Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group.
BACKGROUND
There has been a broad interest in the use of growth factors to treat patients with chronic nonischemic diabetic ulcers.


METHODS
One hundred eighteen patients were studied in a randomized, prospective, double-blind, multicenter trial comparing treatment with topically applied recombinant human platelet-derived growth factor (rhPDGF) or placebo (vehicle) and were treated until completely healed or to 20 weeks. All patients had aggressive sharp debridement of their ulcers before randomization and repeat debridement of callus and necrotic tissue as needed. The influence of debridement was evaluated by reviewing the records of the office visits where debridement was performed.


RESULTS
Forty-eight percent of patients treated with rhPDGF healed compared with 25 percent of patients who received placebo (p = 0.01). The mean percentage of office visits where debridement was performed was comparable for the two treatment groups: 46.8 percent (rhPDGF) and 48.0 percent (placebo). In general, a lower rate of healing was observed in those centers that performed less frequent debridement. The improved response rate observed with more frequent debridement was independent of the treatment group. However, for any given center, the percentage of patients who healed was greater with rhPDGF than placebo.


CONCLUSIONS
Wound debridement is a vital adjunct in the care of patients with chronic diabetic foot ulcers.
Steed
D L
DL
Department of Surgery, University of Pittsburgh, PA, USA.
Donohoe
D
D
Webster
M W
MW
Lindsley
L
L
D000925:Anticoagulants / Q000627:therapeutic use; D000077214:Becaplermin; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000188:drug therapy / Q000601:surgery*; D004311:Double-Blind Method; D006801:Humans; D010982:Platelet-Derived Growth Factor / Q000627:therapeutic use; D011446:Prospective Studies; D020574:Proto-Oncogene Proteins c-sis; D011994:Recombinant Proteins / Q000627:therapeutic use; D014481:United States; D014945:Wound Healing / Q000187:drug effects
D000925:Anticoagulants; D010982:Platelet-Derived Growth Factor; D020574:Proto-Oncogene Proteins c-sis; D011994:Recombinant Proteins; D000077214:Becaplermin