{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:02:44Z","timestamp":1790949764086,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Placental\u2010derived cellular, acellular, and matrix\u2010like products (CAMPs) are widely used as adjuncts to standard care for diabetic foot ulcers (DFUs), but trials differ in product class, comparator, and healing window. We estimated the effect of adjunctive placental\u2010derived CAMPs on complete wound closure at a single, clinically meaningful 12\u2010week endpoint. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261399700) and reported per Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) 2020, with search reporting guided by PRISMA\u2010S. PubMed\/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 21 June 2026 for randomised or quasi\u2010randomised trials comparing a placental, amniotic, chorionic, amnion\u2010chorion, placental membrane, or umbilical cord\u2010derived product plus standard care against standard care or a non\u2010placental control in adults with active DFUs. The primary outcome was complete wound closure at 12\u2009weeks. Risk ratios (RRs) were pooled in a random\u2010effects model (inverse\u2010variance, restricted maximum likelihood [REML], Hartung\u2010Knapp). Risk of bias was assessed with the Cochrane Risk of Bias 2 tool (RoB 2) for the 12\u2010week outcome and certainty with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Prespecified sensitivity analyses included odds ratios, leave\u2010one\u2010out, product\u2010class subgroups, and exclusion of high\u2010risk\u2010of\u2010bias studies. Of 474 records, 14 randomised articles were retained; 9 standard\u2010care\u2010controlled comparisons (944 participants) provided extractable\u00a012\u2010week complete\u2010closure data for the primary analysis. Complete closure occurred in 298 of 505 product\u2010treated participants (59.0%) versus 157 of 439 controls (35.8%). Adjunctive CAMPs increased the likelihood of closure (RR 1.70, 95% confidence interval [CI] 1.31\u20132.20). Heterogeneity was moderate (I\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u200951.9%) and the prediction interval crossed the null (0.93\u20133.11). The effect was robust to leave\u2010one\u2010out analysis (RR 1.59\u20131.81), an odds\u2010ratio model (odds ratio [OR] 3.36, 95% CI 1.68\u20136.71), and exclusion of the single high\u2010risk\u2010of\u2010bias trial (RR 1.73, 95% CI 1.29\u20132.33). Certainty was moderate, downgraded once for inconsistency. Adjunctive placental\u2010derived CAMPs improve 12\u2010week complete closure of DFUs compared with standard care, with moderate certainty. The wide prediction interval indicates that the average benefit may not be reproduced by every product, population, or setting, underscoring the need for product\u2010specific, standard\u2010care\u2010anchored trials and for coverage policy grounded in endpoint\u2010specific randomised evidence.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    Registration number: CRD420261399700.\n                  <\/jats:p>","DOI":"10.1111\/iwj.71058","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:58:41Z","timestamp":1790848721000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cellular, Acellular, and Matrix\u2010Like Placental Products for Diabetic Foot Ulcers: A 12\u2010Week Randomised\u2010Trial Meta\u2010Analysis"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1196-539X","authenticated-orcid":false,"given":"George","family":"Theodorakopoulos","sequence":"first","affiliation":[{"name":"Wound and Foot Specialist  Athens Greece"},{"name":"BSc in Nursing Technological Educational Institute of Patras  Patras Greece"},{"name":"BSc in Podiatry Queen Margaret University  Edinburgh UK"},{"name":"MSc in Wound Care Treatment University of West Attica  Aigaleo Greece"},{"name":"MSc in Diagnostic and Therapeutic Approach to the Diabetic Foot University of Thessaly  Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9175","authenticated-orcid":false,"given":"David G.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Distinguished Professor of Surgery &amp; Neurological Surgery, Director &amp; Co\u2010Founder, Southwestern Academic Limb Salvage Alliance (SALSA), Director, Center to Stream Healthcare in Place (C2SHiP), Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70724"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010020\u201000383\u20102"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.10578"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3644"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2015.0634"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2024.0169"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12329"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12976"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2024.103170"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300\u2010017\u20100298\u20108"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001302"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12851"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13318"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893\u2010021\u201001084\u20108"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010022\u201000575\u2010y"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","unstructured":"G.TheodorakopoulosandD.Armstrong \u201cPlacental and Amniotic Products for Diabetic Foot Ulcers: A 12\u2010Week Randomized\u2010Trial Meta\u2010Analysis. 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