title: A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes.
abstract: The outcome of management of diabetic foot ulcers is poor and there is uncertainty concerning optimal approaches to management. We have undertaken a systematic review to identify interventions for which there is evidence of effectiveness. A search was made for reports of the effectiveness of interventions assessed in terms of healing, ulcer area or amputation in controlled clinical studies published prior to December 2006. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Selected studies fell into the following categories: sharp debridement and larvae; antiseptics and dressings; chronic wound resection; hyperbaric oxygen (HBO); reduction of tissue oedema; skin grafts; electrical and magnetic stimulation and ultrasound. Heterogeneity of studies prevented pooled analysis of results. Of the 2251 papers identified, 60 were selected for grading following full text review. Some evidence was found to support hydrogels as desloughing agents and to suggest that a systemic (HBO) therapy may be effective. Topical negative pressure (TNP) may promote healing of post-operative wounds, and resection of neuropathic plantar ulcers may be beneficial. More information was needed to confirm the effectiveness and cost-effectiveness of these and other interventions. No data were found to justify the use of any other topically applied product or dressing, including those with antiseptic properties. Further evidence to substantiate the effect of interventions designed to enhance the healing of chronic ulcers is urgently needed. Until such evidence is available from robust trials, there is limited justification for the use of more expensive treatments and dressings.
authors.affiliation: Department of Vascular Surgery, Nottingham University Hospitals Trust, Nottingham, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: G D
authors.initials: GD
authors.lastname: Valk
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
authors.forename: D G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: K
authors.initials: K
authors.lastname: Bakker
authors.forename: F L
authors.initials: FL
authors.lastname: Game
authors.forename: A
authors.initials: A
authors.lastname: Hartemann-Heurtier
authors.forename: M
authors.initials: M
authors.lastname: Löndahl
authors.forename: P E
authors.initials: PE
authors.lastname: Price
authors.forename: W H
authors.initials: WH
authors.lastname: van Houtum
authors.forename: W J
authors.initials: WJ
authors.lastname: Jeffcoate
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D001458:Bandages; D002908:Chronic Disease; D003646:Debridement; D017719:Diabetic Foot / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004487:Edema / Q000517:prevention & control; D016523:Foot Ulcer / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D006931:Hyperbaric Oxygenation; D016038:Skin Transplantation; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000890:Anti-Infective Agents; D016179:Granulocyte Colony-Stimulating Factor