Cellular and tissue-based skin substitutes for diabetic foot ulcers

Yenny Elers Mastrapa and Fabian Quiroz Zendejas

SAP Podiatry, 2026

Abstract: Introduction: Diabetic foot ulcers heal slowly and precede most diabetes-related lower limb amputations. Cellular and tissue-based skin substitutes are used when standard care fails, but their effect on complete healing remains uncertain. Methods: This systematic review followed PRISMA 2020. Scopus, PubMed, OpenAlex and Crossref were searched from 2018 to 2026 for randomized controlled trials and comparative studies comparing a cellular or tissue-based skin substitute with standard care, placebo or another substitute in adults with diabetic foot ulcers. Results: Of 414 records identified, 307 were screened and 11 randomized controlled trials were included. Of five trials with a standard-care comparator, intact fish skin graft achieved healing in 44% versus 26% at 16 weeks, ovine forestomach matrix in 46% versus 24% at 12 weeks, and dehydrated amnion-chorion in 50% versus 17%; one large cryopreserved amniotic trial found no significant difference (66.1% versus 59.8%). Conclusions: Cellular and tissue-based skin substitutes increased complete healing of diabetic foot ulcers in most included trials, although the evidence is limited by small samples, open designs and clinical heterogeneity.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:cwf:podart:pod2026267

DOI: 10.62486/pod2026267

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