Autologous Platelet-rich Gel For Treating Diabetic Foot Ulcers (Systematic Review)

BackgroundFoot ulcers are a major chronic complication of diabetes mellitus,often with neurological disease and lower extremity vascular disease.Diabetes-related lower limb amputation,85% occurred after diabetic foot ulcers.The three essential elements of diabetic non-healing or delayed-healing cutaneous ulcers are diabetic neurological disease,vascular disease and infection.APG contains high concentration platelet,which release growth factors and cytokines once activated by calcium.At the same time can form fibrin,and cross-linking the formation of fibrin network structure.Topical application of APG improves the wound healing grades,shortens the healing time and accelerates the healing velocity.It is of great significance for the treatment of diabetic foot and related wound.ObjectiveThe purpose of the review is to assess the effectiveness and safety of topical autologous platelet-rich gel(APG)application on facilitating the healing of diabetic foot and chronic ulcers.MethodsWe searched The Cochrane Library(Issue 1,2017),MEDLINE(1978 ～2017),EMBASE(1978 ～ 2017),PUBMED(1978 ～ 2017),and some Chinese databases for additional articles(CBMdisc,CMCC,VIP).The quality of included randomized controlled trails were evaluated and meta-analysis was performed with Rev Man 5.3.ResultsThe screening retrieved 231 articles related diabetic foot and related wound and 12 studies were included,involving 660 participants.The 12 randomized studies included compared the healing rate of diabetic foot and its related wounds between APG group and control group,12 found significant benefits for the use of APG on diabetic foot ulcers[OR 4.53,95%CI(3.14,6.53)],5 found significant benefits for the use of APG on diabetic chronic ulcers[OR 3.95,95%CI(1.81,8.60)].ConclusionsThe systematic review of APG treatment of diabetic foot and its related wounds of the effectiveness and safety of heterogeneity analysis and systematic evaluation.We found evidence suggesting that APG may increase the likelihood that people will have complete healing of foot ulcers in people with diabetes.And this conclusion is based on randomized clinical trials with low risk of systematic errors(bias).The likelihood of the selection bias,measurement bias and reporting bias are low.Assessment of the quality of the available evidence(GRADE)showed that further trials investigating the effect of APG are needed before firm conclusions can be drawn.DiscussionIn the systematic review,the risk of bias in the study was small and the quality grade was moderate.Therefore,we considered that APG was more effective in the treatment of diabetic foot and its related wounds.We suggest using APG for diabetic foot and its related wounds treatment in clinic.Our study may have the problem of test efficacy because of small number of sample size.So we suggest that clinical RCT trails enlarge their sample size,adopt strict method of random,allocation concealment and double blind.Identify the same APG preparation protocol and APG effective platelet concentration,prescribed medication frequency.At the same time,the adverse effects,quality of life and other related indicators were recorded and analyzed statistically.