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A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes

Hinchliffe, R J; Valk, G D; Apelqvist, Jan LU ; Armstrong, D G; Bakker, K; Game, F L; Hartemann-Heurtier, A; Londahl, M; Price, P E and van Houtum, W H, et al. (2008) In Diabetes/Metabolism Research Reviews 24(S1). p.119-144
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... (More)
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. (Less)
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type
Contribution to journal
publication status
published
subject
keywords
ulcer, diabetes, diabetic foot, wound healing, dressings
in
Diabetes/Metabolism Research Reviews
volume
24
issue
S1
pages
119 - 144
publisher
John Wiley & Sons
external identifiers
  • wos:000256408300025
  • scopus:44949251001
ISSN
1520-7552
DOI
10.1002/dmrr.825
language
English
LU publication?
yes
id
833dc6b8-fc2a-4256-815a-4bade3be36af (old id 1201363)
date added to LUP
2008-09-15 09:59:33
date last changed
2017-08-06 03:36:29
@article{833dc6b8-fc2a-4256-815a-4bade3be36af,
  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.},
  author       = {Hinchliffe, R J and Valk, G D and Apelqvist, Jan and Armstrong, D G and Bakker, K and Game, F L and Hartemann-Heurtier, A and Londahl, M and Price, P E and van Houtum, W H and Jeffcoate, W J},
  issn         = {1520-7552},
  keyword      = {ulcer,diabetes,diabetic foot,wound healing,dressings},
  language     = {eng},
  number       = {S1},
  pages        = {119--144},
  publisher    = {John Wiley & Sons},
  series       = {Diabetes/Metabolism Research Reviews},
  title        = {A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes},
  url          = {http://dx.doi.org/10.1002/dmrr.825},
  volume       = {24},
  year         = {2008},
}