title: Efficacy and safety of acellular dermal matrix in diabetic foot ulcer treatment: A systematic review and meta-analysis.
abstract: BACKGROUND
  Diabetic foot ulcer(DFU) is a chronic, refractory disease in need of multidisciplinary endeavour, miscellaneous strategies have been adopted to address this annoying issue, including acellular dermal matrix(ADM)/negative pressure wound therapy/standard of care (SOC) etc. However, consensus has not been reached. As a promising procedure, the efficacy and safety of ADM remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of acellular dermal matrix to standard of care in DFU.
  
  
  METHODS
  Databases, including Pubmed, Medline, Embase and Cochrane library were searched to identify RCTs comparing ADM to SOC in DFU patients. The outcomes mainly included complete wound healing, mean time to heal and adverse events.
  
  
  RESULTS
  A total of 632 DFU patients from 6 RCTs were subjected to meta-analysis. The results showed that compared with the merely SOC, the complete healing rate in ADM group was higher both at 12 weeks [risk ratio (RR) 2.31, 95% confidence interval (CI) 1.42 to 3.76] and 16 weeks [RR 1.57, 95% CI 1.28 to 1.93]. The mean time to complete wound healing was shorter in ADM group [MD = -2.98, 95% CI: -5.15 to -0.82]. The occurrence of adverse event in both groups showed no significant difference [RR 0.98, 95%CI 0.58 to 1.67].
  
  
  CONCLUSIONS
  Compared with standard of care, acellular dermal matrix may accelerate the healing velocity of uninfected, non-ischemic, full-thickness diabetic foot ulcer. Acellular dermal matrix showed superiority compared with standard of care alone, while generating no more complications.
authors.affiliation: Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China. Electronic address: gxsinjnu@126.com.
authors.forename: Xiaoshuang
authors.initials: X
authors.lastname: Guo
authors.affiliation: Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China. Electronic address: doctormu2015@163.com.
authors.forename: Dali
authors.initials: D
authors.lastname: Mu
authors.affiliation: Department of Orthopedic Surgery, China-Japan Friendship Hospital, 2# Yinghua Dongjie Road, Chaoyang District, 100029, Beijing, People's Republic of China. Electronic address: gaofuqiang@bjmu.edu.cn.
authors.forename: Fuqiang
authors.initials: F
authors.lastname: Gao
mesh_terms: D062088:Acellular Dermis; D000368:Aged; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D059039:Standard of Care / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Acellular matrix; Diabetic foot ulcer; Meta-analysis; Randomized controlled trial; Standard of care