Literature review on the management of diabetic foot ulcer

Table 5 Brief description of commonly used bioengineered tissue products

Type	Explanation	Use	RCT studies
Apligraf (Advanced Biohealing Inc., La Jolla, CA)	A bilayered living-skin construct containing an outer layer of live allogeneic human keratinocytes and a second layer of live allogeneic fibroblasts on type 1 collagen dispersed in a dermal layer matrix. Both cell layers are grown from infant fore skin and looks and feels like human skin[164,165]	It’s used for full-thickness neuropathic DFU of greater than 3 wk duration, resistant to standard therapy (also without tendon, muscle, capsule, or bone exposure) and is contraindicated in infected ulcers[167]	Veves et al[168] Falanga et al[169] Edmonds[170] Steinberg et al[171]
Dermagraft (Organogenesis Inc, Canton, Mass)	An allogeneic living-dermis equivalent and includes neonatal fibroblasts from human fore skin cultured on a polyglactin scaffold[164,165]	It’s used for DFU of greater than 6 wk duration, full thickness in depth but without tendon, muscle, joint, or bone exposure and is contraindicated in infected ulcers[164,167]	Marston et al[172] Gentzkow et al[173]
Oasis (Cook Biotech, West Lafayette, IN)	An acellular biomaterial derived from porcine small intestine submucosa, contains numerous crucial dermal components including collagen, glycosaminoglycans (hyaluronic acid), proteoglycans, fibronectin, and bioactive growth factors such as fibroblast growth factor-2, transforming growth factor β1, and VEGF[164,165]	It’s used for full-thickness DFU[174]	Niezgoda et al[174]

DFU: Diabetic foot ulcer; VEGF: Vascular endothelial growth factor.