Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review.
The outcome of management of diabetic foot ulcers remains a challenge, and there remains continuing uncertainty concerning optimal approaches to management. It is for these reasons that in 2008 and 2012, the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing published systematic reviews of the evidence to inform protocols for routine care and to highlight areas, which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between June 2010 and June 2014. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network criteria. Selected studies fell into the following ten categories: sharp debridement and wound bed preparation with larvae or hydrotherapy; wound bed preparation using antiseptics, applications and dressing products; resection of the chronic wound; oxygen and other gases, compression or negative pressure therapy; products designed to correct aspects of wound biochemistry and cell biology associated with impaired wound healing; application of cells, including platelets and stem cells; bioengineered skin and skin grafts; electrical, electromagnetic, lasers, shockwaves and ultrasound and other systemic therapies, which did not fit in the aforementioned categories. Heterogeneity of studies prevented pooled analysis of results. Of the 2161 papers identified, 30 were selected for grading following full text review. The present report is an update of the earlier IWGDF systematic reviews, and the conclusion is similar: that with the possible exception of negative pressure wound therapy in post-operative wounds, there is little published evidence to justify the use of newer therapies. Analysis of the evidence continues to present difficulties in this field as controlled studies remain few and the majority continue to be of poor methodological quality.
Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS FT, Derby, UK.
F L
FL
Game
Department of Endocrinology, University Hospital of Malmö, Sweden.
J
J
Apelqvist
Department of Plastic Surgery, Medstar Georgetown University, Hospital, Washington D.C., USA.
C
C
Attinger
Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, France.
A
A
Hartemann
St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK.
R J
RJ
Hinchliffe
Department of Endocrinology, University Hospital of Malmö, Sweden.
M
M
Löndahl
Vice-Chancellors' Office, Cardiff University, Cardiff, Wales, UK.
P E
PE
Price
Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
W J
WJ
Jeffcoate
D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use; D001691:Biological Therapy / Q000009:adverse effects / Q000639:trends; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000639:trends; D003646:Debridement / Q000009:adverse effects / Q000639:trends; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology / Q000534:rehabilitation / Q000628:therapy*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects / Q000639:trends; D023821:Limb Salvage / Q000009:adverse effects / Q000639:trends; D057285:Precision Medicine; D012874:Skin Diseases, Infectious / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D016038:Skin Transplantation / Q000009:adverse effects / Q000639:trends; D018461:Soft Tissue Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D035703:Therapies, Investigational / Q000009:adverse effects / Q000639:trends; D014945:Wound Healing / Q000187:drug effects
D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local
diabetes; diabetic foot; dressing; ulcer; wound healing