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Ease of Use, Safety, and Efficacy of Integra Bilayer Wound Matrix in the Treatment of Diabetic Foot Ulcers in an Outpatient Clinical Setting

A Prospective Pilot Study

Min Yao Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA. Dr. Driver is now with the Department of Surgery, VA New England Health Care Division, Providence, RI.

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Khaled Attalla Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA. Dr. Driver is now with the Department of Surgery, VA New England Health Care Division, Providence, RI.

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Yanhan Ren Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA. Dr. Driver is now with the Department of Surgery, VA New England Health Care Division, Providence, RI.
Department of Biology, University of Rochester, Rochester, NY.

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Michael A. French Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA. Dr. Driver is now with the Department of Surgery, VA New England Health Care Division, Providence, RI.

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Vickie R. Driver Limb Preservation and Wound Healing Clinical Research, Department of Surgery, Boston University Medical Center and Boston University School of Medicine, Boston, MA. Dr. Driver is now with the Department of Surgery, VA New England Health Care Division, Providence, RI.

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Background:

Integra bilayer wound matrix (IBWM) is a bilayer skin replacement system composed of a dermal regeneration layer and a temporary epidermal layer. It is used to treat various types of deep, large wounds via an inpatient procedure in an operating room. We sought to determine ease of use and effectiveness of IBWM in an outpatient clinical setting when treating diabetic foot ulcers. In addition, no epidermal autografting was performed in conjunction with the IBWM after silicone release, as is common in the inpatient setting.

Methods:

This 12-week, single-arm, prospective pilot study was conducted in three outpatient clinics. Weekly evaluations included monitoring the wound for signs of infection during the 12-week follow-up phase.

Results:

Eleven patients with diabetic foot ulcers who met the inclusion and exclusion criteria were enrolled. One patient was discontinued from the study owing to noncompliance leading to a serious adverse event. Therefore, ten patients who received the study intervention were included in the per-protocol population reported herein. The mean patient age was 60.6 years, with an average 11-year history of diabetes mellitus. Each ulcer was located on the plantar aspect of the foot. No infection was reported during the study. Patients treated with IBWM showed progressive wound healing over time: the greatest mean wound reduction was approximately 95% in week 12. Seven of ten patients (70%) achieved complete wound closure by week 12. No recurrent ulcers were reported during follow-up.

Conclusions:

These results are consistent with the hypothesis that IBWM is easy to use, safe, and effective when used on diabetic foot ulcers in an outpatient clinical setting without the secondary procedure of autografting for closure. (J Am Podiatr Med Assoc 103(4): 274–280, 2013)

Corresponding author: Vickie R. Driver, DPM, MS, VA New England Health Care Division, Providence, RI. Department of Surgery, Limb Preservation and Wound Healing Research, 830 Chalkstone Ave, Providence, RI 02908. (E-mail: drvdriver@aol.com)