Healing of chronic diabetic foot ulcers with a skin substitute: Patient selection is the key to success

Hasan Alzahrani, Hossam Ammar, Anas Alzahrani, Hossam Shoaib

Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, KSA.

DOI: 10.4236/ojrm.2013.22003                

Abstract

This is a prospective case series study aimed to preliminarily assess the efficacy and safety of a skin substitute (Apligraf) application to heal chronic diabetic foot ulcers (DFUs) in a group of diabetic patients who were treated in the diabetic foot clinic of King Abdulaziz University, Jeddah, Saudi Arabia. Five consecutive patients who presented with large, hard to heal neuropathic ulcer for an average duration of 162.2 weeks were treated with multiple applications of Apligraf and followed up for 40 weeks. Three out of the five ulcers (60%) ended up with complete wound closure. One plantar ulcer healed partially and another plantar ulcer healed after 14 weeks but recurred after 10 weeks of wound closure due to infection. This small case series study indicates the importance of careful patient selection in healing chronic (DFUs) when using a skin substitute like Apligraf. Long standing large plantar ulcer in a non-complaint diabetic patient is the most difficult to heal and this should be kept in mind when using this relatively high cost modality of treatment.

Keywords

Diabetic; Foot; Ulcer; Apligraf; Healing

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Al-Wahbi, A.M. (2006) The diabetic foot in the Arab world. Saudi Medical Journal, 27, 147-153.
[2]	Al Zahrani, H., Ghandourah, N. and Merdad, H. (1992) Limb amputations in Western Saudi Arabia. Asian Journal of Surgery, 15, 119-122.
[3]	Al-Tawfiq, J.A. and Johndrow, J.A. (2009) Presentation and outcome of diabetic foot ulcers in Saudi Arabian patients. Advances in Skin & Wound Care, 22, 119-121. doi:10.1097/01.ASW.0000305450.33693.f8
[4]	Robbins, J.M., Strauss, G., Aron, D., Long, J., Kuba, J. and Kaplan, Y. (2008) Mortality rates and diabetic foot ulcers is it time to communicate mortality risk to patients with diabetic foot ulceration? Journal of the American Podiatric Medical Association, 98, 489-493.
[5]	Alzahrani, H.A. and Sehlo, M.G. (2011) The impact of religious connectedness on health-related quality of life in patients with diabetic foot ulcers. Journal of Religion and Health, 2011, 1-11.
[6]	Kalish, J. and Hamdan, A. (2010) Management of diabetic foot problems. Journal of Vascular Surgery, 51, 476-486. doi:10.1016/j.jvs.2009.08.043
[7]	Dinh, T.L. and Veves, A. (2006) The efficacy of apligraf in the treatment of diabetic foot ulcers. Plastic and Reconstructive Surgery, 117, 152S-157S. doi:10.1097/01.prs.0000222534.79915.d3
[8]	Curran, M.P. and Plosker, G.L. (2002) Bilayered bioengineered skin substitute (Apligraf): A review of its use in the treatment of venous leg ulcers and diabetic foot ulcers. BioDrugs, 16, 439-455. doi:10.2165/00063030-200216060-00005
[9]	Edmonds, M. (2009) Apligraf in the treatment of neuropathic diabetic foot ulcers. The International Journal of Lower Extremity Wounds, 8, 11-18. doi:10.1177/1534734609331597
[10]	Steinberg, J.S., Edmonds, M., Hurley, D.P. and King, W.N. (2010) Confirmatory data from EU study supports apligraf for the treatment of neuropathic diabetic foot ulcers. Journal of the American Podiatric Medical Association, 100, 73-77.
[11]	Felder III, J.M., Goyal, S.S. and Attinger, C.E. (2012) A systematic review of skin substitutes for foot ulcers. Plastic and Reconstructive Surgery, 130, 145-164. doi:10.1097/PRS.0b013e318254b1ea
[12]	Langer, A. and Rogowski, W. (2009) Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers. BMC Health Services Research, 9, 115. doi:10.1186/1472-6963-9-115
[13]	Apelqvist, J., Bakker, K., Van Houtum, W. and Schaper, N. (2008) Practical guidelines on the management and prevention of the diabetic foot. Diabetes/Metabolism Research and Reviews, 24, S181-S187. doi:10.1002/dmrr.848