SLR - May 2017 - Timothy D. Greene
Reference: Guo X, Mu D, Gao F. Efficacy and Safety of Acellular Dermal Matrix in Diabetic Foot Ulcer Treatment: A Systematic Review and Meta-Analysis Int J Surg. 2017 Feb 14;40:1–7. doi: 0.1016/j.ijsu.2017.02.008. [Epub ahead of print] Review. PubMed PMID: 28232031.Reviewed By: Timothy D. Greene, DPM
Residency Program: Temple University Hospital, Philadelphia PA
Podiatric Relevance: Diabetic foot ulceration is a common complication of diabetes, affecting millions of patients annually. In 2013, 382 million people were diagnosed with diabetes. Up to 25 percent of these patients are expected to develop diabetic foot ulcerations. Significant time, financial and healthcare burdens are associated with these wounds, which are often chronic in nature, requiring considerable commitment on the part of physician and patient until adequate healing can be achieved. While there has been significant investment in wound care technologies, modalities and treatments, relatively few studies have considered the effects of the newer acellular dermal matrix (ADM) grafts available on the market, including relatively few randomized controlled trials demonstrating their efficacy. This study is a systematic review and meta-analysis of six such randomized controlled trials that seek to determine the overall safety, efficacy and effects on healing utilizing these grafts in the treatment of diabetic foot wounds.
Methods: Database searches of Pubmed, Medline, Embase and the Cochrane library were conducted to identify randomized controlled trials that enrolled patients who had undergone wound care treatment with acellular dermal matrix grafts. Analysis was made to specifically compare time to healing and complete healing rates between the groups. Additionally, adverse event profiles were compared to draw conclusions about safety and efficacy of these types of acellular dermal matrix grafts.
Results: Systematic review of the literature revealed six randomized controlled trials included in the review, consisting of 632 diabetic foot ulcer patients. When comparing patients who had undergone the use of acellular dermal matrix between the patients in the standard of care (SOC) groups, significant differences were observed in complete healing rate and time to complete wound healing, both of which favored the ADM group. When examining the adverse event profiles between the ADM and SOC groups, no significant differences were observed.
Conclusions: Drawing on the outcomes of these six randomized controlled trials, the authors demonstrated that the time to complete wound healing, as well as complete healing rate, was significantly better in the ADM group. While this outcome is certainly encouraging, these results must be interpreted cautiously. The use of modalities, such as plain gauze dressings or wet-to-dry dressings, while often considered the standard of care, have been criticized by physicians, nurses and other healthcare providers as being inadequate in addressing chronic wounds. Nevertheless, when accounting for the many factors associated with getting diabetic wounds to heal, physicians should continue to be educated on what options are available to them. Especially important is knowing which of these options can accelerate the time to healing while simultaneously maintaining a low risk profile. Providers can take comfort in knowing that acellular dermal matrix grafts are another tool available to help treat these often difficult cases.