SLR - June 2021 - Joseph S. Coppola

The Effect of Kiwifruit Therapeutics in the Treatment of Diabetic Foot Ulcer
Reference: Kardoust M, Salehi H, Taghipour Z, Sayadi A. The Effect of Kiwifruit Therapeutics in the Treatment of Diabetic Foot Ulcer. Int J Low Extrem Wounds. 2021 Feb 2:1534734619851700. doi: 10.1177/1534734619851700. Epub ahead of print. PMID: 33527863.
Level of Evidence: Level III
Scientific Literature Review

Reviewed By: Joseph S. Coppola, DPM
Residency Program: MetroWest Medical Center- Framingham, MA
Podiatric Relevance: Diabetes Mellitus (DM) is a chronic, metabolic disease with increasing prevalence worldwide. Complications are common including foot ulcers seen in approximately 14-24 percent of patients. As ulcers typically precede amputation, wound care is vital to potentially stall this progression. Because of this, it is of utmost importance for the Podiatric Physician to have a sound understanding of wound care. Many different agents and techniques exist, and this article provides a cost-effective, adjunct therapy to the increasing modalities in current practice. 

Methods: A randomized, double-blind clinical trial was performed on patients presenting with diabetic foot ulcers. Initially, 32 patients were identified but 14 patients were excluded due to current antibiotic usage, need for urgent debridement or ulcers classified as Wagner three and above. Patients were then divided both evenly and randomly into control and experimental arms. Baseline images and measurements were taken for all patients. Patients in the control group underwent daily wound dressing with Eucerin ointment and experimental patients underwent daily dressing changes with kiwi extract (pulp of fruit added to Eucerin). Clinical data including general appearance, measurements, recovery rate, and need for surgical debridement were assessed weekly by trained personnel. 
Results: Baseline characteristics of the experimental group compared with control did not show any statistically significant difference between groups (P=.625). Both groups showed the same level of neuropathy severity. However, the mean wound area (size difference) of the experimental group (Baseline 2.19 +/- 0.73, Final visit 0.94 +/- 0.58) was statistically significantly (P= .0001) less than the control (baseline 2.03 +/- 0.58, Final visit 1.83+/-0.57) after four weeks of kiwifruit debridement. The physical alteration of the wound appearance in the first and last days of the study in both groups indicate more wound healing in the experimental group. 
Conclusions: In the present study, the authors conclude that both control and experimental groups show a reduction in overall wound size. However, in those treated with topical kiwifruit extract for four weeks, the reduction rate was significantly different compared to control. This is consistent with current literature revealing actinidin, the main enzyme in kiwifruit, reduces wound surface area in both human and animal studies. In the long term, the use of topical kiwifruit extract is a cost-effective modality showing clinical importance in its ability to heal foot ulcers faster than traditional therapies and can potentially reduce the use of anesthesia and surgery. Further studies, on a larger scale, are warranted to obtain more reliable findings. 

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