title: Total contact casting combined with human fibroblast-derived dermal tissue in 15 DFU patients.
abstract: OBJECTIVE
  To investigate the use of a cryopreserved human fibroblast-derived dermal substitute (Dermagraft; DG) in combination with total contact casting (TCC) in patients with diabetic foot ulcers, compared with previously published rates of healing with TCC alone.
  
  
  METHODS
  Fifteen consecutive diabetic foot ulcer patients were referred to a multi-speciality clinic to be managed with a combination of DG and TCC, after showing no progress toward healing following at least 4 weeks of standard, conservative therapy. Follow-up visits were scheduled every 7 days, for a period of 12 weeks, or until fully healed. At each visit, DG and TCC were applied by the investigating clinician, and ulcer size and depth were recorded. Photographs were taken once a month, or when healed. If indicated, debridement was done to remove fibrotic tissue, callus and slough.
  
  
  RESULTS
  The results demonstrated an average healing rate of 23.7 ± 16.3 days. The average number of DG applications was 2.1. There was no correlation observed between ulcer duration, or ulcer location (forefoot or mid-foot), and time to healing; however, a correlation was found between wound size and healing time.
  
  
  CONCLUSIONS
  The findings may suggest combining advanced healing modalities, such as DG with TCC, can be done and that they may have a benefit of limiting the time spent in TCC, as well as a reduction in time to heal. The study size was small and further studies into combining modalities are warranted to validate these findings.
  
  
  BACKGROUND
  Both authors have been paid consultants for Advanced Biohealing, the producers of Dermagraft (DG). There are no financial disclosures for Med Efficiency, Inc. (MedE-Kast Ultra; TCC), or any other conflicts of interest to declare.
authors.affiliation: UNC Hospitals, North Carolina, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kashefsky
authors.forename: W
authors.initials: W
authors.lastname: Marston
mesh_terms: D000328:Adult; D000368:Aged; D002370:Casts, Surgical; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017768:Skin, Artificial; D014945:Wound Healing