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Daily Medical Update
Leg ulcers
Monday, June 15, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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BMJ Open Diabetes Research & Care (2026) - Systematic Review and Network Meta-analysis
Key Findings
- Across 51 RCTs and 6161 patients, 12 topical therapies improved wound healing vs standard care, with placenta-derived products showing the largest effect (OR 7.85, 95% CrI 4.62-14.15).
- Placenta-derived products were the only intervention to reduce adverse events vs standard care (OR 0.25, 95% CrI 0.10-0.60), while no therapy improved time to healing, serious adverse events, or infection rates.
📋 Practice Implication: When escalating diabetic foot ulcer care beyond standard dressings, prioritize topical biologic options with comparative efficacy data rather than treating advanced dressings as interchangeable.
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Journal of Diabetes (2026) - Meta-analysis
Key Findings
- Negative pressure wound therapy increased wound healing vs conventional care (OR 4.48, 95% CI 2.58-7.77) and produced greater ulcer area reduction (SMD 1.26, 95% CI 0.70-1.82).
- Negative pressure wound therapy lowered amputation risk (OR 0.35, 95% CI 0.19-0.64) with no significant increase in adverse events (OR 0.98, 95% CI 0.56-1.71).
📋 Practice Implication: For difficult diabetic foot ulcers, negative pressure therapy has enough pooled benefit to justify early consideration when the goal is faster closure and limb preservation.
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Journal of Diabetes (2026) - Systematic Review and Meta-analysis
Key Findings
- Combined local plus systemic antibiotics improved clinical cure vs systemic antibiotics alone (OR 2.08, 95% CI 1.30-3.35) and shortened healing time by 9.8 days (95% CI 4.4-15.1 days faster).
- Local antibiotics alone showed no significant improvement vs systemic therapy across cure, recurrence, or amputation outcomes, and the randomized-only subset did not confirm the combined-therapy benefit.
📋 Practice Implication: Use local antimicrobials as a selective adjunct for diabetic foot infection rather than as a routine replacement for systemic therapy, because the apparent benefit weakens in higher-quality randomized data.
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Frontiers in Endocrinology (2025) - Network Meta-analysis
Key Findings
- Compared with standard care, epidermal growth factor, platelet-derived growth factor, and platelet-rich plasma improved healing rates, while epidermal growth factor and platelet-rich plasma also shortened healing time.
- Platelet-rich plasma reduced adverse events and amputation rates, whereas vascular endothelial growth factor significantly increased adverse events.
📋 Practice Implication: If a growth factor strategy is being considered for diabetic foot ulcers, choose agents with both healing and safety advantages instead of adopting the class as a whole.
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Journal of Plastic, Reconstructive & Aesthetic Surgery (2026) - Meta-analysis
Key Findings
- Platelet-rich plasma increased complete healing vs conventional treatment by 1.5-fold (95% CI 1.09-2.07) and improved ulcer area reduction (OR 16.37, 95% CI 6.45-26.28).
- Platelet-rich plasma improved complete healing at week 4 (OR 3.65, 95% CI 1.08-12.32) and reduced ulcer recurrence (OR 0.25, 95% CI 0.06-0.99).
📋 Practice Implication: For venous leg ulcers that remain slow to close despite compression and wound care, platelet-rich plasma is a reasonable escalation option when recurrence reduction is part of the treatment goal.
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Summary
Recent leg-ulcer evidence is concentrated in diabetic foot and venous ulcer meta-analyses rather than broad all-cause ulcer trials. The most consistent signals favor advanced adjuncts layered onto standard care, particularly selected topical biologics, negative pressure wound therapy, growth factor-based approaches, and platelet-rich plasma, with benefits seen in healing rates, ulcer size reduction, and in some cases amputation or recurrence outcomes. Evidence for changing antibiotic strategy in diabetic foot infection is weaker, supporting selective rather than routine use of local antimicrobial add-ons.
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