It’s not what you put on a wound, but what you take off that counts: Message from the literature

This brief summary of recent Cochrane reviews courtesy of our SALSA Alum, University of Washington’s Joe Fiorito.

While there is no doubt some benefit to all of these technologies (particularly in exudate management), to say that they are pivotal for healing all diabetic foot ulcers does not appear to be supported by the evidence.

Hydrogel dressings for healing diabetic foot ulcers

AUTHORS’ CONCLUSIONS:

There is some evidence to suggest that hydrogel dressings are more effective in healing (lower grade) diabetic foot ulcers than basic wound contact dressings however this finding is uncertain due to risk of bias in the original studies. There is currently no research evidence to suggest that hydrogel is  more effective than larval therapy or platelet-derived growth factors in healing diabetic foot ulcers, nor that one brand of hydrogel is more effective than another in ulcer healing. No RCTs comparing hydrogel dressings with other advanced dressing types were found
PMID: 23846869
Alginate dressings for healing diabetic foot ulcers.

AUTHORS’ CONCLUSIONS:

Currently there is no research evidence to suggest that alginate wound dressings are more effective in healing foot ulcers in people with diabetes than other types of dressing however many trials in this field are very small. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management.
PMID: 22336860

 

Foam dressings for healing diabetic foot ulcers.

AUTHORS’ CONCLUSIONS:

Currently there is no research evidence to suggest that foam wound dressings are more effective in healing foot ulcers in people with diabetes than other types of dressing however all trials in this field are very small. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management.
PMID:  21901731
Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers.

CONCLUSIONS/INTERPRETATION:

These findings summarize all available trial evidence regarding the use of dressings to heal diabetic foot ulcers. More expensive dressings may offer no advantages in terms of healing than cheaper basic dressings. In addition, evidence pointing to a difference in favor of ‘advanced’ dressing types over basic wound contact materials is of low or very low quality.
PMID: 22544222

Here’s what does appear to have some evidence:


Source

Cardiff and Vale University Health Board, Cardiff, UK. jane.lewis3@wales.nhs.uk.

Abstract

BACKGROUND:

Diabetes-related foot ulceration is a major contributor to morbidity in diabetes. Diabetic foot ulcers are partly a consequence of abnormal foot pressures and pressure relief is a widely used treatment for healing diabetes-related plantar foot ulcers, but the most effective method for healing is unclear.

OBJECTIVES:

To determine the effects of pressure-relieving interventions on the healing of foot ulcers in people with diabetes.

SEARCH METHODS:

For this update we searched the Cochrane Wounds Group Specialised Register (searched 2 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (1950 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, October 31, 2012); Ovid EMBASE (1980 to 2012 Week 43); and EBSCO CINAHL (1982 to 1 November 2012). There were no restrictions based on language or publication status.

SELECTION CRITERIA:

Randomised controlled trials evaluating the effects of pressure-relieving interventions on the healing of foot ulcers in people with diabetes.

DATA COLLECTION AND ANALYSIS:

Data from eligible trials were extracted, and summarised using a data extraction sheet, by two review authors independently.

MAIN RESULTS:

Fourteen trials (709 participants) met the inclusion criteria for the review. One study compared two different types of non-removable casts with no discernable difference between the groups. Seven studies (366 participants) compared non-removable casts with removable pressure-relieving devices. In five of those studies non-removable casts were associated with a statistically significant increase in the number of ulcers healed compared with the removable device (RR 1.17 95% CI 1.01 to 1.36: P value = 0.04).Two studies (98 participants) found that significantly more ulcers healed with non-removable casts than with dressings alone. Achilles tendon lengthening combined with a non-removable cast in one study resulted in significantly more healed ulcers at 7 months than non-removable cast alone (RR 2.23; 95% CI 1.32 to 3.76). More ulcers remained healed at two years in this group (RR 3.41; 95% CI 1.42 to 8.18).Other comparisons included surgical debridement of ulcers; felt fitted to the foot; felted foam dressings and none of these showed a statistically significant treatment effect in favour of the intervention.

AUTHORS’ CONCLUSIONS:

Non-removable, pressure-relieving casts are more effective in healing diabetes related plantar foot ulcers than removable casts, or dressings alone. Non-removable devices, when combined with Achilles tendon lengthening were more successful in one forefoot ulcer study than the use of a non-removable cast alone.

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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