Novel injectable paste-based treatment promotes diabetic foot wound closure

Micronized injectable human-derived acellular dermal matrices (ADM) may improve the healing of diabetic foot wounds, according to real-world data from Singapore.

In 13 patients (median age 69 years, 61 percent male) treated with micronized ADM at Tan Tock Seng Hospital, the mean wound volume decreased by 46.5 percent, from 19.2 cm³ at baseline to 8.82 cm³ at day 14 (p=0.0026). [Int Wound J 2025;22:e70127]

By day 28, wound volume further decreased to 5.8 cm³, representing a total reduction of 62.5 percent from baseline (p=0.0023).

According to the investigators, the micronized ADM was also effective against infected diabetic foot wounds, given that 84 percent of them had positive tissue cultures at baseline, despite appearing as a clean granulating wound. This suggested that the positive wound cultures did not negatively impact ADM application and engrafting, with wound size successfully reduced.

“ADMs facilitate wound healing by providing an extracellular matrix structural scaffold rich in growth factors to create a favourable microenvironment for cell proliferation, migration, and angiogenesis,” the investigators noted.

They postulated that the so-called scaffold helped improve the overall microenvironment of the wound to resist bacterial proliferation and subsequent infection. [Front Immunol 2022;13:789274]

Unique features

The study is said to present the first reported use of micronized ADM outside of its country of origin, Korea. Although diverse sources of ADM are available, the investigators pointed out that the best option is an allogeneic source that most closely replicates the structural and functional properties of the native extracellular matrix intended to be replaced. Additionally, human-derived ADMs mitigates the risk of immune reactions to foreign proteins. [Adv Drug Deliv Rev 2019;146:267-288]

Micronized human-derived ADM comes in a putty form, which the investigators emphasized is a key advantage, since such a formulation allows for application into irregular wounds, filling deep crevices in three dimensions. In contrast, the more common sheet ADMs are difficult to apply. A paste-based formulation “allows for the delivery of growth factors to hard-to-reach areas, promoting healing and easy application,” they said.

It is also worth noting that the micronized ADM only requires one application, which is a huge plus in terms of cost and convenience for the clinician, according to the investigators. They added that repeat application once the product has been engrafted may further accelerate wound healing.

Taken together, the findings of the present study support the potential of micronized human-derived ADM as an adjunct treatment to standard wound care.