From:  Emerging targets and gene-based therapeutics in diabetic foot ulcer: a comprehensive review

 Skin grafting and low-level laser therapy (LLLT) in the treatment of diabetic foot ulcers (DFUs).

StudyType of ulcer/patient populationInterventionResults
Skin grafting
Saydam et al. [60]A retrospective clinical study with 15 DFU patients.AEG on DFUs.AEG may be used effectively and safely in patients with DFU emergencies.
Shetty et al. [61]An RCT with 52 patients (UTSG vs. conventional dressing).UTSG was used on DFUs.84.61% of wounds managed with UTSG healed completely after 12-weeks compared to 53.84% of wounds managed with conventional dressing.
Tzeng et al. [62]Eight diabetic patients with nine non-healing lower extremity ulcers.Wound debridement, autologous PRP and thrombin, and thin split-thickness skin graft on the wound.Complete wound healing in 2 to 3 weeks in 8 successful cases.
No ulcer recurrence.
Laser treatment
Waluyo and Hidayat [66]55-year-old male patient with DM, diabetic neuropathy, and diabetic foot.Normal saline, topical antibiotics, and LLLT, with a dose of 10 J/cm2, with a frequency of therapy of 3 times per week.Wound tissue growth and no significant adverse effects after 12 weeks.
Santos et al. [67]Thirteen RCTs with a total of 361 participants with DFUs.Treatment with 632.8 to 685 nm, 50 mW/cm2, 3 to 6 J/cm2, and irradiation for 30 to 80 seconds, 3 times weekly.Only 3 RCTs reported a reduction in the size of the ulcers.
LLLT for a month is effective, safe, and of benefit for DFU treatment.
Huang et al. [68]13 RCTs and 413 patients with DFU.LLLT was given to patients with DFUs.
Various wavelengths in these 13 studies were 830 nm, 632.8 nm, 650 nm, 660 nm, 685 nm, 904 nm, and 400–800 nm.
LLLT significantly increased the complete healing rate, reduced the ulcer area, and shortened the mean healing time of patients with DFUs.
Chen et al. [69]A meta-analysis of 11 studies involving 657 participants with grade I–II DFUs.Various wavelengths in these studies were 660 nm, 630 and 810 nm, 400–800 nm, 635 nm, 890 nm, and 685 nm.LLLT significantly increased the complete healing rate, the wound shrinkage area, and the wound bacterial clearance rate compared to the control group and reduced the infection rate.
Sani and Sani [70]20 patients with chronic DFUs.LLLT and PRP therapy, along with standard wound care.Two patients showed significant clinical improvement with resolution of necrotic tissue, reduction in wound size, and formation of healthy granulation tissue.

AEG: autologous epidermal grafting; DM: diabetes mellitus; PRP: platelet-rich plasma; RCT: randomized controlled trial; UTSG: ultrathin skin graft.