Background: Diabetic foot ulcer (DFU) is one of the most dreaded complications of diabetes mellitus and is associated with a high risk of lower limb amputation and mortality. Since the efficacy of conventional treatments for DFUs is often limited, regenerative medicine therapy such as growth factors and stem cells may provide a solution to chronic wound healing. In this study, we compared several kinds of regenerative therapy for the treatment of DFUs in terms of efficacy.
Methods: We systemically searched relevant studies on PubMed, Cochrane Library, and EMBASE. Randomized clinical trials on platelet-rich plasma (PRP), epidermal growth factor (EGF), or stem cells, compared with standard of care alone in patients with DFUs were included in this study.
Results: A total of 1454 patients from 23 randomized controlled trials (RCTs) were included in the network meta-analysis. In terms of the mean time to wound closure, PRP achieved significantly earlier ulcer healing than stem cells, EGF, and standard care alone. No significant difference in the time needed for wound healing between stem cells and EGF was observed. In addition, no significant difference was noted in the number of completely healed ulcers between PRP, stem cells, and EGF. We also performed surface under the cumulative ranking curve analyses to predict the rank of each intervention by the number of completely healed ulcers. The predicted ranking was as follows: Stem cells, PRP, EGF, and standard care alone. Funnel plot analysis demonstrated no publication bias.
Conclusion: PRP combined with standard care significantly accelerates wound healing for DFUs. The mean time to wound healing was similar between stem cells and EGF. However, additional reviews of rigorous, large well-designed RCTs are warranted for further validation of our findings

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