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      A multicentre, randomised controlled clinical trial evaluating the effects of a novel autologous, heterogeneous skin construct in the treatment of Wagner one diabetic foot ulcers: Interim analysis

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          Abstract

          We desired to carefully evaluate a novel autologous heterogeneous skin construct in a prospective randomised clinical trial comparing this to a standard‐of‐care treatment in diabetic foot ulcers (DFUs). This study reports the interim analysis after the first half of the subjects have been analysed. Fifty patients (25 per group) with Wagner 1 ulcers were enrolled at 13 wound centres in the United States. Twenty‐three subjects underwent the autologous heterogeneous skin construct harvest and application procedure once; two subjects required two applications due to loss of the first application. The primary endpoint was the proportion of wounds closed at 12 weeks. There were significantly more wounds closed in the treatment group (18/25; 72%) vs controls (8/25; 32%) at 12 weeks. The treatment group achieved significantly greater percent area reduction compared to the control group at every prespecified timepoint of 4, 6, 8, and 12 weeks. Thirty‐eight adverse events occurred in 11 subjects (44%) in the treatment group vs 48 in 14 controls (56%), 6 of which required study removal. In the treatment group, there were no serious adverse events related to the index ulcer. Two adverse events (index ulcer cellulitis and bleeding) were possibly related to the autologous heterogeneous skin construct. Data from this planned interim analysis support that application of autologous heterogeneous skin construct may be potentially effective therapy for DFUs and provide supportive data to complete the planned study.

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          Most cited references34

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          Diabetic Foot Ulcers and Their Recurrence.

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            An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds

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              Healing of diabetic neuropathic foot ulcers receiving standard treatment. A meta-analysis.

              The aim of the study was to determine the percentage of individuals with neuropathic diabetic foot ulcers receiving good wound care who heal within a defined period of time. We conducted a systematic review of the control groups of clinical trials that evaluated a treatment for diabetic neuropathic foot ulcers. The meta-analytic techniques used include an estimation of the weighted mean percentage healed by end point, an evaluation of the homogeneity of trials, and an estimate of the 95% CI of the grouped data. Grouped-data univariate and multivariate logistic regression was conducted to assess the impact of mean age, ulcer size, and duration on the percentage of ulcers healed at end point. We found a total of 10 control groups meeting our criteria. Six control groups used 20 weeks as the end point for healing or nonhealing. For the six control arms with a 20-week end point, we found a weighted mean healing rate of 30.9% (95% CI 26.6-35.1). A similar analysis for the four 12-week arms found a mean healing rate of 24.2% (19.5-28.8). We failed to detect any statistically significant heterogeneity for either the 20-week or the 12-week trials. After 20 weeks of good wound care, approximately 31% of diabetic neuropathic ulcers heal. Similarly, after 12 weeks of good care, approximately 24% of neuropathic ulcers attain complete healing. Further patient-level analyses are necessary to definitively determine the associations of age, wound size, and wound duration with likelihood of healing.
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                Author and article information

                Contributors
                cmzelen@periedu.com
                Journal
                Int Wound J
                Int Wound J
                10.1111/(ISSN)1742-481X
                IWJ
                International Wound Journal
                Blackwell Publishing Ltd (Oxford, UK )
                1742-4801
                1742-481X
                04 May 2021
                January 2022
                : 19
                : 1 ( doiID: 10.1111/iwj.v19.1 )
                : 64-75
                Affiliations
                [ 1 ] Department of Surgery University of Southern California, Keck School of Medicine Los Angeles California USA
                [ 2 ] Division of Plastic Surgery Brigham and Women's Hospital Boston Massachusetts USA
                [ 3 ] Division of Plastic Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
                [ 4 ] Drexel University Philadelphia Pennsylvania USA
                [ 5 ] Lower Extremity Institute of Research and Therapy Youngstown Ohio USA
                [ 6 ] Center for Clinical Research San Francisco California USA
                [ 7 ] Clinical Research Barry University SPM, Brand Research Center, Barry University Miami Florida USA
                [ 8 ] The Angiogenesis Foundation Cambridge Massachusetts USA
                [ 9 ] Strategic Solutions Bozeman Montana USA
                [ 10 ] Department of Medical Education The Professional Education and Research Institute (PERI) Roanoke Virginia USA
                Author notes
                [*] [* ] Correspondence

                Charles M. Zelen, DPM, Department of Medical Education, The Professional Education and Research Institute, 222 Walnut Ave., Roanoke, VA 24016.

                Email: cmzelen@ 123456periedu.com

                Author information
                https://orcid.org/0000-0001-5682-7056
                Article
                IWJ13598
                10.1111/iwj.13598
                8684853
                33942506
                dd7aeef7-d9e8-4e80-9075-093f6ac440b6
                © 2021 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 28 March 2021
                : 17 February 2021
                : 31 March 2021
                Page count
                Figures: 4, Tables: 3, Pages: 12, Words: 6513
                Funding
                Funded by: Polarity TE
                Award ID: 002
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                January 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.7.0 mode:remove_FC converted:19.12.2021

                Emergency medicine & Trauma
                biological products,diabetic foot,randomised controlled trial,ulcer,wound healing

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