Fat grafting and platelet-rich plasma for the treatment of diabetic foot ulcers: A feasibility-randomised controlled trial

Oliver J Smith, Richard Leigh, Muholan Kanapathy, Peter Macneal, Gavin Jell, Nadine Hachach-Haram, Haroon Mann, Ash Mosahebi, Oliver J Smith, Richard Leigh, Muholan Kanapathy, Peter Macneal, Gavin Jell, Nadine Hachach-Haram, Haroon Mann, Ash Mosahebi

Abstract

Chronic, nonhealing diabetic foot ulcers (DFU) are increasing in prevalence and are often unresponsive to conventional therapy. Adipose tissue, containing adipose-derived stem cells, and platelet rich plasma (PRP) are regenerative therapies rich in growth factors which may provide a solution to chronic wound healing. This study aimed to assess the feasibility of conducting a definitive randomised controlled trial (RCT) to investigate the efficacy of these therapies for the treatment of DFU. This was a single centre, feasibility, three-arm, parallel group RCT. Eligible DFU patients were randomised on a 1:1:1 basis to three intervention arms: control (podiatry); fat grafting; fat grafting with PRP. The intervention was delivered once and patients were followed-up for 12 weeks. The primary objective was to assess measures of trial feasibility. Clinical outcomes and health-related quality of life (HRQoL) were also evaluated. Three hundred and thirty four patients were screened and 32 patients (9.6%) were deemed eligible with 18 enrolled in the trial (6 per arm) over 17 months. All participants completed the trial with no withdrawals or crossover. Participant engagement was high with most HRQoL questionnaires returned and only 4.8% follow-up appointments missed. There were five adverse events (AEs) related to the trial with no serious AEs. Five (28%) of the wounds healed. There was no difference between any of the groups in terms of clinical outcomes. This feasibility study demonstrated that a multi-centre RCT is safe and feasible with excellent patient engagement. We have highlighted crucial information regarding methodology and recruitment, which will guide future trial design. Registration number: NCT03085550 clinicaltrials.gov. Registered 01/03/2017.

Keywords: diabetic foot ulcers; fat grafting; platelet rich plasma; wound healing.

Conflict of interest statement

The authors declare no potential conflict of interest.

© 2020 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram depicting the flow of the participants through the trial
FIGURE 2
FIGURE 2
Percentage change in mean wound volume (mm3) over 12 weeks
FIGURE 3
FIGURE 3
Percentage change in mean wound area (mm2)
FIGURE 4
FIGURE 4
Bland‐Altman plots illustrating the difference between volumetric measurements (mm3) taken by 3D photographs and manual ruler measurement. The red lines indicate the 95% limits of agreement and the blue line represents the mean of the difference. Each dot represents a wound measurement
FIGURE 5
FIGURE 5
Kaplan‐Meier curve showing time from commencement of trial to 100% wound healing
FIGURE 6
FIGURE 6
Mean change in pressure ulcer scale for healing score over 12 weeks
FIGURE 7
FIGURE 7
The change in average cost of dressings in (mean £ ± SEM) over 12 weeks
FIGURE 8
FIGURE 8
A summary of the mean health related quality of life scores from the diabetic foot ulcer scale questionnaire

Source: PubMed

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