***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim was to establish the potential efficacy , tolerability and side-effect profile of electromagnetic therapy as an adjunct to conventional dressings in the treatment of venous leg ulcers .  METHOD A prospect i ve , r and omized , double blind controlled clinical trial was carried out in a dedicated leg ulcer clinic based in one urban general practice . Nineteen patients with leg ulcers of confirmed venous aetiology were assessed . The main outcome measures were rate and scale of venous leg ulcer healing , changes in patient-reported pain levels , quality of life , degree of mobility , side effect profile and acceptability to patients and staff . RESULTS Sixty-eight per cent of patients attending this dedicated clinic achieved improvements in the size of their ulcer ( 4 , 21 % , healed fully ) and in reduced pain levels ( P < 0.05 ) during the trial , despite the chronicity of ulcer histories . Patients treated with electromagnetic therapy at 800 Hz were found at day 50 to have significantly greater healing ( P < 0.05 ) and pain control ( P < 0.05 ) than placebo therapy or treatment with 600 Hz . All patients reported improved mobility at the end of the study . The electromagnetic therapy was well tolerated by patients , with no differences between groups in reporting adverse events , and proved acceptable to staff . CONCLUSIONS Despite the small numbers in this pilot study , electromagnetic therapy provided significant gains in the healing of venous leg ulcers and reduction in pain BACKGROUND Diabetic foot ulcers are associated with significant morbidity . Conventional treatment modalities are often of limited success in promoting complete wound closure . The aim of the present study was to examine the efficacy of noninvasive ozone-oxygen therapy in the treatment of  diabetic foot ulcers .  METHODS Diabetes patients with a Wagner classification stage 2 or 3 ulcer or a stage 4 ulcer after debridement of at least 8 weeks in duration were included in this double-blind , r and omized , placebo-controlled clinical trial . Patients received conventional treatment in combination with either ozone-oxygen treatment or sham treatments for 12 weeks , and after an additional 12 weeks , wound status was re-examined . RESULTS In total , 61 patients ( 62 % male , 62.6±9.8 years old ) participated in the study ; 32 were r and omized to ozone treatment , and 29 to placebo .  The proportion of subjects with full wound closure did not differ significantly by treatment assignment ( 41 % vs. 33 % , P=0.34 ) . Among the 34 subjects who completed the study per protocol ( PP ) ( 16 in the ozone group , 18 in the placebo group ) , a significantly higher rate of complete wound closure was observed in the ozone group ( 81 % vs. 44 % , P=0.03 ) . Among PP patients with wound size ≤5 cm(2 ) , the rate of total wound closure was 100 % versus 50 % in the sham treatment group ( P=0.006 ) . A nonsignificant , 55.5 % relative increase in healed wound area was detected in the ozone group versus the placebo group ( 4.2±4.9 cm(2 ) vs. 2.7±1.5 cm(2 ) , P=0.23 ) . CONCLUSIONS Among PP patients  , ozone treatment in addition to conventional treatment was superior to conventional treatment alone in promoting the complete healing of diabetic foot ulcers Nonhealing  diabetic foot ulcers  are a common cause of amputation . Emerging cellular therapies such as platelet-rich plasma gel provide ulcer management options to avoid loss of limb . The purpose of this prospect i ve , r and omized , controlled , blinded , multicenter clinical study was to evaluate the safety and efficacy of autologous platelet-rich plasma gel for the treatment of  nonhealing diabetic foot ulcers . One hundred , twenty-nine ( 129 ) patients were screened ; 72 completed a 7-day screening period and met the study inclusion criteria . Patients were r and omized into two groups - the st and ard care with platelet-rich plasma gel or control ( saline gel ) dressing group - and evaluated biweekly for 12 weeks or until healing . Healing was confirmed 1 week following closure and monitored for another 11 weeks . An independent audit led to the exclusion of 32 patients from the final per- protocol analysis because of protocol violations and failure to complete treatment . In this group , 13 out of 19 ( 68.4 % ) of the platelet-rich plasma gel and nine out of 21 ( 42.9 % ) of the control wounds healed . After adjusting for wound size outliers ( n = 5 ) , significantly more platelet-rich plasma gel ( 13 out of 16 , 81.3 % ) than control gel ( eight out of 19 , 42.1 % ) treated wounds healed ( P = 0.036 , Fisher 's exact test ) . Kaplan-Meier time-to-healing also was significantly different between groups ( log-rank , P = 0.0177 ) . No treatment-related serious adverse events were reported and bovine thrombin used in the preparation of PRP did not cause Factor V inhibition . When used with good st and ards of care , the majority of nonhealing diabetic foot ulcers treated with autologous platelet-rich plasma gel can be expected to heal OBJECTIVE  Chronic diabetic foot ulcers  are a source of major concern for both patients and health care systems . The aim of this study was to evaluate the effect of hyperbaric oxygen therapy ( HBOT ) in the management of  chronic diabetic foot ulcers .  RESEARCH DESIGN AND METHODS The Hyperbaric Oxygen Therapy in Diabetics with Chronic Foot Ulcers ( HODFU ) study was a r and omized , single-center , double-blinded , placebo-controlled clinical trial . The outcomes for the group receiving HBOT were compared with those of the group receiving treatment with hyperbaric air . Treatments were given in a multi-place hyperbaric chamber for 85-min daily ( session duration 95 min ) , five days a week for eight weeks ( 40 treatment sessions ) . The study was performed in an ambulatory setting . RESULTS Ninety-four patients with Wagner grade 2 , 3 , or 4 ulcers , which had been present for > 3 months , were studied . In the intention-to-treat analysis , complete healing of the index ulcer was achieved in 37 patients at 1-year of follow-up : 25/48 ( 52 % ) in the HBOT group and 12/42 ( 29 % ) in the placebo group ( P = 0.03 ) . In a sub- analysis of those patients completing > 35 HBOT sessions , healing of the index ulcer occurred in 23/38 ( 61 % ) in the HBOT group and 10/37 ( 27 % ) in the placebo group ( P = 0.009 ) . The frequency of adverse events was low . CONCLUSIONS The HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes OBJECTIVE To test the safety , efficacy , and immunological impact of a cultured allogeneic human skin equivalent ( HSE ) in the treatment of venous ulcers . DESIGN Prospect i ve , r and omized study . SETTING Multicenter study in the outpatient setting . INTERVENTION Each patient with a venous ulcer received either compression therapy alone or compression therapy and treatment with HSE . The patients were evaluated for  HSE safety , complete ( 100 % ) ulcer healing , time to wound closure , wound recurrence , and immune response to the HSE .  OUTCOME The study was completed as planned in 293 r and omized patients . RESULTS Treatment with HSE was more effective than compression therapy in the percentage of patients healed by 6 months ( 63 % vs 49 % ; P=.02 , Fisher exact test , 2-tailed ) and the median time to complete wound closure ( 61 days vs 181 days ; P=.003 , log-rank test ) . Treatment with HSE was superior to compression therapy in healing larger ( > 1000 mm2 ; P=.02 ) and deeper ulcers ( P=.003 ) and ulcers of more than 6 months ' duration ( P=.001 ) . Occurrence of adverse events was similar in both groups . No symptoms or signs of rejection occurred in response to treatment with HSE , and no  HSE-specific immune responses were detected in vitro to bovine collagen or to alloantigens expressed on keratinocytes or fibroblasts . CONCLUSIONS Treatment with HSE healed venous ulcers more rapidly and in more patients than compression therapy alone . There was no clinical or laboratory evidence of rejection or sensitization in response to HSE application . These data suggest that HSE represents a significant advance in the treatment of venous ulcers , particularly those that are difficult to heal PURPOSE The purpose of this study was to investigate the efficacy and safety of recombinant human platelet-derived growth factor ( rhPDGF-BB ) in a double-blind , placebo-controlled , multicenter study of patients with chronic diabetic ulcers . METHODS Patients with chronic , full-thickness , lower-extremity diabetic neurotrophic ulcers of at least 8 weeks ' duration , free of necrotic and infected tissue after debridement , and with transcutaneous oxygen tensions of 30 mm Hg or greater were studied . A total of 118 patients were r and omized to receive either topical rhPDGF-BB ( 2.2 micrograms/cm2 of ulcer area ) or placebo until the ulcer was completely resurfaced or for a maximum of 20 weeks , whichever occurred first . RESULTS Twenty-nine ( 48 % ) of 61 patients r and omized to the rhPDGF-BB group achieved complete wound healing during the study compared with only 14 ( 25 % ) of 57 patients r and omized to the placebo group ( p = 0.01 ) . The median reduction in wound area in the group given rhPDGF-BB was 98.8 % compared with 82.1 % in the group given placebo ( p = 0.09 ) . There were no significant differences in the incidence or severity of adverse events between the rhPDGF-BB and placebo groups . CONCLUSIONS Once-daily topical application of rhPDGF-BB is safe and effective in stimulating the healing of chronic , full-thickness , lower-extremity diabetic neurotrophic ulcers OBJECTIVE To evaluate the healing rate of venous leg ulcers treated with Promogran . METHOD Patients with stagnating venous leg ulcers were recruited . Target wounds were > or = 2 cm but < or = 10 cm in any one dimension . Subjects were r and omly allocated to receive either Promogran or a non-adherent dressing ( Adaptic ) with a secondary dressing of gauze followed by short-stress compression ( Biflex ) . Weekly wound assessment s occurred over 12 weeks and dressings were changed twice weekly by the investigator and /or nurse team . Planimetry tracings and photographs were blindly review ed and assessed by two independent investigators . An intent-to-treat analysis was performed . RESULTS Seventy-three patients were included . Thirty-seven were r and omly allocated Promogran and 36 Adaptic . Twenty-nine patients completed the 12-week follow-up visit , 25 healed before week 12 and 19 stopped follow-up before week 12 for reasons unrelated to healing . Significantly more patients in the Adaptic group than in the Promogran group switched to another dressing ( 22.2 % versus 5.4 % ; p = 0.035 ) . Eleven venous leg ulcers healed in the control group ( 31 % ) and 15 in the Promogran group ( 41 % ) ( p = 0.373 ) . Overall , 15 venous leg ulcers healed or improved in the control group ( 42 % ) and 23 in the Promogran group ( 62 % ) ( p = 0.079 ) . Surface area decreased , on average , by 36.5 + /- 11.4 % ( median decrease : 44.6 % ) in the Adaptic group and by 54.4 + /- 10.9 % ( median decrease : 82.4 % ) in the Promogran group ( p < 0.001 ) . A < or = 20 % surface area reduction was observed in 15 patients in the Adaptic group and in seven in the Promogran group ( 42 % versus 19 % ; p = 0.034 ) . No severe local adverse events were noted in either group , although poor tolerability caused a dressing switch in five patients in the control group and three in the Promogran group . Dressing acceptability was good or excellent in more than 60 % of subjects in both groups . CONCLUSION The results suggest that Promogran may accelerate healing in venous leg ulcers and was well tolerated compared with the current st and ard of care Diabetic foot wounds present a great challenge to wound care practitioners . The objective of this pilot study was to determine whether vacuum-assisted closure ( V.A.C. ) therapy would afford quicker wound resolution as compared to saline-moistened gauze in the treatment of postoperative diabetic foot wounds . Ten patients were r and omized into either the  experimental V.A.C.  group or control saline gauze  group . Included in the study were diabetic patients 18 to 75 years of age who had a nonhealing foot ulceration . Excluded were those patients with venous disease , coagulopathy , or those who had active infections not resolved by initial surgical debridement . All foot ulcers were surgically debrided prior to 
    Output:
    
Overall , strength of evidence was low for ulcer healing and low or insufficient for time to complete healing .
Compared with st and ard care , some advanced wound care therapies may improve the proportion of ulcers healed and reduce time to healing , although evidence is limited .