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Monami M, Ragghianti B, Scatena A, Miranda C, Monge L, Uccioli L, Stefanon L, Cappella C, Silverii A, Vermigli C. Effectiveness of different advanced wound dressings versus standard of care for the management of diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024:10.1007/s00592-024-02320-2. [PMID: 38864979 DOI: 10.1007/s00592-024-02320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
AIM to assess the effects of advanced wound dressings (AWD) commonly used in the treatment of predominantly neuropathic diabetic foot ulcers (DFU) The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS). METHODS A Medline and Embase search were performed up to April 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with DFU comparing AWD with placebo/standard of care (SoC), with a duration of at least 12 weeks. Prespecified endpoints were: ulcer healing (principal), time-to-healing, frequency of dressings change, major and minor amputation, pain, and all-cause mortality. AWD assessed were: alginates; foam, hydrocolloids, hydrogels, hyaluronic acid, hemoglobin spray, silver-impregnated, sucrose octasulfate-impregnated, honey-impregnated, micro-organism-binding, and protease-modulating matrix dressings. Mantel-Haenzel Odds ratios and 95% confidence intervals (MH-OR, 95% CIs) were either calculated or extracted directly from the publications. Weighted mean differences (WMD) and 95% CIs were calculated for continuous variables. RESULTS Fifteen studies fulfilled all inclusion criteria. Participants treated with AWD had a significantly higher ulcer healing rate and shorter time-to-healing in comparison with SoC/placebo (MH-OR 1.50 [0.80, 2.79], p = 0.20 and WMD:: - 24.38 [- 42.90, - 5.86] days, p = 0.010). No other significant effect on the above reported prespecified endpoints were observed. For the primary endpoint, the quality of evidence was rated as "moderate". CONCLUSIONS In conclusion, AWD, particularly sucrose-octasulfate, hydrogels, hyaluronic acid, and honey dressings, can actively promote wound healing and shortening time-to-healing in patients with DFU.
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Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.
- Diabetic Foot Unit, Careggi Teaching Hospital, Florence, Italy.
| | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Alessia Scatena
- San Donato Hospital, Health Authorities South East Tuscany, ArezzoArezzo, Italy
| | | | - Luca Monge
- AMD - Italian Association of Clinical Diabetologists, Rome, Italy
| | - Luigi Uccioli
- Diabetes Section CTO Hospital and Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | | | | | - Antonio Silverii
- Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Pennington E, Bell S, Hill JE. Should video laryngoscopy or direct laryngoscopy be used for adults undergoing endotracheal intubation in the pre-hospital setting? A critical appraisal of a systematic review. JOURNAL OF PARAMEDIC PRACTICE : THE CLINICAL MONTHLY FOR EMERGENCY CARE PROFESSIONALS 2023; 15:255-259. [PMID: 38812899 PMCID: PMC7616025 DOI: 10.1002/14651858] [Citation(s) in RCA: 2487] [Impact Index Per Article: 2487.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The safety and utility of endotracheal intubation by paramedics in the United Kingdom is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice.
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Affiliation(s)
| | - Steve Bell
- Consultant Paramedic, North West Ambulance Service NHS Trust
| | - James E Hill
- University of Central Lancashire, Colne, Lancashire
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Mahmood S, Khan NR, Razaque G, Shah SU, Shahid MG, Albarqi HA, Alqahtani AA, Alasiri A, Basit HM. Microwave-Treated Physically Cross-Linked Sodium Alginate and Sodium Carboxymethyl Cellulose Blend Polymer Film for Open Incision Wound Healing in Diabetic Animals-A Novel Perspective for Skin Tissue Regeneration Application. Pharmaceutics 2023; 15:pharmaceutics15020418. [PMID: 36839741 PMCID: PMC9959634 DOI: 10.3390/pharmaceutics15020418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
This study aimed at developing the microwave-treated, physically cross-linked polymer blend film, optimizing the microwave treatment time, and testing for physicochemical attributes and wound healing potential in diabetic animals. Microwave-treated and untreated films were prepared by the solution casting method and characterized for various attributes required by a wound healing platform. The optimized formulation was tested for skin regeneration potential in the diabetes-induced open-incision animal model. The results indicated that the optimized polymer film formulation (MB-3) has significantly enhanced physicochemical properties such as high moisture adsorption (154.6 ± 4.23%), decreased the water vapor transmission rate (WVTR) value of (53.0 ± 2.8 g/m2/h) and water vapor permeability (WVP) value (1.74 ± 0.08 g mm/h/m2), delayed erosion (18.69 ± 4.74%), high water uptake, smooth and homogenous surface morphology, higher tensile strength (56.84 ± 1.19 MPa), and increased glass transition temperature and enthalpy (through polymer hydrophilic functional groups depicting efficient cross-linking). The in vivo data on day 16 of post-wounding indicated that the wound healing occurred faster with significantly increased percent re-epithelialization and enhanced collagen deposition with optimized MB-3 film application compared with the untreated group. The study concluded that the microwave-treated polymer blend films have sufficiently enhanced physical properties, making them an effective candidate for ameliorating the diabetic wound healing process and hastening skin tissue regeneration.
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Affiliation(s)
- Saima Mahmood
- Gomal Centre for Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, DIKhan 29050, Khyber Pakhtunkhwa, Pakistan
| | - Nauman Rahim Khan
- Gomal Centre for Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, DIKhan 29050, Khyber Pakhtunkhwa, Pakistan
- Department of Pharmacy, Kohat University of Science and Technology, Kohat 26000, Khyber Pakhtunkhwa, Pakistan
- Correspondence:
| | - Ghulam Razaque
- Faculty of Pharmacy, University of Baluchistan, Quetta 87300, Baluchistan, Pakistan
| | - Shefaat Ullah Shah
- Gomal Centre for Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, DIKhan 29050, Khyber Pakhtunkhwa, Pakistan
| | | | - Hassan A. Albarqi
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 55461, Saudi Arabia
| | - Abdulsalam A. Alqahtani
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 55461, Saudi Arabia
| | - Ali Alasiri
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran 55461, Saudi Arabia
| | - Hafiz Muhammad Basit
- Akhtar Saeed College of Pharmacy, Bahria Golf City, Rawalpindi 46220, Punjab, Pakistan
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Su HY, Yang CY, Ou HT, Chen SG, Chen JC, Ho HJ, Kuo S. Cost-effectiveness of Novel Macrophage-Regulating Treatment for Wound Healing in Patients With Diabetic Foot Ulcers From the Taiwan Health Care Sector Perspective. JAMA Netw Open 2023; 6:e2250639. [PMID: 36633847 PMCID: PMC9856772 DOI: 10.1001/jamanetworkopen.2022.50639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Diabetic foot ulcers (DFUs) and subsequent amputation incur enormous health and economic burdens to patients, health care systems, and societies. As a novel macrophage-regulating drug, ON101 is a breakthrough treatment for DFUs, which demonstrated significant complete wound healing effects in a phase 3 randomized clinical trial, but its economic value remains unknown. OBJECTIVE To assess the cost-effectiveness of an ON101 cream added on to general wound care (GWC; ie, conventional treatments for DFUs, which comprised initial and regular foot examinations, ulcer management, comorbidity control, patient education, and multidisciplinary care) vs GWC alone for DFUs from the Taiwan health care sector perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a hypothetical cohort of patients with diabetes, with characteristics mirroring those of the participants in the ON101 trial. A Markov state-transition simulation model was constructed to estimate costs and health outcomes associated with the ON101 with GWC and GWC alone strategies over a 5-year time horizon, discounting costs and effectiveness at 3% annually. Costs were in 2021 US dollars. Data were sourced from the ON101 trial and supplemented from published literature. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of input parameters and study generalizability. The analysis was designed and conducted from September 1, 2020, to January 31, 2022. EXPOSURES ON101 with GWC vs GWC alone. MAIN OUTCOMES AND MEASURES DFU-related complications, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. RESULTS Patients in the hypothetical cohort had a mean age of 57 years and an uninfected DFU of 1 to 25 cm2 that was present for 4 or more weeks with a Wagner grade of 1 or 2. Over 5 years, the ON101 with GWC group vs the GWC alone group experienced more healing events, stayed for a longer time in the healing state, and had fewer infected DFUs, gangrene, and amputations (eg, 2787 additional healing events and 2766 fewer infected DFU, 72 fewer amputation, and 7 fewer gangrene events in the ON101 with GWC group vs GWC alone group). The ON101 with GWC strategy vs GWC alone yielded an additional 0.038 QALYs at an incremental cost of $571, resulting in $14 922/QALY gained. Economic results were most sensitive to healing efficacy, drug cost, and health utility of the healing state. Cost-saving results were observed in patient subgroups with poor glycemic control, larger ulcer sizes, longer ulcer durations, and current smoking. The ON101 with GWC strategy was considered cost-effective in 60% to 82% of model iterations against willingness-to-pay thresholds of $32 787/QALY gained to $98 361/QALY gained. CONCLUSIONS AND RELEVANCE In this economic evaluation study using a simulated patient cohort, the ON101 with GWC strategy represented good value compared with GWC alone for patients with DFUs from the Taiwan health care sector perspective and may be prioritized for those with high risks for disease progression of DFUs.
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Affiliation(s)
- Hsuan-Yu Su
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yi Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyi-Gen Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
- Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Jui-Ching Chen
- Department of Medical Science, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Hui-Ju Ho
- Department of Clinical Research, Oneness Biotech Co, Ltd, Taipei, Taiwan
| | - Shihchen Kuo
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Dayya D, O'Neill O, Habib N, Moore J, Iyer K, Huedo-Medina TB. Debridement of diabetic foot ulcers: public health and clinical implications – a systematic review, meta-analysis, and meta-regression. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000081. [PMID: 35721280 PMCID: PMC9152938 DOI: 10.1136/bmjsit-2021-000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/07/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundDiabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%–34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted.ObjectivesAre debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes?Study eligibility criteriaAll SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control.Data sourcesCochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science.Participants and interventionsAdults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control.Main OutcomesAmputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost.Study selection and analysisData extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis.Results10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes.LimitationsThe studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence.Discussion/ConclusionWeak evidence exists that debridement methods are superior to other forms of debridement or control in DFU.ImplicationsResearchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.
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Affiliation(s)
- David Dayya
- Division of Undersea and Hyperbaric Medicine, Department of Surgery, Phelps Hospital Northwell Health, Sleepy Hollow, New York, USA
- Department of Surgery, Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY, USA
- Division of Undersea and Hyperbaric Medicine, Department of Emergency Medicine, State University of New York - Upstate Medical University, Syracuse, New York, USA
- Department of Medicine, Greenwich Hospital - Yale New Haven Health System, Greenwich, NY, USA
| | - Owen O'Neill
- Division of Undersea and Hyperbaric Medicine, Department of Surgery, Phelps Hospital Northwell Health, Sleepy Hollow, New York, USA
- Department of Surgery, Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY, USA
- Division of Undersea and Hyperbaric Medicine, Department of Emergency Medicine, State University of New York - Upstate Medical University, Syracuse, New York, USA
| | - Nusrat Habib
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Joanna Moore
- Department of Medicine, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Kartik Iyer
- Department of Medicine, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
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Lustig A, Gefen A. The performance of gelling fibre wound dressings under clinically relevant robotic laboratory tests. Int Wound J 2022; 19 Suppl 1:3-21. [PMID: 35142062 PMCID: PMC9478960 DOI: 10.1111/iwj.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
The effectiveness of wound dressing performance in exudate management is commonly gauged in simple, non‐realistic laboratory setups, typically, where dressing specimens are submersed in vessels containing aqueous solutions, rather than by means of clinically relevant test configurations. Specifically, two key fluid–structure interaction concepts: sorptivity—the ability of wound dressings to transfer exudate, including viscous fluids, away from the wound bed by capillary action and durability—the capacity of dressings to maintain their structural integrity over time and particularly, at removal events, have not been properly addressed in existing test protocols. The present article reviews our recent published research concerning the development of clinically relevant testing methods for wound dressings, focussing on the clinical relevance of the tests as well as on the standardisation and automation of laboratory measurements of dressing performance. A second objective of this work was to compile the experimental results characterising the performance of gelling fibre dressings, which were acquired using advanced testing methods, to demonstrate differences across products that apparently belong to the same “gelling fibre” family but differ remarkably in materials, structure and composition and, thereby, in performance.
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Affiliation(s)
- Adi Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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Takeuchi T, Ito M, Yamaguchi S, Watanabe S, Honda M, Imahashi T, Yamada T, Kokubo T. Hydrocolloid dressing improves wound healing by increasing M2 macrophage polarization in mice with diabetes. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:487-498. [PMID: 33132433 PMCID: PMC7548260 DOI: 10.18999/nagjms.82.3.487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Impaired wound healing is one of the most common complications of diabetes, and is known to be caused by multiple complicated factors. For instance, impaired angiogenesis, neuropathy, and hyperglycemia all function to delay subsequent wound closure. Alternatively, moist wound healing, which provides an appropriate environment for wounds, was reported to permit rapid healing by managing wound exudate. Accordingly, wound dressing materials that facilitate moist healing have been developed. The present study sought to clarify the effects of wound dressing material for moist healing of diabetic wounds, in terms of the dynamics of angiogenic factors and macrophages, using a mouse model of naturally occurring diabetes. Wounds with full-thickness skin defects were inflicted on the backs of mice and covered with dressing materials of hydrogel or gauze (control), which were retained for 3, 5, 7, 10, or 14 days following wound generation. During this time, the localization of neutrophils, fibroblasts and macrophages as well as the expression of vascular endothelial growth factor (VEGF) in the wounds and surrounding areas was observed each day. Healing clearly occurred in the hydrogel group with an increase in neutrophils and the angiogenic factor, VEGF. Moreover, the use of hydrogel resulted in a rapid rise in M1 macrophages, which appeared in the early stage of the injury, as well as rapid subsequent appearance of M2 macrophages. Thus, herein, we demonstrate that the formation of a moist environment via wound dressing material effectively improves diabetic wound healing.
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Affiliation(s)
- Tamaki Takeuchi
- Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Kasugai, Japan
| | - Morihiro Ito
- Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Kasugai, Japan.,Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Seiji Yamaguchi
- Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Kasugai, Japan
| | - Saki Watanabe
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Masashi Honda
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Takuya Imahashi
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Tsuyoshi Yamada
- Graduate School of Life and Health Sciences, Chubu University, Kasugai, Japan.,Department of Radiological Technology, Mie University Hospital, Tsu, Japan
| | - Tadashi Kokubo
- Department of Biomedical Sciences, College of Life and Health Science, Chubu University, Kasugai, Japan
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Raina N, Rani R, Pahwa R, Gupta M. Biopolymers and treatment strategies for wound healing: an insight view. INT J POLYM MATER PO 2020. [DOI: 10.1080/00914037.2020.1838518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Neha Raina
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences & Research University, Delhi, India
| | - Radha Rani
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences & Research University, Delhi, India
| | - Rakesh Pahwa
- Institute of Pharmaceutical Sciences, Kurukshetra University, Kurukshetra, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences & Research University, Delhi, India
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9
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Vas P, Rayman G, Dhatariya K, Driver V, Hartemann A, Londahl M, Piaggesi A, Apelqvist J, Attinger C, Game F. Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3284. [PMID: 32176446 DOI: 10.1002/dmrr.3284] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022]
Abstract
The management of diabetic foot ulcers (DFU) remains a challenge, and there is continuing uncertainty concerning optimal approaches to wound healing. The International Working Group of the Diabetic Foot (IWGDF) working group on wound healing has previously published systematic reviews of the evidence in 2008, 2012 and 2016 to inform protocols for routine care and to highlight areas which should be considered for further study. The working group has now updated this review by considering papers on the interventions to improve the healing of DFU's published between June 2014 and August 2018. Methodological quality of selected studies was independently assessed by a minimum of two reviewers using the recently published 21-point questionnaire as recommended by IWGDF/European Wound Management Association, as well as the previously incorporated Scottish Intercollegiate Guidelines Network criteria. Of the 2275 papers identified, 97 were finally selected for grading following full text review. Overall, there has been an improvement in study design and a significant rise in the number of published studies. While previous systematic reviews did not find any evidence to justify the use of newer therapies, except for negative pressure wound therapy in post-surgical wounds, in this review we found additional evidence to support some interventions including a sucrose-octasulfate dressing, the combined leucocyte, fibrin and platelet patch as well as topical application of some placental membrane products, all when used in addition to usual best care. Nonetheless, the assessment and comparison of published trials remains difficult with marked clinical heterogeneity between studies: in patient selection, study duration, standard of usual care provision and the timing and description of the clinical endpoints.
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Affiliation(s)
- Prashanth Vas
- Diabetes Foot Clinic, King's College Hospital, London, UK
| | - Gerry Rayman
- Diabetes Centre and Research Unit, East Suffolk and North East Essex Foundation Trust, Colchester, UK
| | - Ketan Dhatariya
- Department of Diabetes, Norfolk and Norwich University Hospitals NHS Foundation Trust, University of East Anglia, Norwich, UK
| | - Vickie Driver
- School of Medicine, Brown University, Providence, RI
| | - Agnes Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, Lyon, France
| | - Magnus Londahl
- Department of Endocrinology, Skane University Hospital, Lund, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | - Chris Attinger
- Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington DC, WA
| | - Fran Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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10
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Rayman G, Vas P, Dhatariya K, Driver V, Hartemann A, Londahl M, Piaggesi A, Apelqvist J, Attinger C, Game F. Guidelines on use of interventions to enhance healing of chronic foot ulcers in diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 Suppl 1:e3283. [PMID: 32176450 DOI: 10.1002/dmrr.3283] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/20/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. In conjunction with advice from internal and external reviewers and expert consultants in the field, this update is based on a systematic review of the literature centred on the following: the Population (P), Intervention (I), Comparator (C) and Outcomes (O) framework; the use of the SIGN guideline/Cochrane review system; and the 21 point scoring system advocated by IWGDF/EWMA. This has resulted in 13 recommendations. The recommendation on sharp debridement and the selection of dressings remain unchanged from the last recommendations published in 2016. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. Recommendations against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide, nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means also remain. New recommendations include consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuro-ischaemic ulcers and consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal, in both cases when used in addition to best standard of care. A further new recommendation is the consideration of topical placental derived products when used in addition to best standard of care.
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Affiliation(s)
- Gerry Rayman
- Diabetes Centre and Research Unit, East Suffolk and North East Essex Foundation Trust, UK
| | - Prashanth Vas
- Diabetes Foot Clinic, King's College Hospital, London, UK
| | - Ketan Dhatariya
- Department of Diabetes, Norfolk and Norwich University Hospitals NHS Foundation Trust, and University of East Anglia, Norwich, UK
| | - Vickie Driver
- Brown University School of Medicine, Providence, Rhode Island
| | - Agnes Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, Paris, France
| | - Magnus Londahl
- Department of Endocrinology, Skane University Hospital, Lund, and Department of Clinical Sciences, Lund, Lund University, Sweden
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Italy
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
| | - Chris Attinger
- Department of Plastic Surgery, Medstar Georgetown University, Hospital, Washington, DC, USA
| | - Fran Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Shah SA, Sohail M, Khan S, Minhas MU, de Matas M, Sikstone V, Hussain Z, Abbasi M, Kousar M. Biopolymer-based biomaterials for accelerated diabetic wound healing: A critical review. Int J Biol Macromol 2019; 139:975-993. [PMID: 31386871 DOI: 10.1016/j.ijbiomac.2019.08.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
Non-healing, chronic wounds place a huge burden on healthcare systems as well as individual patients. These chronic wounds especially diabetic wounds will ultimately lead to compromised mobility, amputation of limbs and even death. Currently, wounds and limb ulcers associated with diabetes remain significant health issues; the associated healthcare cost ultimately leads to the increased clinical burden. The presence of diabetes interrupts a highly coordinated cascade of events in the wound closure process. Advances in the understanding of pathophysiological conditions associated with diabetic wounds lead to the development of drug delivery systems which can enhance wound healing by targeting various phases of the impaired processes. Wound environments typically contain degradative enzymes, along with an elevated pH and demonstrate a physiological cascade involved in the regeneration of tissue, which requires the application of an effective delivery system. This article aims to review the pathophysiological conditions associated with chronic and diabetic wounds. The delivery systems, involved in their treatment are described, highlighting potential biomaterials and polymers for establishing drug delivery systems, specifically for the treatment of diabetic wounds and the promotion of the associated mechanisms involved in advanced wound healing. Emerging approaches and engineered devices for effective wound care are reported. The discussion will give insight into the mechanisms relevant to all stages of wound healing.
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Affiliation(s)
- Syed Ahmed Shah
- Department of Pharmacy, COMSATS University, Islamabad, Abbottabad Campus, 22060, Pakistan
| | - Muhammad Sohail
- Department of Pharmacy, COMSATS University, Islamabad, Abbottabad Campus, 22060, Pakistan.
| | - Shahzeb Khan
- Department of Pharmacy, University of Malakand, Lower Dir, KPK, Pakistan; Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, 2409, USA.; Discipline of Pharmaceutical Sciences, School of Health Sciences, UKZN, Durban, South Africa
| | | | - Marcel de Matas
- SEDA Pharmaceutical Development Services, The BioHub at Alderley Park, Cheshire, UK
| | - Victoria Sikstone
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, UK
| | - Zahid Hussain
- Department of Pharmaceutics & Pharmaceutical Technology, College of Pharmacy, University of Sharjah, Sharjah, 27272, United Arab Emirates
| | - Mudassir Abbasi
- Department of Pharmacy, COMSATS University, Islamabad, Abbottabad Campus, 22060, Pakistan
| | - Mubeen Kousar
- Department of Pharmacy, COMSATS University, Islamabad, Abbottabad Campus, 22060, Pakistan
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12
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Ferroni L, Gardin C, De Pieri A, Sambataro M, Seganfreddo E, Goretti C, Iacopi E, Zavan B, Piaggesi A. Treatment of diabetic foot ulcers with Therapeutic Magnetic Resonance (TMR®) improves the quality of granulation tissue. Eur J Histochem 2017; 61:2800. [PMID: 29046049 PMCID: PMC5572111 DOI: 10.4081/ejh.2017.2800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/25/2017] [Accepted: 06/25/2017] [Indexed: 11/22/2022] Open
Abstract
Diabetic foot ulcers (DFUs) often result in severely adverse outcomes, such as serious infections, hospitalization, and lower extremity amputations. In last few years, to improve the outcome of DFUs, clinicians and researchers put their attention on the application of low intensity pulsating electro-magnetic fields through Therapeutic Magnetic Resonance (TMR®). In our study, patients with DFUs have been divided into two groups: The Sham Group treated with non-functioning TMR® device, and the Active Group treated with a functioning device. Biopsies were recovered from ulcers before and after a 15-day treatment with both kind of TMR® device. To recognize signs of inflammation or healing process, the harvested biopsies were subjected to histological and molecular analyses. The histological analysis showed a change in cell population after treatment with TMR®: an increase of fibroblasts and endothelial cells with a reduction of inflammatory cells. After TMR® application, the gene expression profile analysis revealed an improvement in extracellular matrix components such as matrix metalloproteinases, collagens and integrins, a reduction in pro-inflammatory interleukins, and an increase in growth factors expression. In conclusion, our research has identified histological and molecular features of reduced inflammation and increased cell proliferation during the wound healing process in response to TMR® application.
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13
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Cullum N, Buckley H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Goncalves PS, Soares M, Stubbs N. Wounds research for patient benefit: a 5-year programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04130] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | - Richard Morley
- Department of Health Sciences, University of York, York, UK
| | - Susan O’Meara
- Department of Health Sciences, University of York, York, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
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14
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Dini V, Romanelli M, Piaggesi A, Stefani A, Mosca F. Cutaneous Tissue Engineering and Lower Extremity Wounds (Part 2). INT J LOW EXTR WOUND 2016; 5:27-34. [PMID: 16543210 DOI: 10.1177/1534734606286464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a previous article, this group described the principles involved in the development of bioengineered skin equivalents that held out much promise. This article has examined some of the uses of such products in treating venous ulcers, diabetic foot ulcers, and skin diseases leaving skin wounds. Data encouraging the use of such products in certain indications are available. The costs of using such products are also appreciated.
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Affiliation(s)
- Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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15
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Isei T, Abe M, Nakanishi T, Matsuo K, Yamasaki O, Asano Y, Ishii T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ohtsuka M, Ogawa F, Kadono T, Kodera M, Kawakami T, Kawaguchi M, Kukino R, Kono T, Sakai K, Takahara M, Tanioka M, Nakamura Y, Hashimoto A, Hasegawa M, Hayashi M, Fujimoto M, Fujiwara H, Maekawa T, Madokoro N, Yoshino Y, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene. J Dermatol 2016; 43:591-619. [DOI: 10.1111/1346-8138.13285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Taiki Isei
- Department of Dermatology; Kansai Medical University; Osaka Japan
| | - Masatoshi Abe
- Department of Dermatology; Gunma University Graduate School of Medicine; Gunma Japan
| | - Takeshi Nakanishi
- Department of Dermatology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Koma Matsuo
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Yoshihide Asano
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Takayuki Ishii
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Takaaki Ito
- Department of Dermatology; Hyogo College of Medicine; Hyogo Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Shinichi Imafuku
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka Japan
| | - Ryokichi Irisawa
- Department of Dermatology; Tokyo Medical University; Tokyo Japan
| | - Masaki Ohtsuka
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Mikio Ohtsuka
- Department of Dermatology; Fukushima Medical University; Fukushima Japan
| | - Fumihide Ogawa
- Department of Dermatology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takafumi Kadono
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Masanari Kodera
- Department of Dermatology; Japan Community Health Care Organization Chukyo Hospital; Aichi Japan
| | - Tamihiro Kawakami
- Department of Dermatology; St. Marianna University School of Medicine; Kanagawa Japan
| | - Masakazu Kawaguchi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Ryuichi Kukino
- Department of Dermatology; NTT Medical Center; Tokyo Japan
| | - Takeshi Kono
- Department of Dermatology; Nippon Medical School; Tokyo Japan
| | - Keisuke Sakai
- Intensive Care Unit; Kumamoto University Hospital; Kumamoto Japan
| | - Masakazu Takahara
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Miki Tanioka
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Akira Hashimoto
- Department of Dermatology; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Minoru Hasegawa
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Masahiro Hayashi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Hiroshi Fujiwara
- Department of Dermatology; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - Takeo Maekawa
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Naoki Madokoro
- Department of Dermatology; Mazda Hospital; Hiroshima Japan
| | - Yuichiro Yoshino
- Department of Dermatology; Japanese Red Cross Kumamoto Hospital; Kumamoto Japan
| | | | - Takao Tachibana
- Department of Dermatology; Osaka Red Cross Hospital; Osaka Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
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16
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Game FL, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ. IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:75-83. [PMID: 26340818 DOI: 10.1002/dmrr.2700] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- F L Game
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS FT, Derby, UK
| | - C Attinger
- Department of Plastic Surgery, Medstar Georgetown University. Hospital, Washington DC, USA
| | - A Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, Paris, France
| | - R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M Löndahl
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - P E Price
- Vice-Chancellors' Office, Cardiff University, Cardiff, UK
| | - W J Jeffcoate
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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17
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Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 Suppl 1:154-68. [PMID: 26344936 DOI: 10.1002/dmrr.2707] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- F L Game
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS FT, Derby, UK
| | - J Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
| | - C Attinger
- Department of Plastic Surgery, Medstar Georgetown University, Hospital, Washington D.C., USA
| | - A Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, France
| | - R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M Löndahl
- Department of Endocrinology, University Hospital of Malmö, Sweden
| | - P E Price
- Vice-Chancellors' Office, Cardiff University, Cardiff, Wales, UK
| | - W J Jeffcoate
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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18
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Wu L, Norman G, Dumville JC, O'Meara S, Bell‐Syer SEM. Dressings for treating foot ulcers in people with diabetes: an overview of systematic reviews. Cochrane Database Syst Rev 2015; 2015:CD010471. [PMID: 26171906 PMCID: PMC7083265 DOI: 10.1002/14651858.cd010471.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Foot ulcers in people with diabetes mellitus are a common and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To summarize data from systematic reviews of randomised controlled trial evidence on the effectiveness of dressings for healing foot ulcers in people with diabetes mellitus (DM). METHODS We searched the following databases for relevant systematic reviews and associated analyses: the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 2); Database of Abstracts of Reviews of Effects (DARE; The Cochrane Library 2015, Issue 1); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 14 April 2015); Ovid EMBASE (1980 to 14 April 2015). We also handsearched the Cochrane Wounds Group list of reviews. Two review authors independently performed study selection, risk of bias assessment and data extraction. Complete wound healing was the primary outcome assessed; secondary outcomes included health-related quality of life, adverse events, resource use and dressing performance. MAIN RESULTS We found 13 eligible systematic reviews relevant to this overview that contained a total of 17 relevant RCTs. One review reported the results of a network meta-analysis and so presented information on indirect, as well as direct, treatment effects. Collectively the reviews reported findings for 11 different comparisons supported by direct data and 26 comparisons supported by indirect data only. Only four comparisons informed by direct data found evidence of a difference in wound healing between dressing types, but the evidence was assessed as being of low or very low quality (in one case data could not be located and checked). There was also no robust evidence of a difference between dressing types for any secondary outcomes assessed. AUTHORS' CONCLUSIONS There is currently no robust evidence for differences between wound dressings for any outcome in foot ulcers in people with diabetes (treated in any setting). Practitioners may want to consider the unit cost of dressings, their management properties and patient preference when choosing dressings.
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Affiliation(s)
- Lihua Wu
- University of ManchesterSchool of Nursing, Midwifery and Social WorkJean McFarlane Buildung (Room 5.311), Oxford RoadManchesterUKM13 9PL
| | - Gill Norman
- University of ManchesterSchool of Nursing, Midwifery and Social WorkJean McFarlane Buildung (Room 5.311), Oxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of ManchesterSchool of Nursing, Midwifery and Social WorkJean McFarlane Buildung (Room 5.311), Oxford RoadManchesterUKM13 9PL
| | - Susan O'Meara
- University of LeedsSchool of HealthcareRoom LG.12, Baines WingLeedsUKLS2 9JT
| | - Sally EM Bell‐Syer
- University of YorkDepartment of Health SciencesArea 2 Seebohm Rowntree BuildingHeslingtonYorkNorth YorkshireUKYO10 5DD
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19
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Mo X, Cen J, Gibson E, Wang R, Percival SL. An open multicenter comparative randomized clinical study on chitosan. Wound Repair Regen 2015; 23:518-24. [DOI: 10.1111/wrr.12298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/16/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Xiaohui Mo
- Foshan United Medical Technologies Ltd; Guangdong China
| | - John Cen
- Foshan United Medical Technologies Ltd; Guangdong China
| | | | - Robin Wang
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London United Kingdom
| | - Steven L. Percival
- Institute of Ageing and Chronic Disease and Surface Science Research Centre; University of Liverpool; Liverpool United Kingdom
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20
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Wound dressings are regarded as important components of ulcer treatment, with clinicians and patients having many different types to choose from including hydrocolloid dressings. There is a range of different hydrocolloids available including fibrous-hydrocolloid and hydrocolloid (matrix) dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To compare the effects of hydrocolloid wound dressings with no dressing or alternative dressings on the healing of foot ulcers in people with diabetes. SEARCH METHODS For this first update, in April 2013, we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrocolloid with alternative wound treatments in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included five studies (535 participants) in the review: these compared hydrocolloids with basic wound contact dressings, foam dressings, alginate dressings and a topical treatment. Meta-analysis of two studies indicated no statistically significant difference in ulcer healing between fibrous-hydrocolloids and basic wound contact dressings: risk ratio 1.01 (95% CI 0.74 to 1.38). One of these studies found that a basic wound contact dressing was more cost-effective than a fibrous-hydrocolloid dressing. One study compared a hydrocolloid-matrix dressing with a foam dressing and found no statistically significant difference in the number of ulcers healed. There was no statistically significant difference in healing between an antimicrobial (silver) fibrous-hydrocolloid dressing and standard alginate dressing; an antimicrobial dressing (iodine-impregnated) and a standard fibrous hydrocolloid dressing or a standard fibrous hydrocolloid dressing and a topical cream containing plant extracts. AUTHORS' CONCLUSIONS Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing or a topical cream containing plant extracts. 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.
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Affiliation(s)
- Jo C Dumville
- University of ManchesterDepartment of Nursing, Midwifery and Social WorkManchesterUKM13 9PL
| | - Sohan Deshpande
- Kleijnen Systematic ReviewsUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Susan O'Meara
- University of LeedsSchool of HealthcareRoom LG.12, Baines WingLeedsUKLS2 9JT
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21
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including hydrogel dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To assess the effects of hydrogel wound dressings compared with alternative dressings or none on the healing of foot ulcers in people with diabetes. SEARCH METHODS For this first update, in April 2013, we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrogel with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included five studies (446 participants) in this review. Meta analysis of three studies comparing hydrogel dressings with basic wound contract dressings found significantly greater healing with hydrogel: risk ratio (RR) 1.80, 95% confidence interval (CI) 1.27 to 2.56. The three pooled studies had different follow-up times (12 weeks, 16 weeks and 20 weeks) and also evaluated ulcers of different severities (grade 3 and 4; grade 2 and grade unspecified). One study compared a hydrogel dressing with larval therapy and found no statistically significant difference in the number of ulcers healed and another found no statistically significant difference in healing between hydrogel and platelet-derived growth factor. There was also no statistically significant difference in number of healed ulcers between two different brands of hydrogel dressing. All included studies were small and at unclear risk of bias and there was some clinical heterogeneity with studies including different ulcer grades. No included studies compared hydrogel with other advanced wound dressings. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Nursing, Midwifery and Social Work, University of Manchester, Manchester,
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Abstract
BACKGROUND Foot ulcers in people with diabetes mellitus are a common and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To compare the effects of alginate wound dressings with no wound dressing or alternative dressings on the healing of foot ulcers in people with diabetes mellitus. SEARCH METHODS For this first update, in April 2013, we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of alginate dressings with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included six studies (375 participants) in this review; these compared alginate dressings with basic wound contact dressings, foam dressings and a silver-containing, fibrous-hydrocolloid dressing. Meta analysis of two studies found no statistically significant difference between alginate dressings and basic wound contact dressings: risk ratio (RR) 1.09 (95% CI 0.66 to 1.80). Pooled data from two studies comparing alginate dressings with foam dressings found no statistically significant difference in ulcer healing (RR 0.67, 95% CI 0.41 to 1.08). There was no statistically significant difference in the number of diabetic foot ulcers healed when an anti-microbial (silver) hydrocolloid dressing was compared with a standard alginate dressing (RR 1.40, 95% CI 0.79 to 2.47). All studies had short follow-up times (six to 12 weeks), and small sample sizes. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES The review aimed to evaluate the effects of foam wound dressings on the healing of foot ulcers in people with diabetes. SEARCH METHODS For this first update we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL in April 2013. There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that evaluated the effects on ulcer healing of one or more foam wound dressings in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included six studies (157 participants) in this review. Meta analysis of two studies indicated that foam dressings do not promote the healing of diabetic foot ulcers compared with basic wound contact dressings (RR 2.03, 95%CI 0.91 to 4.55). Pooled data from two studies comparing foam and alginate dressing found no statistically significant difference in ulcer healing (RR 1.50, 95% CI 0.92 to 2.44). There was no statistically significant difference in the number of diabetic foot ulcers healed when foam dressings were compared with hydrocolloid (matrix) dressings. All included studies were small and/or had limited follow-up times. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Nursing,Midwifery and Social Work, University of Manchester, Manchester,UK.
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Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 2: role of growth factors in normal and pathological wound healing: therapeutic potential and methods of delivery. Adv Skin Wound Care 2012; 25:349-70. [PMID: 22820962 DOI: 10.1097/01.asw.0000418541.31366.a3] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the second of 2 articles that discuss the biology and pathophysiology of wound healing, reviewing the role that growth factors play in this process and describing the current methods for growth factor delivery into the wound bed.
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Dumville JC, Soares MO, O'Meara S, Cullum N. Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers. Diabetologia 2012; 55:1902-10. [PMID: 22544222 PMCID: PMC3369130 DOI: 10.1007/s00125-012-2558-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/19/2012] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS Foot ulcers in people with diabetes are a common and serious global health issue. Dressings form a key part of ulcer treatment. Existing systematic reviews are limited by the lack of head-to-head comparisons of alternative dressings in a field where there are several different dressing options. We aimed to determine the relative effects of alternative wound dressings on the healing of diabetic foot ulcers. METHODS This study was a systematic review involving Bayesian mixed treatment comparison. We included randomised controlled trials evaluating the effects on diabetic foot ulcer healing of one or more wound dressings. There were no restrictions based on language or publication status. RESULTS Fifteen eligible studies, evaluating nine dressing types, were included. Ten direct treatment comparisons were made. Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias. The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality. CONCLUSIONS/INTERPRETATION These findings summarise 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 favour of 'advanced' dressing types over basic wound contact materials is of low or very low quality.
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Affiliation(s)
- J C Dumville
- Department of Health Sciences, University of York, Area 2, Seebohm Rowntree Building, York YO10 5DD, UK.
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Plectranthus amboinicus and Centella asiatica Cream for the Treatment of Diabetic Foot Ulcers. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:418679. [PMID: 22693530 PMCID: PMC3369464 DOI: 10.1155/2012/418679] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/05/2012] [Indexed: 01/20/2023]
Abstract
Effects of a topical cream containing P. amboinicus (Lour.) Spreng. (Lamiaceae) and C. asiatica (L.) Urban (Umbelliferae) were evaluated and compared to effects of hydrocolloid fiber wound dressing for diabetic foot ulcers. A single-center, randomized, controlled, open-label study was conducted. Twenty-four type 1 or type 2 diabetes patients aged 20 years or older with Wagner grade 3 foot ulcers postsurgical debridement were enrolled between October 2008 and December 2009. Twelve randomly assigned patients were treated with WH-1 cream containing P. amboinicus and C. asiatica twice daily for two weeks. Another 12 patients were treated with hydrocolloid fiber dressings changed at 7 days or when clinically indicated. Wound condition and safety were assessed at days 7 and 14 and results were compared between groups. No statistically significant differences were seen in percent changes in wound size at 7- and 14-day assessments of WH-1 cream and hydrocolloid dressing groups. A slightly higher proportion of patients in the WH-1 cream group (10 of 12; 90.9%) showed Wagner grade improvement compared to the hydrocolloid fiber dressing group but without statistical significance. For treating diabetic foot ulcers, P. amboinicus and C. asiatica cream is a safe alternative to hydrocolloid fiber dressing without significant difference in effectiveness.
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Wound dressings are regarded as important components of ulcer treatment, with clinicians and patients having many different types to choose from including hydrocolloid dressings. There is a range of different hydrocolloids available including fibrous-hydrocolloid and hydrocolloid (matrix) dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To compare the effects of hydrocolloid wound dressings with no dressing or alternative dressings on the healing of foot ulcers in people with diabetes. SEARCH METHODS We searched The Cochrane Wounds Group Specialised Register (searched 4 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (1950 to December Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 03, 2012); Ovid EMBASE (1980 to 2011 Week 52); and EBSCO CINAHL (1982 to 30 December 2011). There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrocolloid with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included four studies (511 participants) in the review: these compared hydrocolloids with basic wound contact dressings, foam dressings and alginate dressings. Meta-analysis of two studies indicated no statistically significant difference in ulcer healing between fibrous-hydrocolloids and basic wound contact dressings: risk ratio 1.01 (95% CI 0.74 to 1.38). One of these studies found that a basic wound contact dressing was more cost-effective than a fibrous-hydrocolloid dressing. One study compared a hydrocolloid-matrix dressing with a foam dressing and found no statistically significant difference in the number of ulcers healed. There was no statistically significant difference in healing between an antimicrobial (silver) fibrous-hydrocolloid dressing and standard alginate dressing; or an antimicrobial dressing (iodine-impregnated) and a standard fibrous hydrocolloid dressing. AUTHORS' CONCLUSIONS Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Health Sciences, University of York, York, UK.
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28
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Abstract
BACKGROUND Foot ulcers in people with diabetes mellitus are a common and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To compare the effects of alginate wound dressings with no wound dressing or alternative dressings on the healing of foot ulcers in people with diabetes mellitus. SEARCH METHODS We searched The Cochrane Wounds Group Specialised Register (searched 4 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (1950 to December Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 03, 2012); Ovid EMBASE (1980 to 2011 Week 52); and EBSCO CINAHL (1982 to 30 December 2011). There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of alginate dressings with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included six studies (375 participants) in this review; these compared alginate dressings with basic wound contact dressings, foam dressings and a silver-containing, fibrous-hydrocolloid dressing. Meta analysis of two studies found no statistically significant difference between alginate dressings and basic wound contact dressings: risk ratio (RR) 1.09 (95% CI 0.66 to 1.80). Pooled data from two studies comparing alginate dressings with foam dressings found no statistically significant difference in ulcer healing (RR 0.67, 95% CI 0.41 to 1.08). There was no statistically significant difference in the number of diabetic foot ulcers healed when an anti-microbial (silver) hydrocolloid dressing was compared with a standard alginate dressing (RR 1.40, 95% CI 0.79 to 2.47). All studies had short follow-up times (six to 12 weeks), and small sample sizes. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Health Sciences, University of York, York, UK.
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES The review aimed to evaluate the effects of foam wound dressings on the healing of foot ulcers in people with diabetes. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (searched 10 June 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); Ovid MEDLINE (1950 to June Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 8 June, 2011); Ovid EMBASE (1980 to 2011 Week 22); EBSCO CINAHL (1982 to 3 June 2011). There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that evaluated the effects on ulcer healing of one or more foam wound dressings in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included six studies (157 participants) in this review. Meta analysis of two studies indicated that foam dressings do not promote the healing of diabetic foot ulcers compared with basic wound contact dressings (RR 2.03, 95%CI 0.91 to 4.55). Pooled data from two studies comparing foam and alginate dressing found no statistically significant difference in ulcer healing (RR 1.50, 95% CI 0.92 to 2.44). There was no statistically significant difference in the number of diabetic foot ulcers healed when foam dressings were compared with hydrocolloid (matrix) dressings. All included studies were small and/or had limited follow-up times. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Health Sciences, University of York, York, UK, YO10 5DD
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Abstract
BACKGROUND Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including hydrogel dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use. OBJECTIVES To assess the effects of hydrogel wound dressings compared with alternative dressings or none on the healing of foot ulcers in people with diabetes. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (searched 10 June 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); Ovid MEDLINE (1950 to June Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, June 8, 2011); Ovid EMBASE (1980 to 2011 Week 22) and EBSCO CINAHL (1982 to 3 June 2011). There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrogel with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included five studies (446 participants) in this review. Meta analysis of three studies comparing hydrogel dressings with basic wound contract dressings found significantly greater healing with hydrogel: risk ratio (RR) 1.80, 95% confidence interval (CI) 1.27 to 2.56. The three pooled studies had different follow-up times (12 weeks, 16 weeks and 20 weeks) and also evaluated ulcers of different severities (grade 3 and 4; grade 2 and grade unspecified). One study compared a hydrogel dressing with larval therapy and found no statistically significant difference in the number of ulcers healed and another found no statistically significant difference in healing between hydrogel and platelet-derived growth factor. There was also no statistically significant difference in number of healed ulcers between two different brands of hydrogel dressing. All included studies were small and at unclear risk of bias and there was some clinical heterogeneity with studies including different ulcer grades. No included studies compared hydrogel with other advanced wound dressings. 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.
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Affiliation(s)
- Jo C Dumville
- Department of Health Sciences, University of York, York, UK, YO10 5DD
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Ramli NA, Wong TW. Sodium carboxymethylcellulose scaffolds and their physicochemical effects on partial thickness wound healing. Int J Pharm 2011; 403:73-82. [DOI: 10.1016/j.ijpharm.2010.10.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/05/2010] [Accepted: 10/15/2010] [Indexed: 11/25/2022]
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O'Loughlin A, McIntosh C, Dinneen SF, O'Brien T. Review Paper: Basic Concepts to Novel Therapies: A Review of the Diabetic Foot. INT J LOW EXTR WOUND 2010; 9:90-102. [DOI: 10.1177/1534734610371600] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetes mellitus is a global epidemic. Peripheral neuropathy and peripheral vascular disease are complications of diabetes mellitus and the primary causative factors for foot ulceration. Foot ulceration is the leading cause of hospitalization in people with diabetes mellitus. The burden of foot ulceration on health care systems and individual patients is immense. Despite conventional treatment, there persists a high incidence of amputation. A multidisciplinary approach is required to prevent ulcers. This review describes the etiology and risk factors for diabetic foot ulceration and a system for evaluating the diabetic foot. The assessment of neuropathy and the grading of foot ulcers are critically examined. This is important to allow for standardization in clinical trials. The management of diabetic foot syndrome is reviewed. The treatments to ensure vascular supply to the lower limb and control of infection as well as novel therapies, which are becoming available to treat nonhealing, “no-option” diabetic ulcers, are discussed.
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Affiliation(s)
| | | | - Sean F. Dinneen
- National University of Ireland, Galway, Ireland, Department of Endocrinology, Galway University Hospitals, Galway, Ireland
| | - Timothy O'Brien
- National University of Ireland, Galway, Ireland, , Department of Endocrinology, Galway University Hospitals, Galway, Ireland
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Abstract
BACKGROUND Foot ulceration is thought to affect 15% of people with diabetes at some time in their lives. Debridement is widely regarded as an effective intervention to speed up ulcer healing. The most effective method is unclear. OBJECTIVES To assess the effects of debridement interventions on the healing of diabetic foot ulcers. SEARCH STRATEGY For this third update we searched the Cochrane Wounds Group Specialised Register (June 2009); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2009, Issue 2; Ovid MEDLINE - 1950 to June Week 3 2009; Ovid EMBASE - 1980 to 2009 Week 25 and Ovid CINAHL - 1982 to June Week 3 2009. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating any method of debriding diabetic foot ulcers and measuring complete healing or rate of healing. There was no restriction on articles/trials based on language or publication status. DATA COLLECTION AND ANALYSIS Data extraction and assessment of study quality were undertaken by one review author and checked by an Editor of the Wounds Group. MAIN RESULTS Six RCTs of debridement were identified: four assessed hydrogels, with an additional study evaluating larval therapy against hydrogel and one evaluated surgical debridement. Pooling the three RCTs which compared hydrogel with gauze or standard care suggested that hydrogels are significantly more effective in healing diabetic foot ulcers (Relative Risk 1.84, 95% Confidence Interval (CI)1.3 to 2.61). Surgical debridement showed no significant benefit over standard treatment. One small trial suggested that larvae resulted in a more than 50% reduction in wound area compared with hydrogel. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in diabetic foot ulcers. AUTHORS' CONCLUSIONS There is evidence to suggest that hydrogel increases the healing rate of diabetic foot ulcers compared with gauze dressings or standard care and larval therapy resulted in significantly greater reduction in wound area than hydrogel. More research is needed to evaluate the effects of a range of widely used debridement methods and of debridement per se.
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Affiliation(s)
- Jude Edwards
- Trafford CollegeDepartment of Health and Social CareManchester RoadWest TimperleyAltrinchamCheshireUKWA14 5PQ
| | - Sally Stapley
- Teesside UniversitySchool of Health and Social CareC1.10, Constantine BuildingMiddlesbroughTees ValleyUKTS1 3BA
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Comparison of the ionic silver-containing hydrofiber and paraffin gauze dressing on split-thickness skin graft donor sites. Ann Plast Surg 2009; 62:421-2. [PMID: 19325350 DOI: 10.1097/sap.0b013e31818a65e9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The split-thickness skin graft (STSG) donor site dressing has been an inconclusive topic. Each of the Hydrofiber (Aquacel, ConvaTec A Bristol-Myers Squibb Company, Deeside, UK) and silver dressings have applied in many types of wound care with favorable outcomes. Our study compared the ionic silver-containing Hydrofiber dressing and paraffin gauze dressing. The subjects were randomized into group A: ionic silver-containing Hydrofiber and group B: paraffin gauze. From February 2006 to 2007, 20 donor sites were recorded. The mean donor site surface area was 145.5 cm2 (group A) and 135.8 cm2 (group B). The completed re-epithelization day was 7.90 and 11.20 days, respectively (P = 0.031). The average pain score at rest were 0.74 and 0.80, respectively (P = 0.894). The average pain score on dressing removal were 3.12 and 4.70, respectively (P = 0.027). There was no infection or seroma in both groups. In conclusion, ionic silver-containing Hydrofiber dressing can reduce STSG donor site pain and promote re-epithelization compared to paraffin gauze dressing.
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Jeffcoate WJ, Lipsky BA, Berendt AR, Cavanagh PR, Bus SA, Peters EJG, van Houtum WH, Valk GD, Bakker K. Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med 2008; 25:1380-9. [PMID: 19046235 DOI: 10.1111/j.1464-5491.2008.02573.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of diabetic foot ulcers presents a major clinical challenge. The response to treatment is often poor and the outcome disappointing, while the costs are high for both healthcare providers and the patient. In such circumstances, it is essential that management should be based on firm evidence and follow consensus. In the case of the diabetic foot, however, clinical practice can vary widely. It is for these reasons that the International Working Group on the Diabetic Foot has published guidelines for adoption worldwide. The Group has now also completed a series of non-systematic and systematic reviews on the subjects of soft tissue infection, osteomyelitis, offloading and other interventions designed to promote ulcer healing. The current article collates the results of this work in order to demonstrate the extent and quality of the evidence which is available in these areas. In general, the available scientific evidence is thin, leaving many issues unresolved. Although the complex nature of diabetic foot disease presents particular difficulties in the design of robust clinical trials, and the absence of published evidence to support the use of an intervention does not always mean that the intervention is ineffective, there is a clear need for more research in the area. Evidence from sound clinical studies is urgently needed to guide consensus and to underpin clinical practice. It is only in this way that patients suffering with these frequently neglected complications of diabetes can be offered the best hope for a favourable outcome, at the least cost.
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Affiliation(s)
- W J Jeffcoate
- Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK.
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36
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White R, McIntosh C. Topical therapies for diabetic foot ulcers: standard treatments. J Wound Care 2008; 17:426, 428-32. [DOI: 10.12968/jowc.2008.17.10.31305] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - C. McIntosh
- Department of Podiatry, National University of Ireland, Galway, Ireland
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37
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Woo KY, Harding K, Price P, Sibbald G. Minimising wound-related pain at dressing change: evidence-informed practice. Int Wound J 2008; 5:144-57. [PMID: 18494621 PMCID: PMC7951469 DOI: 10.1111/j.1742-481x.2008.00486.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pain is a common concern in patients with chronic wounds. The purpose of this article is to inform clinicians of empirical evidence for practice based on a recent published consensus document on wound related pain. A team approach is needed to address the experience of living with wound related pain within a holistic framework. The importance of regular pain assessment and strategies to minimize traumatic during wound care are highlighted.
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Affiliation(s)
- Kevin Y Woo
- Women's College Hospital, Toronto, ON, Canada.
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38
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Hinchliffe RJ, Valk GD, Apelqvist J, Armstrong DG, Bakker K, Game FL, Hartemann-Heurtier A, Löndahl M, Price PE, van Houtum WH, Jeffcoate WJ. A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2008; 24 Suppl 1:S119-44. [PMID: 18442185 DOI: 10.1002/dmrr.825] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- R J Hinchliffe
- Department of Vascular Surgery, Nottingham University Hospitals Trust, Nottingham, UK
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39
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Faucher N, Ehrler S, Vin F, Dugré T. Phase 2 study of a new Hydrofiber dressing for superficial chronic or acute wounds. J Wound Care 2008; 17:180-2, 184, 187. [DOI: 10.12968/jowc.2008.17.4.28840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N. Faucher
- Hôpital Bichat-Claude Bernard, Paris, France
| | - S. Ehrler
- Centre de Rééducation Fonctionnelle, Strasbourg, France
| | - F. Vin
- Cabinet d’Angéiologie, Neuilly sur Seine, France
| | - T. Dugré
- Centre Hospitalier Camille Guérin, Chatellerault, France
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40
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Berdal M, Appelbom HI, Eikrem JH, Lund A, Zykova S, Busund LT, Seljelid R, Jenssen T. Aminated beta-1,3-D-glucan improves wound healing in diabetic db/db mice. Wound Repair Regen 2008; 15:825-32. [PMID: 18028130 DOI: 10.1111/j.1524-475x.2007.00286.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Delayed wound healing in diabetes is caused by neuropathy, vascular changes, and impaired cellular response to the injury. Macrophages are crucial in normal wound healing, and impaired functions of these cells have been shown in diabetes. beta-1,3-D-glucans stimulate macrophage function. This open-label study was performed to see if aminated beta-1,3-D-glucan (AG) stimulates wound healing in diabetes. Four groups (1-4) of diabetic db/db mice and one nondiabetic control group, db/+(5) were studied: group 1 (n=11): topical AG; group 2 (n=10): topical AG and subcutaneous insulin; group 3 (n=14): topical placebo and subcutaneous insulin; group 4 (n=10): diabetic control (placebo); group 5 (n=12): normal control (placebo). At the end of the experiments fasting blood glucose and A1C were (mean +/- SE) as follows: Group 1: 30.5 +/- 1.9 mmol/L and 11.3 +/- 0.6%; group 2: 12.0 +/- 1.7 mmol/L and 8.0 +/- 0.6%; group 3: 15.4 +/- 2.4 mmol/L and 7.4 +/- 0.3%; group 4: 32.6 +/- 2.6 mmol/L and 12.3 +/- 0.6%; group 5: 7.2 +/- 0.4 mmol/L and 3.9 +/- 0.04%, respectively. The closed wound area was the same in group 1 (AG alone) and group 2 (AG plus insulin) after 17 days, 57.3 +/- 4.7 vs. 50.1 +/- 4.9% (p=0.7). The results of these two groups were superior to group 3 (insulin treatment alone, 32.0 +/- 4.3%, p<0.001) and diabetic controls (38.2 +/- 5.1%, p=0.001). The macrophage-stimulant AG improves wound healing in db/db mice.
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Affiliation(s)
- Margrete Berdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway.
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41
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Tatsioni A, Balk E, O'Donnell T, Lau J. Usual Care in the Management of Chronic Wounds: A Review of the Recent Literature. J Am Coll Surg 2007; 205:617-624e57. [PMID: 17903739 DOI: 10.1016/j.jamcollsurg.2007.05.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 05/13/2007] [Accepted: 05/24/2007] [Indexed: 12/31/2022]
Affiliation(s)
- Athina Tatsioni
- Tufts-New England Medical Center Evidence-Based Practice Center, Institute for Clinical Research and Health Policy Studies, Boston, MA 02111, USA
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42
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Jude EB, Apelqvist J, Spraul M, Martini J. Prospective randomized controlled study of Hydrofiber dressing containing ionic silver or calcium alginate dressings in non-ischaemic diabetic foot ulcers. Diabet Med 2007; 24:280-8. [PMID: 17305788 DOI: 10.1111/j.1464-5491.2007.02079.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Diabetic foot ulcers (DFUs) are at risk of infection and impaired healing, placing patients at risk of lower extremity amputation. DFU care requires debridement and dressings. A prospective, multicentre study compared clinical efficacy and safety of AQUACEL Hydrofiber dressings containing ionic silver (AQAg) with those of Algosteril calcium alginate (CA) dressings in managing out-patients with Type 1 or 2 diabetes mellitus and non-ischaemic Wagner Grade 1 or 2 DFUs. METHODS Patients stratified by antibiotic use on enrolment were randomly assigned to similar protocols including off-loading, AQAg (n = 67) or CA (n = 67) primary dressings and secondary foam dressings for 8 weeks or until healing. Clinical efficacy measures were healing outcomes and primarily healing speed. Adverse events were recorded. RESULTS AQAg and CA groups were comparable at baseline. All ulcer healing outcomes improved in both groups. The mean time to healing was 53 days for AQAg ulcers and 58 days for CA ulcers (P = 0.34). AQAg-treated ulcers reduced in depth nearly twice as much as CA-treated ulcers (0.25 cm vs. 0.13 cm; P = 0.04). There was more overall ulcer improvement and less deterioration in AQAg subjects (P = 0.058), particularly in the subset initially using antibiotics (P = 0.02). Safety profiles of both groups were similar. CONCLUSION When added to standard care with appropriate off-loading, AQAg silver dressings were associated with favourable clinical outcomes compared with CA dressings, specifically in ulcer depth reduction and in infected ulcers requiring antibiotic treatment. This study reports the first significant clinical effects of a primary wound dressing containing silver on DFU healing.
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Affiliation(s)
- E B Jude
- Department of Diabetic Medicine, Tameside General Hospital, Ashton-Under-Lyne, UK.
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43
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Eldor R, Raz I, Ben Yehuda A, Boulton AJM. New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies. Diabet Med 2004; 21:1161-73. [PMID: 15498081 DOI: 10.1111/j.1464-5491.2004.01358.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Diabetic foot ulcers occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. Neuropathy, abnormal foot biomechanics, peripheral vascular disease and external trauma are the major contributors to the development of a foot ulcer in the diabetic patient. Therapy today includes repeated debridement, offloading, and dressings, for lower grade ulcers, and broad spectrum antibiotics and occasionally limited or complete amputation for higher grades, requiring a team effort of health care workers from various specialties. The large population affected by diabetic foot ulcers and the high rates of failure ending with amputation even with the best therapeutic regimens, have resulted in the development of new therapies and are the focus of this review. These include new off loading techniques, dressings from various materials, methods to promote wound closure using artificial skin grafts, different growth factors or wound bed modulators and methods of debridement. These new techniques are promising but still mostly unproven and traditional approaches cannot be replaced. New and generally more expensive therapies should be seen as adding to traditional approaches.
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Affiliation(s)
- R Eldor
- Diabetes Research Centre, Hadassah University Hospital, Ein Kerem, Jerusalem 91120, Israel.
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44
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Cohn SM, Lopez PP, Brown M, Namias N, Jackowski J, Li P, Mishkin D, Lopez JM. Open surgical wounds: how does Aquacel compare with wet-to-dry gauze? J Wound Care 2004; 13:10-2. [PMID: 14969020 DOI: 10.12968/jowc.2004.13.1.26556] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the healing rates of a hydrofibre dressing (Aquacel) and normal wet-to-dry gauze in the treatment of open surgical wounds. METHOD Fifty patients with open surgical wounds were randomized to receive either saline-moistened gauze or Aquacel. The rate of wound healing was measured as ml/day (deep wounds) or cm2/day (superficial wounds) at each dressing change until an investigator blinded to the patient group diagnosed the wounds as having healed or the patient was withdrawn from the study. RESULTS Of the 50 patients, seven were withdrawn from the study after the first evaluation. Of the remaining 43 patients, 21 had been randomly allocated to the gauze group and 22 to the Aquacel group. For deep wounds, a mean change in the wound healing rate of 1.9 +/- 1.3 cm3/day was reported for the gauze group and 2.9 +/- 2.3 cm3/day for the Aquacel group. These results approach statistical significance (p = 0.082). For superficial wounds, the mean change in the healing rate was 1.6 +/- 1.5 cm2/day for the gauze group and 1.9 +/- 2.2 cm2/day for the Aquacel group, but this was not statistically significant. CONCLUSION Aquacel appears to be at least as effective as wet-to-dry gauze in the healing of open surgical wounds.
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Affiliation(s)
- S M Cohn
- Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami School of Medicine, USA.
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45
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Yelimlieş B, Alponat A, Cubukçu A, Kuru M, Oz S, Erçin C, Gönüllü N. Carboxymethylcellulose coated on visceral face of polypropylene mesh prevents adhesion without impairing wound healing in incisional hernia model in rats. Hernia 2003; 7:130-3. [PMID: 12687427 DOI: 10.1007/s10029-003-0125-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Accepted: 02/10/2003] [Indexed: 11/29/2022]
Abstract
Adhesions between viscera and mesh may result in intestinal obstruction and fistulae formation. Fewer adhesions with sodium carboxymethylcellulose (SCMC)-coated polypropylene mesh (PM) has been reported, but impaired wound healing was the major concern. We investigated the adhesion-prevention effect of SCMC in different concentrations, as coating only on visceral face of PM and its effects on wound healing. A full-thickness abdominal wall defect was created in 28 rats, which were then divided into three groups. In Group I (control), the defect was repaired with PM only; in Group II and Group III, the defects were repaired with 1% and 1.6% SCMC-coated-PM, respectively. All animals were sacrificed at day 30, and histological evaluation and adhesion scoring were done. Animals in the group in which 1.6% SCMC-coated PM was used developed significantly fewer adhesions compared with other animals (P=0.04). Histological evaluation using a semiquantitative scoring system showed no difference between the groups in fibrosis and inflammation scores (P=0.9 and P=0.3, respectively), and thickness of fibrosis on mesh was also similar (P=0.5). SCMC in 1.6% concentration as coating only on the visceral face of PM reduced the incidence and severity of adhesions without impairing wound healing.
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Affiliation(s)
- B Yelimlieş
- Kocaeli Medical School Department of Surgery, University of Kocaeli, Kocaeli Derince Izmit, Turkey
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Abstract
BACKGROUND Foot ulceration is thought to affect 15% of people with diabetes at some time in their lives. OBJECTIVES The aim of this review is to assess the evidence for the effectiveness of debridement as a treatment for diabetic foot ulcers. SEARCH STRATEGY Searches of electronic databases, hand searching journals, bibliographies and identification of unpublished work by written communication with recognised experts in the diabetic foot. SELECTION CRITERIA Randomised controlled trials evaluating a method of debridement in the treatment of diabetic foot ulcers. The outcome had to include either complete healing or rate of healing. There was no restriction on articles/trials based on language or publication status. DATA COLLECTION AND ANALYSIS Data extraction and assessment of study quality were undertaken by one reviewer and checked by an Editor of the Wounds Group. MAIN RESULTS 5 RCTs of debridement were identified; 3 RCTs assessed the effectiveness of a hydrogel as a debridement method, 1 RCT evaluated surgical debridement and 1 RCT evaluated larval therapy. Pooling the 3 hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers (absolute risk difference 0.23; 95% CI: 0.10,0.36). Surgical debridement and larval therapy showed no significant benefit in these small trials. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes. REVIEWER'S CONCLUSIONS There is evidence to suggest that hydrogel increases the healing rate of diabetic foot ulcers. More research is needed to evaluate the effects of a range of widely used debridement methods and of debridement per se.
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Affiliation(s)
- J Smith
- Department of Podiatry, Selby & York NHS Primary Care Trust, Diabetes Centre, York District Hospital, Wigginton Road, York, North Yorkshire, YO31 7HE, UK.
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