title: A prospective, multicenter, randomized, controlled clinical trial comparing a bioengineered skin substitute to a human skin allograft.
abstract: An estimated 25% of all people with diabetes may experience a foot ulcer in their lifetime, which may lead to serious complications including infection and amputation. A prospective, multicenter, randomized, controlled clinical trial was conducted to compare an in vitro-engineered, human fibroblast-derived dermal skin (HFDS) substitute and a biologically active cryopreserved human skin allograft (HSA) to determine the relative number of diabetic foot ulcers (DFUs) healed (100% epithelialization without any drainage) and the number of grafts required by week 12. Secondary variables included the proportion of healed patients at weeks 16 and 20, time to healing during the study, and wound size progression. The 23 eligible participants (11 randomized to the HSA, 12 to the HFDS group) were recruited from two hospital-based outpatient wound care centers. Baseline patient (body mass index, age, gender, race, type and duration of diabetes, presence of neuropathy and/or peripheral arterial disease, tobacco use) and wound characteristics (size and duration) were recorded, and follow-up visits occurred every week for up to 20 weeks. Descriptive and multivariate regression analyses were used to compare wound outcomes. At baseline, no statistically significant differences between patients and wounds were observed. At week 12, seven (63.6%) patients in the HSA and four (33.3%) in the HFDS group were healed (P = 0.0498). At the end of the 20-week evaluation period, 90.91% of HSA versus 66.67% of HFDS were healed (P = 0.4282). Among the subset of wounds that healed during the first 12 weeks of treatment, an average of 4.36 (range 2-7) HSA grafts were applied versus 8.92 (range 6-12) in the HFDS subset (P <0.0001, SE 0.77584). Time to healing in the HSA group was significantly shorter (8.9 weeks) than in the HFDS group (12.5 weeks) (log-rank test, P = 0.0323). The results of this study are similar to previous outcomes reported using these treatment modalities and suggest that, after 12 weeks of care, DFUs managed with HSA are approximately twice as likely to heal as DFUs managed with HFDS with approximately half the number of grafts required. Research confirming these results with a larger sample size and inpatients with different types of wounds is warranted.
authors.affiliation: Department of Podiatric Medicine, Temple University, School of Podiatric Medicine, Philadelphia, PA.
authors.forename: Lee
authors.initials: L
authors.lastname: Sanders
authors.affiliation: Harvard Medical School, Cambridge, MA; and Cambridge Health Alliance, Cambridge, MA; email:alandsman@cha.harvard.edu.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Landsman
authors.affiliation: Soluble Systems, Newport News, VA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Landsman
authors.affiliation: Colonial Foot Care, Hampton, VA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Keller
authors.affiliation: Harvard Medical School, Cambridge, MA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cook
authors.affiliation: Harvard Medical School, Cambridge, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Cook
authors.affiliation: TPMG Orthopedics and Sports Medicine, Williamsburg, VA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hopson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000502:physiology*; D057005:Bioengineering / Q000379:methods*; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017768:Skin, Artificial / Q000639:trends*; D014945:Wound Healing