Comparison of a Bioimplant Dressing With a Wet Dressing for the Treatment of Diabetic Foot Ulcers: A Randomized, Controlled Clinical Trial.

BACKGROUND: The authors aimed to evaluate the efficacy of a bioimplant dressing in comparison with a wet dressing in patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Fifty-seven patients with diabetes who had an ulcer of Wagner Grades 2-4 were included in this controlled clinical trial. The study was conducted in the outpatient diabetic foot clinic of Dr. Shariati Hospital, affiliated with the Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran, from November 2010 to March 2012. Fifty-seven cases of DFUs were equally and randomly divided into control and test groups. The bioimplant group received an amniotic membrane dressing while the control group was treated with a wet dressing. Both groups were evaluated once a week for 6 weeks for the degree of epithelialization and granulation tissue of the wound. RESULTS: The complete healing rate (ie, wound closure) in the whole study population was 28.1% (control group, 16.7%; bioimplant group, 40.7%, P = 0.04). In 21 patients (77.77%) of the bioimplant group, granulation tissue was extended within the third visit. Amputation and hospitalization rates were higher in the control group compared to the bioimplant group; however, the difference was not statistically significant (relative risk [RR]: 1.11, 95% CI 0.91-1.34, P = 0.258; RR: 1.27, 95% CI 0.97-1.66, P = 0.076, respectively). CONCLUSION: The bioimplant dressing was significantly superior to the wet dressing in prompting the complete healing of DFUs. Ease of use, absence of adverse effects, and a facilitated wound healing process are among properties of amniotic membrane that make it an appropriate dressing in the management of DFUs. Additional research will shed more light on the promising advantages of this material in healing DFUs.

Low-frequency ultrasound debridement in patients with diabetic foot ulcers and osteomyelitis.

BACKGROUND: Although debridement plays a significant role in the healing of diabetic foot ulcers, it may delay the healing process by damaging the granulation tissue. In this study, the efficacy of low-frequency ultrasound (LFU) in chronic wound healing in diabetic foot ulcers in patients with osteomyelitis was evaluated. METHODS: This randomized clinical trial was conducted on 40 patients with diabetes recruited from the Diabetic Foot Ulcer Clinic of the Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences, Tehran, Iran. All patients with a grade 3 ulcer (Wagner Classification) with 0.6 ≤ ankle brachial index ≤ 1.2, were included. Patients were divided into 2 groups; 1 group received ultrasound-assisted wound therapy (UAW) in conjunction with standard wound care (n = 20) and the control group received only standard wound care. Patients were followed for 6 months. RESULTS: The complete healing rate in the study population was 55.7% (control group = 55%, UAW group = 60%). The mean wound size reduction percentage was significantly higher in the UAW group only in the second month (78% ± 28.7 vs 55.7% ± 31.4, P = 0.01) and third month (63.6% ± 24.5 vs 39.3% ± 32.2 , P = 0.02) of follow up, but not at 6 months. CONCLUSION: In grade 3 diabetic foot ulcers, LFU debridement accompanied by standard wound care can initially accelerate ulcer healing; however, there is no significant difference between the 2 modalities in the healing rate after 6 months. .