The effect of low‐level laser therapy on diabetic foot ulcers: A meta‐analysis of randomised controlled trials

Our purpose was to perform a meta‐analysis to evaluate the effect of Low‐level laser therapy (LLLT) on diabetic foot ulcers (DFUs). The PubMed, Cochrane, Embase, Web of Science, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang databases were searched systematically up to August 27, 2020. Studies that met the inclusion criteria were included in the analysis. A total of 13 randomised controlled trials (RCTs) and 413 patients were analysed. Compared with the control group, LLLT significantly increased the complete healing rate (risk ratio [RR] = 2.10, 95% confidence interval [CI] 1.56‐2.83, P < .00001), reduced the ulcer area (standardised mean difference [SMD] = 3.52, 95% CI 1.65‐5.38, P = .0002), and shortened the mean healing time (SMD = −1.40, 95% CI −1.90 to −0.91, P < .00001) of patients with DFUs. The quality of the evidence was very low according to the GRADE system. LLLT is a promising and effective adjuvant treatment to accelerate the healing of DFUs. Further evidence from larger samples and higher quality RCTs is needed to prove the effect of LLLT and to determine the most appropriate parameters for the healing of DFUs.     

Efficacy of topical silicone gel in scar management: A systematic review and meta‐analysis of randomised controlled trials

To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta‐analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = −0.55 [−0.83 to –0.26], P = .0002; Height: SMD = −0.73 [−1.02 to –0.44], P < .00001; Pliability: SMD = −0.49 [−0.95 to –0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non‐silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post‐operative scar prevention.     

Effectiveness of moist dressings in wound healing after surgical suturing: A Bayesian network meta‐analysis of randomised controlled trials

The moist healing theory proves that a moderately moist and airtight environment is conducive to wound healing. However, different moist dressings have different functions. We aim to evaluate the effects of moist dressings on wound healing after surgical suturing and identify superior moist dressings. Randomised controlled trials investigating the application of moist dressings were retrieved from electronic databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library. Wound healing, surgical site infection (SSI), and times of dressing change were assessed. The values of the surface under the cumulative ranking (SUCRA) curve were calculated based on the Bayesian network meta‐analysis. Inconsistency tests and funnel plots were applied to analyse the consistency and publication bias. All the analysis complies with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) 2020 Checklist and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Sixteen randomised controlled trials involving 4444 patients were pooled in the network meta‐analysis. The ionic silver dressing (SUCRA, 93%) ranked first in wound healing, the metallic silver dressing (SUCRA, 75.9%) ranked first in SSI, and the hydrocolloid dressing (SUCRA, 73.9%) ranked first in times of dressing change. Inconsistency was only observed in wound healing, and no publication bias was observed in this study. The effects of moist dressings are better than gauze dressings in the process of wound healing. The ionic silver dressing is effective in wound healing, whereas the metallic silver dressing is effective in SSI prevention. The hydrocolloid dressing requires the fewest times of dressing change. More high‐quality RCTs are required to support the network meta‐analysis.     

The application of platelet‐rich plasma for skin graft enrichment: A meta‐analysis

Existing evidence demonstrated that the role of platelet‐rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%‐8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13‐0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11‐0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta‐analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.     

A systematic review and meta‐analysis of perforator flaps in plantar defects: Risk analysis of complications

The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta‐analysis. Our meta‐analysis identified two risk factors for postoperative complications: flap size over 50 cm² (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high‐quality studies with adequate sample sizes are needed, this meta‐analysis indicated that flap size over 50 cm² and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.     

The likelihood of severe COVID‐19 outcomes among PLHIV with various comorbidities: a comparative frequentist and Bayesian meta‐analysis approach

IntroductionThe SARS‐CoV‐2 virus can currently pose a serious health threat and can lead to severe COVID‐19 outcomes, especially for populations suffering from comorbidities. Currently, the data available on the risk for severe COVID‐19 outcomes due to an HIV infection with or without comorbidities paint a heterogenous picture. In this meta‐analysis, we summarized the likelihood for severe COVID‐19 outcomes among people living with HIV (PLHIV) with or without comorbidities.MethodsFollowing PRISMA guidelines, we utilized PubMed, Web of Science and medRxiv to search for studies describing COVID‐19 outcomes in PLHIV with or without comorbidities up to 25 June 2021. Consequently, we conducted two meta‐analyses, based on a classic frequentist and Bayesian perspective of higher quality studies.Results and discussionWe identified 2580 studies (search period: January 2020–25 June 2021, data extraction period: 1 January 2021–25 June 2021) and included nine in the meta‐analysis. Based on the frequentist meta‐analytical model, PLHIV with diabetes had a seven times higher risk of severe COVID‐19 outcomes (odd ratio, OR = 6.69, 95% CI: 3.03–19.30), PLHIV with hypertension a four times higher risk (OR = 4.14, 95% CI: 2.12–8.17), PLHIV with cardiovascular disease an odds ratio of 4.75 (95% CI: 1.89–11.94), PLHIV with respiratory disease an odds ratio of 3.67 (95% CI: 1.79–7.54) and PLHIV with chronic kidney disease an OR of 9.02 (95% CI: 2.53–32.14) compared to PLHIV without comorbidities. Both meta‐analytic models converged, thereby providing robust summative evidence. The Bayesian meta‐analysis produced similar effects overall, with the exclusion of PLHIV with respiratory diseases who showed a non‐significant higher risk to develop severe COVID‐19 outcomes compared to PLHIV without comorbidities.ConclusionsOur meta‐analyses show that people with HIV, PLHIV with coexisting diabetes, hypertension, cardiovascular disease, respiratory disease and chronic kidney disease are at a higher likelihood of developing severe COVID‐19 outcomes. Bayesian analysis helped to estimate small sample biases and provided predictive likelihoods. Clinical practice should take these risks due to comorbidities into account and not only focus on the HIV status alone, vaccination priorities should be adjusted accordingly.     

Continuous tension reduction technique in facial scar management: A comparison of W‐plasty and straight‐line closure on aesthetic effects in Asian patients

W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar''s aesthetic appearance.     

Use of oxidised regenerated cellulose/collagen dressings versus standard of care over multiple wound types: A systematic review and meta‐analysis

Oxidised regenerated cellulose (ORC)/collagen dressings help maintain physiologically moist wound environments conducive to wound healing. While evidence supporting ORC/collagen dressing use exists, comprehensive assessment is needed. This systematic review/meta‐analysis evaluated the performance of ORC/collagen dressings compared with standard dressings. A systematic literature search was performed using PUBMED, EMBASE, and QUOSA Virtual Library. Published studies and conference abstracts were assessed between 1 January 1996 and 27 July 2020. Comparative studies in English completed by 31 December 2019, with a study population ≥10 were included. Patient demographics, wound healing, and protease concentrations were extracted. A random‐effect model was used to assess the effect of ORC/collagen dressings. Twenty studies were included following removal of duplicates and articles not meeting inclusion criteria. A statistically significant effect in favour of ORC/collagen dressings was found for wound closure (P = 0.027) and percent wound area reduction (P = 0.006). Inconclusive evidence or limited reporting prevented assessment of time to complete healing, days of therapy, number of dressing applications, pain, matrix metalloproteinase, elastase, plasmin, and gelatinase concentration. Statistically significant increase in wound closure rates and percent wound area reduction were observed in patients receiving ORC/collagen dressings compared with standard dressings in this systematic review/meta‐analysis.     

Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study

This proof‐of‐concept study sought to determine the effects of standard of care (SOC) and a topically applied concentrated surfactant gel (SG) on the total microbial load, community composition, and community diversity in non‐healing diabetic foot ulcers (DFUs) with chronic biofilm infections. SOC was provided in addition to a topical concentrated SG, applied every 2 days for 6 weeks. Wound swabs were obtained from the base of ulcers at baseline (week 0), week 1, mid‐point (week 3), and end of treatment (week 6). DNA sequencing and real‐time quantitative polymerase chain reaction (qPCR) were employed to determine the total microbial load, community composition, and diversity of patient samples. Tissue specimens were obtained at baseline and scanning electron microscopy and peptide nucleic acid fluorescent in situ hybridisation with confocal laser scanning microscopy were used to confirm the presence of biofilm in all 10 DFUs with suspected chronic biofilm infections. The application of SG resulted in 7 of 10 samples achieving a reduction in mean log10 total microbial load from baseline to end of treatment (0.8 Log10 16S copies, ±0.6), and 3 of 10 samples demonstrated an increase in mean Log10 total microbial load (0.6 log10 16S copies, ±0.8) from baseline to end of treatment. Composition changes in microbial communities were driven by changes to the most dominant bacteria. Corynebacterium sp. and Streptococcus sp. frequently reduced in relative abundance in patient samples from week 0 to week 6 but did not disappear. In contrast, Staphylococcus sp., Finegoldia sp., and Fusobacterium sp., relative abundances frequently increased in patient samples from week 0 to week 6. The application of a concentrated SG resulted in varying shifts to diversity (increase or decrease) between week 0 and week 6 samples at the individual patient level. Any shifts in community diversity were independent to changes in the total microbial loads. SOC and a topical concentrated SG directly affect the microbial loads and community composition of DFUs with chronic biofilm infections.     

Effect of platelet‐rich plasma vs standard management for the treatment of diabetic foot ulcer wounds: A meta‐analysis

We performed a meta‐analysis to evaluate the effect of platelet‐rich plasma vs standard management for the treatment of diabetic foot ulcer wounds. A systematic literature search up to March 2022 was performed and 1435 subjects with diabetic foot ulcer wounds at the baseline of the studies; 723 of them were treated with platelet‐rich plasma, and 712 used control. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated to assess the effect of platelet‐rich plasma vs standard management for the treatment of diabetic foot ulcer wounds using the dichotomous method with a random or fixed‐effect model. The use of autologous platelet‐rich plasma resulted in significantly higher complete‐healed diabetic foot ulcer wounds compared with control (OR, 1.95; 95% CI, 1.49‐2.56, P < 0.001). The use of allogeneic platelet‐rich plasma resulted in significantly higher complete‐healed diabetic foot ulcer wounds compared with control (OR, 6.19; 95% CI, 2.32‐16.56, P < 0.001). The use of autologous and allogeneic platelet‐rich plasma resulted in significantly higher complete‐healed diabetic foot ulcer wounds compared with control. Though, the analysis of outcomes should be with caution because of the low number of studies in certain comparisons, for example, allogeneic platelet‐rich plasma compared with control.     

The comparison between experimental nursing and routine nursing interventions on the quality of life of stoma patients: A systematic review and meta‐analysis

The advance in nursing care for stoma patients is a challenging issue, which will influence the life quality. The quality of life is a major issue in the recovery of stoma patients. The evidence of experimental nursing has not been explored enough. A systematic search and a meta‐analysis were performed for the studies of experimental nursing interventions versus routine warming interventions on patients with a stoma. The comparisons between nursing interventions were performed to find which kind of intervention will be superior in improving life quality. After a restricted selection, 10 studies, 460 subjects with experimental nursing intervention, and 478 controls with the routine nursing intervention were enrolled in a variety of causes of the stoma. The focused outcome was the quality of life. The meta‐analysis was performed by Review Manager 5.4. Among the stoma patients, the meta‐analysis favours the experimental nursing intervention group with higher scores of life quality when compared to the routine nursing intervention group. The meta‐analysis results were with positive mean differences, significant tests for overall effect, and significant heterogeneities in the random‐effects model. The experimental nursing intervention showed higher positive effects on the quality of life when compared to routine nursing intervention for stoma patients. Experimental nursing intervention might be an option for stoma nursing practitioners to improve stoma care.     

Increasing awareness of HIV pre‐exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta‐analysis of global data

IntroductionIntegrated knowledge regarding pre‐exposure prophylaxis (PrEP) awareness and willingness to use PrEP can be useful for HIV prevention in high incidence groups. This review summarizes the awareness of PrEP and willingness to use PrEP among men who have sex with men (MSM).MethodsOnline electronic databases were searched before 31 August 2021. A meta‐analysis was conducted to pool studies analysing PrEP awareness and willingness to use PrEP. LOESS regression and linear regression were applied to fit the trends over time for the proportion of MSM aware of PrEP and willing to use PrEP. Dose–response meta‐analysis (DRMA) was conducted by a restricted cubic spline model to explore the relationship between willingness to use PrEP and selected factors.Results and DiscussionA total of 156 articles involving 228,403 MSM were included. The pooled proportions of MSM aware of PrEP and willing to use PrEP were 50.0 (95% CI: 44.8–55.2) and 58.6% (95% CI: 54.8–62.4), respectively. PrEP awareness varied among countries with different economic status and different WHO regions, among different publication and research years, PrEP types and support policies. PrEP willingness differed among countries with different economic status and groups with different risks of HIV. The awareness of PrEP increased from 2007 to 2019 with a slope of 0.040260 (p<0.0001), while the proportion of MSM willing to use PrEP decreased from 2007 to 2014 (slope = –0.03647, p = 0.00390) but increased after 2014 (slope = 0.04187, p = 0.03895). The main facilitators of willingness to use PrEP were PrEP awareness, condomless sexual behaviours, high perceived risk of HIV infection and influence of social network. The main barriers were doubts about the efficacy and side effects of PrEP. DRMA results indicated that MSM with more sexual partners and lower level of education were more willing to use PrEP. No publication bias was observed.ConclusionsThe proportions of PrEP awareness and willingness to use PrEP among MSM have increased since 2014, although the awareness was low and the willingness was moderate. Improving awareness of PrEP through increasing access to PrEP‐related health education and enhancing risk perceptions of HIV infection could have positive effects on the willingness to use PrEP among MSM.     

Effect of chitosan‐based gel dressing on wound infection,synechia, and granulations after endoscopic sinus surgery of nasal polyps: A meta‐analysis

A meta‐analysis was performed to evaluate the effect of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. A systematic literature search until March 2022 incorporated 386 subjects after endoscopic sinus surgery of nasal polyps at the beginning of the study; 187 were using chitosan‐based gel dressing, and 199 were control. Statistical tools like the dichotomous method were used within a random or fixed‐influence model to establish the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the influence of chitosan‐based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps. Chitosan‐based gel dressing had significantly lower wound infection (OR, 0.48; 95% CI, 0.25–0.92, P = 0.03), and synechia (OR, 0.25; 95% CI, 0.13–0.50, P < 0.001) compared with control in subjects with endoscopic sinus surgery of nasal polyps. However, no significant difference was found in granulations between chitosan‐based gel dressing and control in subjects with endoscopic sinus surgery of nasal polyps. Chitosan‐based gel dressing had significantly lower wound infection, synechia compared with control in subjects with endoscopic sinus surgery of nasal polyps, and no significant difference in granulations. Further studies are required to validate these findings.     

A meta‐review of the impact of compression therapy on venous leg ulcer healing

This meta‐review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR‐2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan. We identified 12 systematic reviews published between 1997 and 2021. AMSTAR‐2 assessment identified three as high quality, five as moderate quality, and four as low quality. Seven comparisons were reported, with a meta‐analysis undertaken for five of these comparisons: compression vs no compression (risk ratio [RR]: 1.55; 95% confidence interval [CI] 1.34‐1.78; P < .00001; moderate‐certainty evidence); elastic compression vs inelastic compression (RR: 1.02; 95% CI: 0.96‐1.08; P < .61 moderate‐certainty evidence); four layer vs <four‐layer bandage systems (RR: 1.07; 95% CI: 0.82‐1.40; P < .63; moderate‐certainty evidence); comparison between different four‐layer bandage systems (RR: 1.08; 95% CI: 0.93‐1.25; P = .34; moderate‐certainty evidence); compression bandage vs compression stocking (RR 0.95; 95% CI 0.87‐1.03; P = .18; moderate‐certainty evidence). The main conclusion from this review is that there is a statistically significant difference in healing rates when compression is used compared with no compression, with moderate‐certainty evidence. Otherwise, there is no statistically different difference in healing rates using elastic compression vs inelastic compression, four layer vs <four‐layer bandage systems, different four‐layer bandage systems, or compression bandages vs compression stockings.     

Comparative effectiveness of oral antibiotics,probiotics, prebiotics,and synbiotics in the prevention of postoperative infections in patients undergoing colorectal surgery: A network meta‐analysis

Oral antibiotics (OAB), probiotics, prebiotics, and synbiotics are reported to be effective for preventing postoperative infection following colorectal surgery, but the comparative effectiveness between them has not been studied. To compare these interventions through a network meta‐analysis. Ovid Medline, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to January 1, 2022 without any language restriction. Two reviewers independently screened the retrieved articles, assessed risk of bias, and extracted information from the included randomised controlled trials (RCTs). The primary outcome was infection rate, and the secondary outcome was anastomotic leakage rate. 4322 records were retrieved after literature search, and 20 RCTs recruiting 3726 participants were finally included. The analysis showed that usual care (UC) + Synbiotics ranked the most effective treatment (SUCRA = 0.968), UC + OAB ranked the second (SUCRA = 0.797), and UC + IAB ranked the third (SUCRA = 0.678) for preventing postoperative infection rate, but only UC + OAB achieved statistical significance. UC + OAB was the most effective treatment (SUCRA = 0.927) for preventing anastomotic leakage rate. Our study confirmed that preoperative administration of OAB was associated with lower infection rate and anastomotic leakage rate than placebo and UC alone. However, the beneficial effect of probiotics and synbiotics should still be investigated by large‐scale randomised controlled trials.     

Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta‐analysis of observational studies and randomised controlled trials

The application of negative pressure wound therapy (NPWT) in cancer surgical wounds is still controversial, despite its promising usage, because of the risks of increased tumorigenesis and metastasis. This study aimed to review the risks and benefits of NPWT in surgical wounds with the underlying malignant disease compared with conventional wound care (CWC). The first outcome was wound complications, divided into surgical site infection (SSI), seroma, hematoma, and wound dehiscence. The secondary outcome was hospital readmission. We performed a separate meta‐analysis of observational studies and randomised controlled trials (RCTs) with CI 95%. Thirteen observational studies with 1923 patients and seven RCTs with 1091 patients were included. NPWT group showed significant decrease in the risk of SSI (RR = 0.45) and seroma (RR = 0.61) in observational studies with P value <0.05, as well as RCTs but were not significant (RR = 0.88 and RR = 0.68). Wound dehiscence (RR = 0.74 and RR = 1.15) and hospital readmission (RR = 0.90 and RR = 0.62) showed lower risks in NPWT group but were not significant. Hematoma (RR = 1.08 and RR = 0.87) showed no significant difference. NPWT is not contraindicated in cancer surgical wounds and can be considered a beneficial palliative treatment to promote wound healing.     

Comparison of Single‐Radius with Multiple‐Radius Femur in Total Knee Arthroplasty: A Meta‐Analysis of Prospective Randomized Controlled Trials

BackgroundWhether there was clinical superiority for the single‐radius prosthesis over the multi‐radius prothesis in total knee arthroplasty (TKA) still remains to be clarified. We updated a meta‐analysis including prospective randomized controlled trials (RCTs) to compare the clinical prognosis of patients receiving single‐radius TKA (SR‐TKA) or multi‐radius TKA (MR‐TKA).MethodsWe searched the databases of PubMed, Web of Science, EMBASE, Cochrane Library, MEDLINE for eligible RCTs. Two reviewers evaluated the study quality according to the Risk of Bias tool of the Cochrane Library and extracted the data in studies individually. The extracted data included the baseline data and clinical outcome. The baseline data include the author''s name, country, and year of included studies, the name of knee prosthesis used in studies, sample size, follow‐up time, and BMI of patients. The clinical data comprised primary indicators including postoperative knee range of motion (ROM), sit‐to‐stand rest, severe postoperative scorings, such as visual analog scale (VAS), American Knee Society knee score (AKS), Oxford knee scoring (OKS), and SF‐36 Quality of Life Scale, as well as various secondary indicators of complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision. The data analysis was performed using Review Manager 5.3 software and STATA 12.0. The sensitivity analysis was performed using STATA 12.0.ResultsA total of 13 RCTs, along with 1720 patients and 1726 knees, were finally included in our present meta‐analysis. We found that patients in SR‐TKA group performed better in the sit‐to‐stand test (OR = 1.89, 95% CI: 1.05–3.41, p = 0.03) and satisfaction evaluation (OR = 3.27, 95% CI: 1.42–7.53, p = 0.005), which were only evaluated in two included RCTs. While no significant difference was found between SR‐TKA and MR‐TKA groups in terms of postoperative ROM, VAS scoring, AKS scoring, SF‐36 scoring, OKS scoring, and various complications including anterior knee pain, postoperative infection, aseptic prosthesis loosening, and prosthesis revision.ConclusionIn conclusion, our present meta‐analysis indicated that SR implants were noninferior to MR implants in TKA, and SR implants could be an alternative choice over MR implants, since patients after SR‐TKA felt more satisfied and performed better in the sit‐to‐stand test, with no significant difference in complications between SR‐TKA and MR‐TKA groups. While more relevant clinical trials with long‐term follow‐up time and specific tests evaluating the function of knee extension mechanism should be carried out to further investigate the clinical performance of SR implants.     

Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial

Diabetic foot ulcers are often unresponsive to conventional therapy and are a leading cause of amputation. Animal studies have shown stem cells and growth factors can accelerate wound healing. Adipose‐derived stem cells are found in fat grafts and mixing them with platelet‐rich plasma (PRP) may improve graft survival. This study aimed to establish the histological changes when diabetic foot ulcers are treated with fat grafts and PRP. A three‐armed RCT was undertaken of 18 diabetic foot ulcer patients: fat grafting; fat grafting with PRP; and routine podiatry care. Biopsies were obtained at week 0, 1, and 4, and underwent quantitative histology/immunohistochemistry (H&E, CD31, and Ki67). Treatment with fat and PRP increased mean microvessel density at 1 week to 1645 (SD 96) microvessels/mm² (+32%‐45% to other arms, P = .035). PRP appeared to increase vascularity surrounding fat grafts, and histology suggested PRP may enhance fat graft survival. There was no clinical difference between arms. This study demonstrates PRP with fat grafts increased neovascularisation and graft survival in diabetic foot ulcers. The histology was not, however, correlated with wound healing time. Future studies should consider using apoptosis markers and fluorescent labelling to ascertain if enhanced fat graft survival is due to proliferation or reduced apoptosis. Trial registration {"type":"clinical-trial","attrs":{"text":"NCT03085550","term_id":"NCT03085550"}}NCT03085550.