Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent: a new paradigm in wound healing

Arch Surg. 2000 Jun;135(6):627-34. doi: 10.1001/archsurg.135.6.627.


Hypothesis: In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds.

Design: In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds.

Setting: A single university teaching hospital and tertiary care center.

Patients and methods: Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses.

Main outcome measure: Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site.

Results: Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE.

Conclusions: In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Beds
  • Collagen
  • Debridement
  • Diabetic Foot / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pressure Ulcer / therapy*
  • Prospective Studies
  • Skin, Artificial*
  • Wound Healing / physiology*


  • Apligraf
  • Collagen