The Effects of Cellular Skin Substitutes on Diabetic Foot Ulcer Healing: A Systematic Review
Authors:   Organización médica de Investigación, Buenos Aires, Argentina, Lizarraga Ana , Alzlaiq Wafa Ali ,   Department of Clinical Pharmacy, College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Awad Camila ,   Centro de Epidemiología y Políticas de la Salud, Universidad del Desarrollo, Santiago, Chile, Rodrigues Barbosa Ingrid Pereira ,   D’Or Institute for Research and Education, Sao Paulo, Brazil, Chávez-Nomberto Ruth E. ,   Hospital Nacional Docente Madre Niño San Bartolomé, Perú, Zapparoli Claro Mateus ,   Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil, Haddad Alaq , Hemmann Jenny ,   Department of Internal Medicine IV - Pneumology/ Oncology/ Sleep and Respiratory Medicine, Klinikum Chemnitz, Chemnitz, Germany, Ifeyinwa Iloañusi Nneka ,   Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria, Landea Daniela ,   Clínica Alemana Santiago, Universidad del Desarollo, Lara Sofia , Fernando López Luis ,   Pontificia Universidad Católica Madre y Maestra, Dominican Republic, Moll-Bernardes Renata ,   D’Or Institute for Research and Education, Rio de Janeiro, Brazil, Nunes Ribeiro Nathasha ,   Department of Population Health, Sirio Libanes Hospital, São Paulo, Brazil, Khalid Sani Dalhat ,   Department of Nursing Science, Ahmadu Bello University, Zaria-Nigeria, Sanchez-Tovar Laura M. ,   Universidad del Rosario, Bogotá-Colombia, Umar Shehu Salihu ,   Department of Oncology, Federal Medical Centre Gusau, Zamfara State, Nigeria, de Freitas Nascimento Leonardo ,   Department of Anesthesiology, University of Sao Paulo, Sao Paulo, Brazil, Ivankovich-Escoto Gabriela ,   Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños, “Dr. Carlos Saénz Herrera”, San José, Costa Rica, Rodriguez-Castellanos Victoria E. ,   Universidad de los Andes, Bogotá-Colombia, Rojas Carlos ,   Department of Orthopaedics, Hospital del Trabajador, Santiago, Chile, Stoeckel Soeren ,   Department of General and Visceral Surgery, Klinikum Chemnitz, Chemnitz, Germany, Thomas Tintu ,   Nursing Education, Hamad Medical Corporation, Qatar, Carvalho Alessandra ,   SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil
Published: February 2024

Introduction: Diabetic foot ulcer (DFU) is one of the most common lower extremity diabetes-related complications. New therapies have been developed to increase the likelihood of wound healing and reduce complications, including biological and/or synthetic grafts that allow a temporary or permanent occlusion of wounds. Although their efficacy has been demonstrated, novel skin substitutes have been available, and few studies have described the head-to-head comparative effectiveness of those products. Therefore, this mini-review aims to analyze the available randomized clinical trials studying the impact of different cellular skin products on the healing of DFUs. Methods: The databases PubMed, EMBASE, Scopus, Scielo, and Lilacs were assessed from inception to July 30th, 2023, to identify randomized clinical trials on the effects of cellular skin substitutes on ulcer healing in adult patients aged 18 years or older with DFUs restricted to the skin and subcutaneous tissue, compared to standard of care or other skin substitutes. Results: Based on eligibility criteria, 22 articles were selected. These studies showed the efficacy and safety of cell skin substitutes compared to standard treatments, as demonstrated by the reduction in the total area of the ulcer and rates of complete wound healing. We identified a few studies with head-to-head comparisons among those products. Discussion: Cellular skin substitutes have shown promising results in healing DFUs as complementary therapies to the standard of care. Their incorporation into standard-of-care treatments could be discussed. Future studies should focus on head-to-head comparisons, cost-effective analysis, and long-term efficacy and safety.