and economic evaluations. Additionally, Google Scholar was used to gather relevant literature on commonly used CTPs, including Apligraf®, EpiFix®, and Dermagraft®. Findings Results from randomized controlled trials (RCTs) provided evidence for the superior efficacy of CTPs over SOC alone in treatment of chronic DFUs. In recent studies evaluating commonly used CTPs, significantly higher number of DFUs achieved complete closure with EpiFix® when compared to either Apligraf® or Dermagraft®. While cost-effectiveness studies continue to be limited, current literature suggests that CTPs can decrease the long-term costs associated with the care of DFUs by increasing the healing rate, reducing recovery time, and lowering the risk of infection and complications. Cellular and/or tissue-based products (CTPs) may result in higher average number of ulcer-free months and lower average number of amputations or resections compared to SOC alone. How to cite this article Serena TE, Yaakov RA, Mostow EN. Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):92-96.