Skin replacement therapies for diabetic foot ulcers: systematic review and meta-analysis.

Diabetic ulcers complications are a leading cause of hospitalization and amputation. Ten to 15% of the 20 million individuals with diabetes are at risk of developing diabetic ulcers. Standard therapy involves the use of dressings to protect the wound bed from trauma and to absorb exsudate, offloading of high pressure on the wound bed e.g. by prescribing protective footwear, and wound bed preparation to accelerate endogenous healing and to facilitate the effectiveness of topically applied substances. But these measures are often deficient to heal all diabetic ulcers when the patient’s own intrinsic wound healing system is insufficient. In this group of patients skin replacement therapies are second line treatment options. However, the evidence of skin replacement therapies in diabetic ulcers is unclear. The objective of this study is to assess their evidence from randomized trials in diabetic leg and foot ulceration.