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Manchester Scar Scale (MSS) score differences in the experimental and control groups by Mann-Whitney U analysis (p ¼ 0.006). ADM, acellular dermal matrix.
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Background:
Composite split-thickness skin grafting (STSG) with acellular dermal matrix (ADM) has been used successfully in burn injuries and trauma, but its use in treating diabetic foot ulcers (DFUs) has not been reported to date. This study investigated the efficacy and safety of composite STSG with ADM in the treatment of DFUs.
Study design:...
Context in source publication
Context 1
... experimental group compared with the control group (1 of 23 [4.3%] vs 5 of 22 [22.7%]; p ¼ 0.02). Patients with recurrence underwent secondary surgical interventions. Median MSS scores were lower in the experimental group (median 9 [inter- quartile range 8 to 10.25]) than the control group (me- dian 11 [interquartile range 10 to 12]; p ¼ 0.006) (Fig. ...
Similar publications
Background:
Chronic wounds occur due to failure of the normal healing process, associated with a lack of deposition of cellular components and a suitable microenvironment such as the extracellular matrix (ECM). Acellular dermal matrix (ADM) is viewed as an ECM substitute, and a paste-type ADM has recently been introduced. We hypothesized that CGPa...
Citations
... 13 Moreover, some studies have suggested that composite STSG over an ADM scaffold is a new option to treat diabetic foot ulcers, with high tolerance to friction and pressure and a low incidence of ulceration. 14 Unfortunately, it is unclear whether thick STSG or ADM combined with thin STSG is better for treating deep dermal burns of the dorsum of the hand, particularly regarding functional outcomes. No related articles or literature has been reported. ...
Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split‐thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post‐surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen–Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post‐surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.
... A futher 334 records were excluded after screening the titles/ abstracts, leaving 54 articles for fulltext review. As a result, a total of 15 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 14 [22,23,[25][26][27][28][29][30][31][32][33][34][35][36] RCTs were included in the qualitative and quantitative synthesis (meta-analysis), respectively. Table 1 summarizes the characteristics of the included studies. ...
... A futher 334 records were excluded after screening the titles/ abstracts, leaving 54 articles for fulltext review. As a result, a total of 15 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and 14 [22,23,[25][26][27][28][29][30][31][32][33][34][35][36] RCTs were included in the qualitative and quantitative synthesis (meta-analysis), respectively. Table 1 summarizes the characteristics of the included studies. ...
... The mean BMI was available in 10 studies, ranging from 28.5 to 36.5 kg/m 2 . The followup periods were 4, 6, 12, 16, 21, 24, 28, and 42 weeks in 1 [22], 1 [36], 5 [25,[29][30][31]34], 4 [23,24,27,35], 1 [32], 1 [26], 1 [28] and 1 [33] studies, respectively. At the final follow-up, a total of 147 and 155 patients dropped out for follow-up. ...
Background
Diabetic foot ulcers (DFUs) have become a global health concern, which can lead to diabetic foot infection (DFI), lower leg amputation, and even mortality. Though the standard of care (SOC) practices have been recognized as the “gold standard” for DFU care, SOC alone may not be adequate to heal all DFUs and prevent their recurrence. The use of dermal matrix has emerged as an adjuvant treatment to enhance DFU healing. The current study aimed to evaluate the effectiveness and safety of dermal matrix application as an adjuvant treatment to the SOC.
Methods
The databases of PubMed, Embase and CENTRAL were independently searched by two authors, with the following key terms: “diabetic foot ulcer”, “acellular dermal matrix”, “wound healing”, and so on. Randomized controlled trials (RCTs) evaluated the efficacy and safety of dermal matrix in the treatment of DFUs were eligible for inclusion. The primary outcomes analyzed included time to complete healing and complete healing rate at the final follow-up, while secondary outcomes included wound area, ulcer recurrence rate, amputation risk and complication risk. Meta-analyses were performed using random-effect or fixed-effect models, based on the heterogeneity test.
Results
This study included a total of 15 RCTs with a total of 1524 subjects. Of these, 689 patients were treated with SOC alone, while 835 patients received SOC plus dermal matrix. Compared to the SOC group, significantly shorter time (MD = 2.84, 95%CI: 1.37 ~ 4.32, p < 0.001***) was required to achieve complete healing in dermal matrix group. Significantly higher complete healing rate (OR = 0.40, 95%CI: 0.33 ~ 0.49, p < 0.001***) and lower overall (RR = 1.83, 95%CI: 1.15 ~ 2.93, p = 0.011*) and major (RR = 2.64, 95%CI: 1.30 ~ 5.36, p = 0.007**) amputation risks were achieved in dermal matrix group compared to SOC group. No significant difference was found in the wound area, ulcer recurrence rate, and complication risk between the two groups.
Conclusions
The application of dermal matrix as an adjuvant therapy in conjunction with SOC effectively improved the healing process of DFUs and reduced the amputation risk when compared to SOC alone. Furthermore, dermal matrix application was well tolerated by the subjects with no added complication risk.
... When compared to standard care alone, the use of DRT has been shown to increase the likelihood of wound healing, reduce wound healing time, decrease the risk of major amputation within 1 year, and does not elevate the likelihood of complications [16,22,23] . Furthermore, among patients undergoing split-thickness skin grafts (STSGs), those who received DRT exhibited lower Manchester Scar Scale scores, lower wound recurrence rates within 12 months, and increased transcutaneous oxygen pressure (TcPO 2 ) values at 3 and 6 months after the application [26,27] . We have used both DRTs in various types of wounds, including large and high-graded DFUs, following an approach that differs from those of other hospitals. ...
Background
The dermal regeneration template (DRT), a tissue-engineered skin substitute composing a permanent dermal matrix and an upper temporary silicone layer that serves as the epidermis, has demonstrated efficacy in treating uncomplicated diabetic foot ulcers (DFUs). Our institution has obtained good outcomes with DRT in patients with more complicated DFUs. Because of its chronicity, we are working to identify a clinical target that anticipates delayed healing early in the treatment in addition to determining the risk factors linked to this endpoint to increase prevention.
Materials and methods
This retrospective single-center study analyzed patients with DFUs who underwent wound reconstruction using DRT between 2016 and 2021. The patients were categorized into poor or good graft-take groups based on their DRT status on the 21 st day after the application. Their relationship with complete healing rate at day 180 was analyzed. Variables were collected for risk factors for poor graft take at day 21. Independent risk factors were identified after multivariable analysis. The causes of poor graft take were also reported.
Results
This study examined 80 patients (38 and 42 patients in the poor and good graft-take groups, respectively). On day 180, the complete healing rate was 86.3% overall, but the poor graft-take group had a significantly lower complete healing rate (76.3% vs. 95.2%, P = 0.021) than the good graft-take group. Our analysis identified four independent risk factors: transcutaneous oxygen pressure < 30 mmHg (odds ratio, 154.14), off-loading device usage (0.03), diabetic neuropathy (6.51), and toe wound (0.20). The most frequent cause of poor graft take was infection (44.7%), followed by vascular compromise (21.1%) and hematoma (15.8%).
Conclusion
Our study introduces the novel concept of poor graft take at day 21 associated with delayed wound healing. Four independent risk factors were identified, which allows physicians to arrange interventions to mitigate their effects or select patients more precisely. DRT represents a viable alternative to address DFUs, even in complicated wounds. A subsequent split-thickness skin graft is not always necessary to achieve complete healing.
... In addition, dermal-derived substitutes (acellular dermal matrices) have been evaluated as possible coverage options for diabetic foot ulcers. Various trials have produced mixed, conflicting results with regard to improvement in wound healing rates; thus, there is insufficient evidence to support their use as standard of care [71,96,97]. There is significant enthusiasm regarding the potential of biologic adjuncts in assisting with wound healing, and this will likely continue to be an ongoing avenue of research interest. ...
Peripheral arterial disease (PAD) is characterized by atherosclerotic arterial occlusive disease of the lower extremities and is associated with an increased risk of major adverse cardiovascular events (MACE) in addition to disabling clinical sequelae, including intermittent claudication and chronic limb-threatening ischemia (CLTI). Given the growing burden of disease, knowledge of modern practices to prevent MACE and major adverse limb events (MALE) is essential. This review article examines evidence for medical management of PAD and its associated risk factors, as well as wound prevention and care.
A thorough review of the literature was performed, with attention to evidence for the management of modifiable atherosclerotic risk factors, claudication symptoms, wound prevention, and wound care.
Contemporary management of PAD requires a multi-faceted approach to care, with medical optimization of smoking, hypertension, hyperlipidemia, and diabetes mellitus. The use of supervised exercise therapy for intermittent claudication is highlighted. The anatomic disease patterns of smoking and diabetes mellitus are discussed further, and best practices for diabetic foot ulcer prevention, including offloading footwear, are described. Quality wound care is essential in this patient population and involves strategic use of debridement, wound-healing adjuncts, and skin substitutes, when appropriate.
The objective of medical management of PAD is to reduce the risk of MACE and MALE. Atherosclerotic risk factor optimization, appropriate wound care, and management of diabetic foot ulcers, foot infections, gangrene, and chronic, non-healing wounds are critical components of PAD care. Interdisciplinary care is essential to coordinate care, leverage expertise, and improve outcomes.
... One study compared 26 diabetic foot ulcer wounds treated with co-grafts to 26 similar ulcer wounds treated with STSGs and reported statistically significant and improved median MSS of 9 for the co-grafts and 11 for STSGs alone (P = 0.006). 104 In another study, 10 wounds were created as a result of scalp skin cancer excision to the skull bone were treated with co-grafts, whereas 10 were treated with STSGs. The mean MSS of 7.2 (0.833 SD) was found for the co-grafts versus 10 (1.33 SD) for the Fig. 7. Weighted average graft failure rate among studies utilizing co-grafts of FtSgs with acellular tcs revealed a 5.7% average failure rate among the two studies included. ...
... In all four studies, the authors reported improved scar scale outcomes or functionality of the wounded site for the co-grafts. 40,69,104,107 Additionally, six studies reported thinner STSGs used in their co-grafts compared with the STSG alone (thickness of co-graft STSGs ranging from 0.004 to 0.010 inches; the STSG alone ranging from 0.010 to 0.016-in). 37,38,76,94,106,112 In three of these six studies focused on burns, no difference was found in functional improvement or healing times between the co-graft and the STSG site alone, 38,94,106 whereas improvement in functional outcomes was reported in the remaining three studies for the co-grafted sites. ...
... http://links.lww.com/PRSGO/C638.) Based on definitions listed below, 25 studies were prospective cohorts, 29,37,53-74 14 were retrospective cohorts, 75-88 eight were intrapatient-controlled nonrandomized studies, 38,89-95 and 19 were randomized prospective trials of variable blinding and control levels.39,40,[96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] ...
Background:. For over 100 years, autologous skin grafts have remained the gold standard for the reconstruction of wounds but are limited in availability. Acellular tissue-engineered skin constructs (acellular TCs) and cellular tissue-engineered skin constructs (cellular TCs) may address these limitations. This systematic review and meta-analysis compare outcomes between them.
Methods:. A systematic review was conducted using PRISMA guidelines, querying MEDLINE, Embase, Web of Science, and Cochrane to assess graft incorporation, failure, and wound healing. Case reports/series, reviews, in vitro/in vivo work, non-English articles or articles without full text were excluded.
Results:. Sixty-six articles encompassing 4076 patients were included. No significant differences were found between graft failure rates (P = 0.07) and mean difference of percent reepithelialization (p = 0.92) when split-thickness skin grafts were applied alone versus co-grafted with acellular TCs. Similar mean Vancouver Scar Scale was found for these two groups (p = 0.09). Twenty-one studies used at least one cellular TC. Weighted averages from pooled results did not reveal statistically significant differences in mean reepithelialization or failure rates for epidermal cellular TCs compared with split-thickness skin grafts (p = 0.55).
Conclusions:. This systematic review is the first to illustrate comparable functional and wound healing outcomes between split-thickness skin grafts alone and those co-grafted with acellular TCs. The use of cellular TCs seems promising from preliminary findings. However, these results are limited in clinical applicability due to the heterogeneity of study data, and further level 1 evidence is required to determine the safety and efficacy of these constructs.
... In addition, DTSs retain many active growth factors, and they have good biocompatibility, which can promote cell growth and differentiation [72]. Therefore, DTS has a similar ultimate tensile load, high porosity and disorganised core material to normal tendons, and it shows tissue integration in the rotator cuff model [95,96]. Guo, M et al., bridged the extracellular matrix scaffold of multi-layer decellularised tendon slices to the defect of the rotator cuff in a rabbit model. ...
The tendon–bone junction (TBJ) is a graded structure consisting of tendons, nonmineralised, and mineralised fibrocartilage and bone. Given the complex gradient of the TBJ structure, TBJ healing is particularly challenging. Injuries to the TBJ such as anterior cruciate ligament (ACL) tears and rotator cuff injuries are common and serious sports injuries, affecting more than 250,000 patients annually in the United States, particularly people older than 50 years. ACL reconstruction and rotator cuff repair are the commonly performed TBJ repair surgeries. However, the re-tear rate is high post-operation. In recent years, studies on improving TBJ healing have focused on promoting tendon–bone integration at tendon sites. This process includes the use of periosteum, hydrogels, scaffolds, growth factors, stem cells or other reconstruction materials that promote bone growth or ligament attachment. In this study, we will highlight the utilisation of the unique properties of biomaterial coating in promoting tendon–bone healing and discuss recent advances in understanding their role in TBJ healing. Furthermore, we aim to provide a systematic and comprehensive review of approaches to promoting TBJ healing.
... The application of ADMs has been developing in hand surgery over the past 15 years, and it has become the treatment of choice for conditions affecting the hand, wrist, and forearm as a temporary cover after skin tumour excision [6,7]. However, the use of ADM entails a delay (often approximately 2 weeks) to allow vascular ingrowths and fibroblast infiltration before they can be covered with skin autograft and requires two-stage procedures [7][8][9][10]. Animal study in a rat model [10] confirmed that the epithelisation time of one-stage procedure of heterogeneous ADM (Integra) and skin autograft was 13-29 days, which is significantly shorter than the 28-35 days of two-stage grafting. ...
Background:
Hot-crush injuries to the hands can be devastating, and early debridement and coverage with skin autograft remains the golden standard of wound treatment. However, this type of treatment is not feasible or unlikely to succeed due to limited donor sites and wound characteristics of hot-crush injuries on hands. Thus, the composite grafting of acellular dermal matrix (ADM) and split-thickness skin graft (STSG) as a novel alternative method has been attempted. In this series, the results are presented to demonstrate the feasibility and effectiveness of the use of one-stage procedure for early reconstruction in hand hot-crush injuries.
Methods:
All consecutive patients with hand hot-crush injuries, who underwent one-stage procedure of ADM and ultrathin STSG for soft tissue coverage at our institution from December 2018 to November 2019, were retrospectively analyzed. Wound dressings were opened on 7 days after operation to examine graft survival and complications. Patients were followed up for at least 9 months to evaluate their hand profiles.
Results:
Samples of 14 patients with a total of 23 wounds were involved in the study. Thirteen of the 23 third-fourth-degree wounds had varying degrees of tendon exposure. On 7 days postoperation, the composite grafts survived in 12 patients with minimal focal graft losses and liquefaction and necrosis in 2 patients, which achieved successful healing following new coverage of ultrathin STSG. All the wounds healed with hospital stays ranging from 9 days to 32 days (median: 24.5 days). At the final follow-up (from 9 months to 20 months), all patients achieved excellent or good total active motion grade and good scar quality (Vancouver scar scale scored 1-3) with no revision surgery.
Conclusions:
One-stage composite grafting of ADM and ultrathin STSG is a reliable alternative for early reconstruction in hand hot-crush injuries, which delivers good functional outcomes and a good cosmetic appearance.
... They have reported that ADMs can provide a proper scaffold for cell colonization, which can be favorably combined with wound site edges. ADM materials have been shown to promote cell migration, proliferation, and vascularization, and therefore accelerate wound healing [74]. Until now, many commercial ADM dressings have been successfully applied in clinical practice with good therapeutic effects and have become a routine treatment for burns and other skin wounds. ...
Acellular dermal matrix (ADM) is derived from natural skin by removing the entire epidermis and the cell components of dermis, but retaining the collagen components of dermis. It can be used as a therapeutic alternative to “gold standard” tissue grafts and has been widely used in many surgical fields, since it possesses affluent predominant physicochemical and biological characteristics that have attracted the attention of researchers. Herein, the basic science of biologics with a focus on ADMs is comprehensively described, the modification principles and technologies of ADM are discussed, and the characteristics of ADMs and the evidence behind their use for a variety of reconstructive and prosthetic purposes are reviewed. In addition, the advances in biomedical applications of ADMs and the common indications for use in reconstructing and repairing wounds, maintaining homeostasis in the filling of a tissue defect, guiding tissue regeneration, and delivering cells via grafts in surgical applications are thoroughly analyzed. This review expectedly promotes and inspires the emergence of natural raw collagen-based materials as an advanced substitute biomaterial to autologous tissue transplantation.
Graphical Abstract
... Acellular allogenic dermal matrix refers to the fixation and cross-linking of allogenic skin extracellular matrix with solid agent treatment. en, chelating agents and trypsin were used to remove the epidermis, and DNA and RNA enzymes and chemical agents were used to treat the reticular acellular allogenic dermis to reduce the cellular immune response [21]. ...
This study aimed to analyze the role of magnetic resonance imaging (MRI) data characteristics based on the deep learning algorithm in evaluating the treatment of diabetic foot (DF) with composite skin graft. In this study, 78 patients with DF were randomly rolled into the experimental group (composite skin graft) and control group (autologous skin graft) with 39 patients in each group. MRI scans were performed before and after treatment to compare the changes of experimental observation indicators such as healing time, recurrence rate, and scar score. The results showed that T1-weighted imaging (T1WI) of the scanning sequence was considerably increased in the experimental group after treatment. The signal intensity of fat-suppressed T2-weighted imaging (T2WI) and fat-suppressed T1WI enhancement sequences was considerably decreased P < 0.05 . In addition, compared with the control group, the recurrence rate, healing time, and scar score in the experimental group were considerably decreased P < 0.05 . The accuracy, specificity, and sensitivity of MRI imaging information in evaluating the therapeutic effect of DF patients were 85.2%, 89.75%, and 86.47%, respectively. According to the specificity and sensitivity, the subject operating characteristic curve was drawn, and the area under the curve was determined to be 0.838. In summary, MRI image data characteristics based on the deep learning algorithm can provide auxiliary reference information for the efficacy evaluation of compound skin transplantation for DF.
... 45 Hu et al. reported the efficacy and safety of ADM combined with STSG after serial NPWT in DFUs. 46 Deng et al. reported preservation of limb and limb function using the combination treatment of ADM, platelet-rich plasma and STSG after NPWT. 19 Several possible mechanisms of effective wound healing using ADM on soft tissue defects have been reported. ...
Objective
Skin grafts after negative pressure wound therapy (NPWT) and acellular dermal matrix (ADM) usage have both been useful for treating diabetic foot amputation. We hypothesised that injectable ADM combined with NPWT would be more useful than NPWT only for healing after amputation in patients with diabetic foot ulcers (DFUs). The aim of this study was to investigate the clinical outcomes of injectable ADM combined with NPWT in patients with DFU who have undergone amputation.
Method
This retrospective study reviewed patients with infected DFUs who were administered NPWT. Patients were divided into two groups: Group 1 included patients who were treated with NPWT only, while Group 2 included patients who were treated with injectable ADM combined with NPWT. Clinical results including the number of NPWT dressing changes, wound healing duration, and full-thickness skin graft (FTSG) incident rate between the two groups were compared.
Results
A total of 41 patients took part in the study (Group 1=20, Group 2=21). The mean number of NPWT dressing changes was significantly lower in Group 2 (8.71±3.77) than in Group 1 (13.90±5.62) (p=0.001). Mean wound healing period was shorter in Group 2 (3.17±1.36 weeks) than in Group 1 (5.47±1.68 weeks) (p=0.001). Finally, the rate of patients who underwent FTSG for complete wound closure was 85% in Group 1, whereas it was only 14.3% in Group 2.
Conclusion
In this study, the use of injectable ADM combined with NPWT in patients with DFU who underwent amputation favoured complete wound healing, without the need to resort to the use of skin grafts.
