Skin grafts and tissue replacement accelerate foot ulcer healing and prevent amputation, study finds

Skin grafts and tissue replacement therapy, when used in conjunction with standard therapy, accelerates the healing of foot ulcers, according to new research.
The study, which was conducted by researchers at the Academic Medical Centre at the University of Amsterdam, Department of Surgery, also found that the same treatments resulted in lower incidence of amputation.
How was the study conducted?
The researchers conducted a systematic review of the available data on the subject. Selection criteria was limited to randomised controlled trials (RCTs) of skin graft or tissue replacement therapy that had been used to treat foot ulcers in people with diabetes.
Several data libraries were used, including The Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Ovid EMBASE and EBSCO CINAHL.
In total, the researchers analysed data from 1,655 people, with the data being taken from 17 studies. When the results of each study were brought together, it was clear that skin graft and tissue replacement therapies increased the rate of healing of diabetic foot ulcers, compared to participants who received only standard care. Although few of the studies observed the rates of lower-limb amputation in their participants, those that did observe them reported lower rates of amputation in participants given skin grafts and tissue replacement therapy compared to standard care.
The researchers were unable to gather enough evidence to suggest that one type of skin graft is more effective than another.
Are these treatments likely to become widely available as a result of the study?
Not necessarily. Although the evidence in favour of skin grafts and tissue replacement is apparent, the researchers were unable to collect enough evidence as to its cost-effectiveness. It may be that the benefits of skin grafts and tissue replacement therapy are not significant enough to be worth the cost.
“Based on the seventeen studies included in this review, skin grafts and tissue replacements, used in conjunction with standard care, increase the healing rate of foot ulcers and lead to slightly fewer amputations in people with diabetes compared to standard care alone,” the researchers wrote.
“However, evidence of long-term effectiveness is lacking and cost-effectiveness is uncertain. There was not enough evidence for us to be able to recommend a specific type of skin graft or tissue replacement.”
The findings are published in the Cochrane Database of Systematic Reviews.