Most Read Articles
2 days ago
Use of potassium citrate and thiazides appears to improve health-related quality of life (HRQOL) among stone formers across all Wisconsin Stone Quality of Life (WISQOL) domains without increasing the likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively, reports a study.
Pearl Toh, 6 days ago
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
4 days ago
Eating high amounts of red and processed meat prior to a diagnosis of colorectal cancer appears to be associated with shorter survival time, although a possible weak association cannot be excluded, a study has shown.
3 days ago
Middle-aged Caucasian men who are dissatisfied with their marriage are at higher risk of sudden cardiac death regardless of other cardiovascular risk factors, a new study reports.

Patch therapy improves healing of diabetic foot ulcers

Roshini Claire Anthony
12 Oct 2018

A new patch comprising autologous leucocytes, platelets, and fibrin improved the healing rate of hard-to-heal foot ulcers among patients with diabetes compared with standard therapy, a recent study found.

Participants in this multinational (32 diabetic foot clinics in UK, Denmark, and Sweden) trial were 269 patients (mean age 61.9 years, 82 percent male) with diabetes (baseline HbA1c 12 percent; 83 percent with type 2 diabetes) and one or more non-infected, hard-to-heal foot ulcers. They were randomized to receive the intervention (weekly application of the LeucoPatch on the ulcer plus usual care [n=132]) or usual care alone (n=137) for 20 weeks. The patch was made at the bedside during weekly visits to the foot clinic, with the patient’s blood drawn into the patch device, spun for 20 minutes in a centrifuge, the three-layered patch removed, cut into an appropriate size, and placed on the ulcer.

A majority of patients (74 percent) had ulcers with an area >100 mm2, 87 percent had superficial ulcers, and 78 percent had ulcers affecting the total forefoot.

The proportion of ulcers healed was higher among patients who used the patch, with 34 percent of ulcers healed within 20 weeks compared with 22 percent among patients whose ulcers were treated with usual care (adjusted odds ratio, 1.58, 96 percent confidence interval [CI], 1.04–2.40; p=0.0235). [Lancet Diabetes Endocrinol 2018;doi:10.1016/S2213-8587(18)30240-7]

The ulcers that healed also did so in a shorter amount of time with the patch compared with usual care (hazard ratio, 1.709, 95 percent CI, 1.071–2.728; p=0.0246), with a significant reduction in ulcer area (p=0.0168).

Adverse event (AE) incidence was comparable between patients using the patch and those treated with usual care, as was the incidence of diabetic foot infection during the treatment period. Diabetic foot infection was the most frequently occurring serious AE (n=24 vs 20), with 16 and 12 infections in the patch and usual care groups, respectively, related to the index ulcer. The incidence of new cases of anaemia was also comparable between patients using the patch and those treated with usual care (10 percent vs 8 percent; p=0.6408). None of the AEs were deemed patch-related.

According to the researchers, the benefits conferred by platelets and platelet-based applications as seen in this and other studies could be mediated by inflammation and tissue repair mechanisms.

“In people with diabetes complicated by foot ulcers that are not healing despite best standard of care, this new bedside treatment has the potential to significantly accelerate wound healing,” said the researchers. They also highlighted an added benefit, the lack of increase in anaemia events despite the weekly blood draws in the patients who used the patch.

“To avoid patients losing a leg to infection, the goal should be to heal ulcers as quickly as possible,” said Professor Michael Edmonds from King’s College Hospital in London, UK, in a commentary. [Lancet Diabetes Endocrinol 2018;doi:10.1016/S2213-8587(18)30262-6]

“[I]t is hoped that this renaissance in diabetic foot care will usher in a new age of enlightenment in the study of the basic and clinical science of diabetic foot ulcers, finally eradicating the major amputations that result from complications of unhealed foot ulcers,” he said.

Edmonds also suggested that revascularization, which was only done in 3 percent of the participants, may have improved ulcer healing, and pointed out the importance of infection prevention due to its effect on infective necrosis and major amputation.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
2 days ago
Use of potassium citrate and thiazides appears to improve health-related quality of life (HRQOL) among stone formers across all Wisconsin Stone Quality of Life (WISQOL) domains without increasing the likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively, reports a study.
Pearl Toh, 6 days ago
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
4 days ago
Eating high amounts of red and processed meat prior to a diagnosis of colorectal cancer appears to be associated with shorter survival time, although a possible weak association cannot be excluded, a study has shown.
3 days ago
Middle-aged Caucasian men who are dissatisfied with their marriage are at higher risk of sudden cardiac death regardless of other cardiovascular risk factors, a new study reports.