Skip to main content
Top
Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

The LeucoPatch® system in the management of hard-to-heal diabetic foot ulcers: study protocol for a randomised controlled trial

Authors: Frances Game, William Jeffcoate, Lise Tarnow, Florence Day, Deborah Fitzsimmons, Judith Jacobsen

Published in: Trials | Issue 1/2017

Login to get access

Abstract

Background

Diabetic foot ulcers are a common and severe complication of diabetes mellitus. Standard treatment includes debridement, offloading, management of infection and revascularisation where appropriate, although healing times may be long. The LeucoPatch® device is used to generate an autologous platelet-rich fibrin and leucocyte wound dressing produced from the patient’s own venous blood by centrifugation, but without the addition of any reagents. The final product comprises a thin, circular patch composed predominantly of fibrin together with living platelets and leucocytes. Promising results have been obtained in non-controlled studies this system, but this now needs to be tested in a randomised controlled trial (RCT). If confirmed, the LeucoPatch® may become an important new tool in the armamentarium in the management of diabetic foot ulcers which are hard-to-heal.

Methods

People with diabetes and hard-to-heal ulcers of the foot will receive either pre-specified good standard care or good standard care supplemented by the application of the LeucoPatch® device.
The primary outcome will be the percentage of ulcers healed within 20 weeks. Healing will be defined as complete epithelialisation without discharge that is maintained for 4 weeks and is confirmed by an observer blind to randomisation group.

Discussion

Ulcers of the foot are a major source of morbidity to patients with diabetes and costs to health care economies. The study population is designed to be as inclusive as possible with the aim of maximising the external validity of any findings. The primary outcome measure is healing within 20 weeks of randomisation and the trial also includes a number of secondary outcome measures. Among these are rate of change in ulcer area as a predictor of the likelihood of eventual healing, minor and major amputation of the target limb, the incidence of infection and quality of life.

Trial registration

International Standard Randomised Controlled Trial, ISRCTN27665670. Registered on 5 July 2013.
Literature
1.
go back to reference Gershater MA, Londahl M, Nyberg P, Larsson J, Thorne J, Eneroth M, et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia. 2009;52(3):398–407. Epub 2008/11/28.CrossRefPubMed Gershater MA, Londahl M, Nyberg P, Larsson J, Thorne J, Eneroth M, et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia. 2009;52(3):398–407. Epub 2008/11/28.CrossRefPubMed
2.
go back to reference Boulton AJ. The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab Res Rev. 2008;24 Suppl 1:S3–6. Epub 2008/04/30.CrossRefPubMed Boulton AJ. The diabetic foot: grand overview, epidemiology and pathogenesis. Diabetes Metab Res Rev. 2008;24 Suppl 1:S3–6. Epub 2008/04/30.CrossRefPubMed
3.
go back to reference Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–85. Epub 2008/07/30.CrossRefPubMedPubMedCentral Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–85. Epub 2008/07/30.CrossRefPubMedPubMedCentral
4.
go back to reference Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885–910. Epub 2004/10/09.CrossRefPubMed Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39(7):885–910. Epub 2004/10/09.CrossRefPubMed
5.
go back to reference Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ, International Working Group on the Diabetic Foot (IWGDF). IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:75–83.CrossRefPubMed Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ, International Working Group on the Diabetic Foot (IWGDF). IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:75–83.CrossRefPubMed
6.
go back to reference Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ, International Working Group on the Diabetic Foot (IWGDF). Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32 Suppl 1:154–68.CrossRefPubMed Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ, International Working Group on the Diabetic Foot (IWGDF). Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32 Suppl 1:154–68.CrossRefPubMed
7.
go back to reference Vileikyte L. Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Rev. 2001;17(4):246–9. Epub 2001/09/07.CrossRefPubMed Vileikyte L. Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Rev. 2001;17(4):246–9. Epub 2001/09/07.CrossRefPubMed
8.
go back to reference Löndahl M, Landin-Olsson M, Katzman P. Hyperbaric oxygen therapy improves health-related quality of life in patients with diabetes and chronic foot ulcer. Diabet Med. 2011;28(2):186–90. Epub 2011/01/12.CrossRefPubMed Löndahl M, Landin-Olsson M, Katzman P. Hyperbaric oxygen therapy improves health-related quality of life in patients with diabetes and chronic foot ulcer. Diabet Med. 2011;28(2):186–90. Epub 2011/01/12.CrossRefPubMed
9.
go back to reference Jeffcoate WJ, Lipsky BA, Berendt AR, Cavanagh PR, Bus SA, Peters EJ, et al. Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med. 2008;25(12):1380–9. Epub 2008/12/03.CrossRefPubMed Jeffcoate WJ, Lipsky BA, Berendt AR, Cavanagh PR, Bus SA, Peters EJ, et al. Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med. 2008;25(12):1380–9. Epub 2008/12/03.CrossRefPubMed
10.
go back to reference Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic-Canic M. Growth factors and cytokines in wound healing. Wound repair and regeneration: official publication of the Wound Healing Society [and] the European Tissue Repair. Society. 2008;16(5):585–601. Epub 2009/01/09. Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic-Canic M. Growth factors and cytokines in wound healing. Wound repair and regeneration: official publication of the Wound Healing Society [and] the European Tissue Repair. Society. 2008;16(5):585–601. Epub 2009/01/09.
11.
go back to reference Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008;453(7193):314–21. Epub 2008/05/16.CrossRefPubMed Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008;453(7193):314–21. Epub 2008/05/16.CrossRefPubMed
12.
go back to reference Papanas N, Maltezos E. Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises? Int J Low Extrem Wounds. 2007;6(1):37–53. Epub 2007/03/09.CrossRefPubMed Papanas N, Maltezos E. Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises? Int J Low Extrem Wounds. 2007;6(1):37–53. Epub 2007/03/09.CrossRefPubMed
13.
go back to reference Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9:283–9.CrossRefPubMed Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9:283–9.CrossRefPubMed
14.
go back to reference Suh DY, Hunt TK. Time line of wound healing. Clin Podiatr Med Surg. 1998;15(1):1–9.PubMed Suh DY, Hunt TK. Time line of wound healing. Clin Podiatr Med Surg. 1998;15(1):1–9.PubMed
16.
go back to reference Lepisto J, Laato M, Niinikoski J, Lundberg C, Gerdin B, Heldin CH. Effects of homodimeric isoforms of platelet-derived growth factor (PDGF-AA and PDGF-BB) on wound healing in rat. J Surg Res. 1992;53(6):596–601.CrossRefPubMed Lepisto J, Laato M, Niinikoski J, Lundberg C, Gerdin B, Heldin CH. Effects of homodimeric isoforms of platelet-derived growth factor (PDGF-AA and PDGF-BB) on wound healing in rat. J Surg Res. 1992;53(6):596–601.CrossRefPubMed
17.
18.
go back to reference Knighton DR, Ciresi K, Fiegel VD, Schumerth S, Butler E, Cerra F. Stimulation of repair in chronic, nonhealing, cutaneous ulcers using platelet-derived wound healing formula. Surg Gynecol Obstet. 1990;170(1):56–60.PubMed Knighton DR, Ciresi K, Fiegel VD, Schumerth S, Butler E, Cerra F. Stimulation of repair in chronic, nonhealing, cutaneous ulcers using platelet-derived wound healing formula. Surg Gynecol Obstet. 1990;170(1):56–60.PubMed
19.
go back to reference Crovetti G, Martinelli G, Issi M, Barone M, Guizzardi M, Campanati B, et al. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci. 2004;30(2):145–51.CrossRefPubMed Crovetti G, Martinelli G, Issi M, Barone M, Guizzardi M, Campanati B, et al. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci. 2004;30(2):145–51.CrossRefPubMed
20.
go back to reference Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Effectiveness of platelet releasate for the treatment of diabetic neuropathic foot ulcers. Diabetes Care. 2001;24(3):483–8. Epub 2001/04/06.CrossRefPubMed Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Effectiveness of platelet releasate for the treatment of diabetic neuropathic foot ulcers. Diabetes Care. 2001;24(3):483–8. Epub 2001/04/06.CrossRefPubMed
21.
go back to reference Stacey MC, Mata SD, Trengove NJ, Mather CA. Randomised double-blind placebo controlled trial of topical autologous platelet lysate in venous ulcer healing. Eur J Vasc Endovasc Surg. 2000;20(3):296–301.CrossRefPubMed Stacey MC, Mata SD, Trengove NJ, Mather CA. Randomised double-blind placebo controlled trial of topical autologous platelet lysate in venous ulcer healing. Eur J Vasc Endovasc Surg. 2000;20(3):296–301.CrossRefPubMed
22.
go back to reference Senet P, Vicaut E, Beneton N, Debure C, Lok C, Chosidow O. Topical treatment of hypertensive leg ulcers with platelet-derived growth factor-BB: a randomized controlled trial. Arch Dermatol. 2011;147(8):926–30. Epub 2011/04/13.CrossRefPubMed Senet P, Vicaut E, Beneton N, Debure C, Lok C, Chosidow O. Topical treatment of hypertensive leg ulcers with platelet-derived growth factor-BB: a randomized controlled trial. Arch Dermatol. 2011;147(8):926–30. Epub 2011/04/13.CrossRefPubMed
23.
go back to reference Jörgensen B, Karlsmark T, Vogensen H, Haase L, Lundquist R. A pilot study to evaluate the safety and clinical performance of LeucoPatch®, an autologous, additive-free, platelet-rich fibrin for the treatment of recalcitrant chronic wounds. Int J Low Extrem Wounds. 2011;10(4):218–23. Epub 2011/10/20.CrossRefPubMed Jörgensen B, Karlsmark T, Vogensen H, Haase L, Lundquist R. A pilot study to evaluate the safety and clinical performance of LeucoPatch®, an autologous, additive-free, platelet-rich fibrin for the treatment of recalcitrant chronic wounds. Int J Low Extrem Wounds. 2011;10(4):218–23. Epub 2011/10/20.CrossRefPubMed
24.
go back to reference Löndahl M, Tarnow L, Karlsmark T, Lundquist R, Nielsen AM, Michelsen M, Nilsson A, Zakrzewski M, Jörgensen B. Use of an autologous leucocyte and platelet-rich fibrin patch on hard-to-heal DFUs: a pilot study. J Wound Care. 2015;24(4):172–8.CrossRefPubMed Löndahl M, Tarnow L, Karlsmark T, Lundquist R, Nielsen AM, Michelsen M, Nilsson A, Zakrzewski M, Jörgensen B. Use of an autologous leucocyte and platelet-rich fibrin patch on hard-to-heal DFUs: a pilot study. J Wound Care. 2015;24(4):172–8.CrossRefPubMed
25.
go back to reference Drummond M, Barbieri M, Cook J, et al. Transferability of economic evaluations across jurisdiction: ISPOR good research practices task force report. Value Health. 2009;12:409–18.CrossRefPubMed Drummond M, Barbieri M, Cook J, et al. Transferability of economic evaluations across jurisdiction: ISPOR good research practices task force report. Value Health. 2009;12:409–18.CrossRefPubMed
Metadata
Title
The LeucoPatch® system in the management of hard-to-heal diabetic foot ulcers: study protocol for a randomised controlled trial
Authors
Frances Game
William Jeffcoate
Lise Tarnow
Florence Day
Deborah Fitzsimmons
Judith Jacobsen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-2216-9

Other articles of this Issue 1/2017

Trials 1/2017 Go to the issue