title: Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial.
abstract: OBJECTIVE
  We assessed in a randomized prospective trial the effectiveness of Graftskin, a living skin equivalent, in treating noninfected nonischemic chronic plantar diabetic foot ulcers.
  
  
  METHODS
  In 24 centers in the U.S., 208 patients were randomly assigned to ulcer treatment either with Graftskin (112 patients) or saline-moistened gauze (96 patients, control group). Standard state-of-the-art adjunctive therapy, which included extensive surgical debridement and adequate foot off-loading, was provided in both groups. Graftskin was applied at the beginning of the study and weekly thereafter for a maximum of 4 weeks (maximum of five applications) or earlier if complete healing occurred. The major outcome of complete wound healing was assessed by intention to treat at the 12-week follow-up visit.
  
  
  RESULTS
  At the 12-week follow-up visit, 63 (56%) Graftskin-treated patients achieved complete wound healing compared with 36 (38%) in the control group (P = 0.0042). The Kaplan-Meier median time to complete closure was 65 days for Graftskin, significantly lower than the 90 days observed in the control group (P = 0.0026). The odds ratio for complete healing for a Graftskin-treated ulcer compared with a control-treated ulcer was 2.14 (95% CI 1.23-3.74). The rate of adverse reactions was similar between the two groups with the exception of osteomyelitis and lower-limb amputations, both of which were less frequent in the Graftskin group.
  
  
  CONCLUSIONS
  Application of Graftskin for a maximum of 4 weeks results in a higher healing rate when compared with state-of-the-art currently available treatment and is not associated with any significant side effects. Graftskin may be a very useful adjunct for the management of diabetic foot ulcers that are resistant to the currently available standard of care.
authors.affiliation: Joslin-Beth Israel Deaconess Foot Center and Harvard Medical School, Boston, Massachusetts 02215, USA. aveves@caregroup.harvard.edu
authors.forename: A
authors.initials: A
authors.lastname: Veves
authors.forename: V
authors.initials: V
authors.lastname: Falanga
authors.forename: D G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: M L
authors.initials: ML
authors.lastname: Sabolinski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003094:Collagen; D003646:Debridement; D017719:Diabetic Foot / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016038:Skin Transplantation; D017768:Skin, Artificial / Q000009:adverse effects; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: C117898:Apligraf; D003094:Collagen