• 1.

    Steed, DL, C Attinger, T Colaizzi, et al. :Guidelines for the treatment of diabetic ulcers. .Wound Repair Regen 14::680. ,2006. .

  • 2.

    Boulton, AJ, L Vileikyte, G Ragnarson-Tennvall, et al. :The global burden of diabetic foot disease. .Lancet 366::1719. ,2005. .

  • 3.

    Reiber, GE and LV McFarland. : “Epidemiology and Health Care Costs for Diabetic Foot Problems. ,” inThe Diabetic Foot, ,2nd Ed. , edited byVeves, A, JM Giurini, and FW LoGerfo. , p39. ,Humana Press. ,Totowa, NJ. ,2006. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Gordois, A, P Scuffham, A Shearer, et al. :The health care cost of diabetic peripheral neuropathy in the US. .Diabetes Care 26::1790. ,2003. .

  • 5.

    Singh, N, DG Armstrong, and BA Lipsky. :Preventing foot ulcer in patients with diabetes. .JAMA 293::217. ,2005. .

  • 6.

    Bern, H, P Sheehan, and AJ Boulton. :Protocol for treatment of diabetic foot ulcer. .Am J Surg 187::1S. ,2004. .

  • 7.

    Zachary, T . :Bloomgarden: the diabetic foot. .Diabetes Care 31::372. ,2008. .

  • 8.

    Steed, DL, D Donohoe, MW Webster, et al. :Diabetic Ulcer Study Group: Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. .J Am Coll Surg 183::61. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Gentzkow, GD, SD Iwasaki, KS Hershon, et al. :Use of Dermagraft, a cultured human dermis, to treat diabetic foot ulcers. .Diabetes Care 19::350. ,1996. .

  • 10.

    Martson, WA, J Hanft, P Norwood, et al. :The efficacy and safety of Dermagraft in improving the healing of chronic DFU. .Diabetes Care 26::1701. ,2003. .

  • 11.

    Veves, A, V Falanga, DG Armstrong, et al. :Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic DFU: a prospective randomized multicenter clinical trial. .Diabetes Care 24::290. ,2001. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Edmonds, M . European and Australian Apligraf Diabetic Foot Ulcer Study Group :Apligraf in the treatment of neuropathic diabetic foot ulcers. .Int J Low Extrem Wounds 8::11. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13.

    Fleischli, JG, TJ Laughlin, and JW Fleischli. :Equine pericardium collagen wound dressing in the treatment of the neuropathic diabetic foot wound: a pilot study. .JAPMA 99::301. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Mulder, G and DK Lee. :A retrospective clinical review of extracellular matrices for tissue reconstruction: equine pericardium as a biological covering to assist with wound closure. .Wounds 21::254. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Mulder, G and DK Lee. :Case presentation: xenograft resistance to protease degradation in a vasculitic ulcer. .Int J Low Extrem Wounds 8::157. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 16.

    Niezgoda, JA, CC Van Gils, RG Frykberg, et al. :Randomized clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers. .Adv Skin Wound Care 18::258. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Reyzelman, A, RT Crews, JC Moore, et al. :Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. .Int Wound J 6::196. ,2009. .

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 18.

    Martin, BR, M Sangalang, S Wu, et al. :Outcomes of allogenic acellular matrix therapy in treatment of diabetic foot wounds: an initial experience. .Int Wound J 2::161. ,2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Brigido, SA . :The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study. .Int Wound J 3::181. ,2006. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Nataraj, C, G Ritter, S Dumass, et al. :Extracellular wound matrices: novel stabilization and sterilization method for collagen-based biologic wound dressing. .Wounds 19::148. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Veves, A, P Sheehan, and HT Pham. :A randomized, controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. .Arch Surg 137::822. ,2002. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Mulder, G and DK Lee. :Use of equine derived pericardium as a biological cover to promote closure of a complicated wound with associated scleroderma and Raynaud’s disease. .Wounds 21::297. ,2009. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Margolis, DJ, J Kantor, and JA Berlin. :Healing of diabetic neuropathic foot ulcers receiving standard treatment: a meta-analysis. .Diabetes Care 22::692. ,1999. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    International Consensus :Acellular Matrices for the Treatment of Wounds: An Expert Working Group Review. ,Wounds International. ,London. ,2010. .

Equine Pericardium as a Biological Covering for the Treatment of Diabetic Foot Wounds

A Prospective Study

Jeffery H. Alexander Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL.

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David A. Yeager Department of Surgery, KSB Hospital, Dixon, IL.

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Dean S. Stern Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL.

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Carlo A. Messina Department of Orthopedic Surgery, Rush University Medical Center, Oak Park, IL.

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Brian J. Griffeth Department of Orthopedic Surgery, Podiatry Section, St. Joseph Hospital, Chicago, IL.

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Elizabeth Pacocha Department of Orthopedic Surgery, Podiatry Section, St. Joseph Hospital, Chicago, IL.

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Mark Barakat Synovis Orthopedic and Woundcare Inc, Irvine, CA.

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Background:

Diabetic foot wounds remain a significant health-care issue. Healing these wounds in a timely manner is of paramount importance because the duration of ulceration correlates with increased rates of infection and amputation, costing billions of dollars yearly. Collagen-based matrices have been used as wound covers and have been shown to improve and expedite healing. We present our experience with equine pericardium biomatrix for the treatment of neuropathic foot wounds.

Methods:

Thirty-four patients with 37 diabetic foot wounds were evaluated at two institutions prospectively. All of the wounds were debrided, and equine pericardium biomatrix was applied. Secondary dressings were changed every 48 to 72 hours until healed or for 12 weeks after application. Healing rate at 12 weeks, time to wound closure, and complications were evaluated.

Results:

Twenty-two men and 12 women (mean age, 56.9 years) were treated and evaluated. Mean and median wound sizes at initial treatment were 715.8 and 440 mm2, respectively. The overall wound healing rate by 12 weeks was 75.7% (n =28). Mean and median times to wound closure were 7.2 and 7.0 weeks, respectively. No device or procedure-related complications were reported.

Conclusions:

The use of equine pericardium as a temporary biological scaffold is safe and effective for the treatment of chronic neuropathic foot wounds. (J Am Podiatr Med Assoc 102(5): 352–358, 2012)

Corresponding author: Jeffery H. Alexander, DPM, Department of Orthopedic Surgery, Rush University Medical Center, 610 S Maple Ave, Suite 2550, Oak Park, IL 60304. (E-mail: jeffery_alexander@rush.edu)
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