Placental products and ovine forestomach matrix for diabetic foot ulcers: two results built on industry funding

Two papers in the International Wound Journal on 1 October 2026, both testing advanced wound products added to standard care for diabetic foot ulcers.

A meta-analysis of placental-derived products (cellular, acellular and matrix-like), which pooled 9 randomised comparisons against standard care, 944 participants in all, with complete closure at 12 weeks as the outcome.

A multicentre randomised trial of an ovine forestomach matrix with hyaluronic acid, which randomised 143 people with Wagner grade 1–2 diabetic foot wounds to the matrix plus standard care or standard care alone, with complete healing at 12 weeks as the outcome.

A risk ratio (RR) compares how often something happens in one group against another. An RR of 1.70 means wounds were 1.7 times as likely to close, about 70% more likely. An RR of 1.0 means no difference.

The 95% confidence interval (CI) estimates the range for the average effect. The prediction interval estimates the range a new clinic, or a new product, could expect, and it's wider when trials disagree.

At 12 weeks, 59.0% of wounds closed with a placental product against 35.8% with standard care alone: RR 1.70 (95% CI 1.31 to 2.20).

The prediction interval was 0.93 to 3.11. Because it crosses 1.0, some products in some settings may not beat standard care, even though the average benefit is real.

The authors rated the certainty of evidence moderate, and said most of the pooled trials were industry-funded or industry-linked. The review itself had no funding.

At 12 weeks, 46% of wounds healed with the matrix plus standard care against 24% with standard care alone. After adjusting for wound area and history of ulcer recurrence, the gap narrowed to 43% against 26% (p=0.045).

Almost twice as many standard-care patients withdrew: 27.8% against 14.7% in the matrix group. Anyone who withdrew was counted as not healed, a rule that lowers the healing rate in whichever arm loses more people.

Offloading adherence wasn't reported. Both arms received standard care, but the trial didn't report how well patients kept to their offloading between visits, so differences in offloading can't be ruled out as part of the gap.

The trial was funded by Aroa Biosurgery, which makes the product.

Both results come mainly from industry-funded research. The placental meta-analysis pools trials that were mostly industry-funded or industry-linked, and the matrix trial was funded by its manufacturer.

The placental benefit is an average across different products. The prediction interval crossing 1.0 means the average can't be assumed for any one product, which needs its own trial evidence.

The matrix trial's withdrawal imbalance favours the product. With more standard-care patients counted as not healed after withdrawing, the true difference is probably smaller than 46% against 24%, and the adjusted result only just reached significance.

Both papers test a product added to standard care. Neither is evidence for using it in place of offloading, vascular assessment or infection control.

Placental products closed more diabetic foot ulcers than standard care on average, at moderate certainty, from mostly industry-linked trials and with wide variation between products. The ovine matrix trial reported more healing, but it was manufacturer-funded and lost twice as many comparison patients, so the effect size is uncertain.