Autologous tissue-engineered grafts significantly improve healing when compared with nonadherent paraffin gauze in dorsal diabetic foot ulcers, according to an Italian study.

Research published in Diabetes Care (http://care.diabetesjournals.org/) randomized 79 patients with diabetic dorsal or plantar ulcers to nonadherent paraffin gauze dressing (control group) or to autologous grafting (treatment group).

Both groups received aggressive debridement, wound infection control, and, for plantar ulcers, pressure relief via fiberglass off-loading casts, and they were assessed weekly.

In the dorsal ulcer group, 67% of ulcers treated with autologous grafting healed compared with 31% in the control group, a statistically significant difference.

In the plantar ulcer group, however, autologous grafts did not significantly increase the rate of ulcer healing compared with standard dressing, 55% versus 50%.

'It is clear, therefore, that what is fundamental to the healing of plantar diabetic foot ulcers is not the type of dressing, but rather correct debridement and off-loading of pressure to the foot,' say the authors.

Autologous grafts may be useful for plantar ulcers in patients for whom the total off-loading cast is 'not recommended and only a less effective off-loading device can be applied,' they conclude.

Reference: Caravaggi C et al (2003) HYAFF 11-Based Autologous Dermal and Epidermal Grafts in the Treatment of Noninfected Diabetic Plantar and Dorsal Foot Ulcers: A prospective, multicenter, controlled, randomized clinical trial Diabetes Care 26 (10) 2853-2859.