Research Article

The Efficacy and Safety of Acellular Matrix Therapy for Diabetic Foot Ulcers: A Meta-Analysis of Randomized Clinical Trials

Table 1

The characteristics of included studies.
(a) Entry criteria, intervention and control groups, and primary outcome for the included RCTs

StudyMain entry criteriaIntervention treatmentControl treatmentAdditional treatments in both groupsPrimary outcomeFollow-up, weeks

Brigido et al. [21]DFU: Full thickness, > 1 cm2in size, present for ≥6 weeks without epidermal coverage, on the leg or footReceived a single application of the GJ-ADMST: Curasol wound gel, gauze dressingsOffloading, debridementNR4
Brigido et al. [22]T1/T2DM; DFU: Full thickness, chronic (present for ≥6 weeks without epidermal coverage), absence of active infectionReceived a single application of the GJ-ADMST: Wound gelSharp debridement, dressing, offloadingNR16
Reyzelman et al. [23]T1/T2DM; ≥18 years of age; adequate circulation to the affected extremity; DFU: UT grade 1 or 2; 1-25 cm2 in size, absence of infectionReceived a single application of the GJ-ADMST: Moist-wound therapy (alginates, foams, hydrogels or hydrocolloids)Debridement, dressing, offloading, systemic antibiotic treatmentProportion of ulcers that completely healed at 12 weeks12
Driver et al. [24]T1/T2DM; ≥18 years of age; HbA1c<12%; adequate vascular perfusion; DFU: Neuropathic, Wagner grade 1 or 2, 1 cm2 ≤ area ≤ 12 cm2, depth ≤ 5 mm, distal to the malleolus, present for ≥30 daysReceived single or multiple applications of IFRTST: Moist wound therapy (sodium chloride gel, nonadherent foam dressing, outer gauze wrap)Debridement, dressing, offloadingPercentage of subjects with complete closure of ulcer as assessed by the investigator16
Cazzell et al. [25]T1/T2DM; ≥18 years of age; HbA1c ≤ 12%; adequate arterial blood flow; DFU: Neuropathic, Wagner grade 1-2, 0.5 cm2 to 10 cm2 in size, plantar surface of the foot, a duration ≥6 weeks but<12 months; absence of infectionReceived weekly applications of OASIS® ultra tri-layer matrixST: Dressing, debridementOffloadingThe proportion of
Subjects with complete ulcer closure over the 12-week treatment period
16
Cazzell et al. [26]21-80 years of age; adequate circulation to the affected area; DFU: Wagner grades 1-2, , absence of infectionReceived one or two applications of D-ADM or GJ-ADMST: moist wound treatment (alginate, foam, or hydrogel dressings)Debridement, offloading, dressingThe proportion of chronic DFUs completely closed at the end of 12 weeks24
Campitiello et al. [27]Diabetes; >18 years of age; ; DFU: Wagner grade 3Treated with IFWNST: wet dressingOffloading, antibiotics, compression therapyPercentage of patients with complete closure6
Zelen et al. [28]T1/T2DM; ≥18 years of age; ; adequate circulation to the affected extremity; DFU: >1 cm2 in size, on the foot, present for ≥4 weeks, absence of infectionReceived weekly applications of HR-ADMSTDressing, debridement, offloading, systemic antibioticsThe difference between the 2 groups in the proportion of ulcers healed at 6 weeks12
Tchanque-Fossuo et al. [29]T1/T2DM; 18-85 years of age; ; or ; DFU: full thickness (not extending to the bone, muscle, or tendon), , present for ≥4 weeks, absence of infectionTreated with oasis matrixSTNonadherent gauze dressing, Iodosorb gel, offloadingThe percentage of patients who achieved complete ulcer closure by 12 weeks of treatment28

(b) Participants’ descriptive demographics and wound characteristics for the included RCTs

StudyGroupSample sizeAge (years)Male (%)ABIBMI (kg/m2)HbA1c (%)Ulcer grade (Wagner or UT)Ulcer area (cm2)Ulcer duration (weeks)

Brigido S. A. [22]GJ-ADM20NRNRNRNRNRNR (full thickness)9.725
ST20NRNRNRNRNRNR (full thickness)5.427
Brigido S. A. [22]GJ-ADM1461.4 (4.2)NRNRNR8.1 (1.0)Wagner grade 2NRNR
ST1466.2 (4.4)NRNRNR7.9 (0.6)Wagner grade 2NRNR
Reyzelman A. [23]GJ-ADM4755.4 (9.6)NRNR33.1 (6.7)8.2 (2.0)UT grades 1A-2A3.6 (4.3)23.3 (22.4)
ST3958.9 (11.6)NRNR34.6 (8.5)8.0 (1.6)UT grades 1A-2A5.1 (4.8)22.9 (29.8)
Driver V. R. [24]IDRT15455.8 (10.6)76.6NR34.0 (7.2)8.0 (1.8)Wagner grade 1 or 23.5 (2.5)44.0 (70.1)
ST15357.3 (9.8)74.5NR34.1 (8.4)8.2 (1.9)Wagner grade 1 or 23.7 (2.7)43.3 (59.7)
Cazzell S. M. [25]OASIS4157.1 (10.9)78NRNRNRWagner grade 1 or 22.1 (2.3)21.3 (12.3)
ST4156.6 (10.8)73NRNRNRWagner grade 1 or 22.6 (7.5)22.2 (13.5)
Cazzell S. [26]D-ADM7159.1 (12.8)80.3NR32.6 (8.3)8.5 (1.8)Wagner grade 1 or 23.9 (4.2)40.0 (71.6)
GJ-ADM2858.5 (9.8)71.4NR31.4 (5.1)7.6 (1.4)Wagner grade 1 or 23.3 (2.7)36.8 (53.6)
ST6956.9 (10.9)73.9NR32.8 (6.9)8.4 (1.9)Wagner grade 1 or 23.6 (3.6)36.4 (38.8)
Campitiello F. [27]IFWM2364.0 (8.9)65.20.92 (0.1)28.5 (2.5)7.9 (0.8)Wagner grade 3NR38.8 (12.6)
ST2362.1 (7.7)56.50.94 (0.1)28.9 (2.7)7.8 (0.8)Wagner grade 3NR39.5 (9.9)
Zelen C. M. [28]HR-ADM4059.0 (12.0)70NR35.0 (7.9)7.8 (1.5)UT grades 1-23.2 (4.0)NR
ST4062.0 (13.0)60NR34.0 (8.8)7.6 (1.4)UT grades 1-22.7 (2.4)NR
Tchanque-Fossuo C. N. [29]OASIS3161.9 (8.6)94.71.10 (0.1)36.5 (11.6)7.7 (1.6)NR (full thickness)3.1 (3.8)10.9 (7.6)
ST2963.3 (9.1)89.51.07 (0.1)36.5 (6.6)8.6 (1.7)NR (full thickness)1.3 (0.9)21.7 (36.0)

Continuous data are presented in mean (standard difference). NR: not reported; DFU: diabetic foot ulcer; DM: diabetic mellitus; UT: University of Texas; HbA1c: glycosylated hemoglobin; ABI: ankle brachial index; BMI: body mass index; ST: standard therapy; ADM: acellular dermal matrix; GJ-ADM: GraftJacket ADM; D-ADM: DermACELL ADM; IDRT: Integra Dermal Regeneration Template; IFWM: Integra Flowable Wound Matrix; HR-ADM: human reticular ADM; CG-ADM: CGBio ADM.