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Present and new techniques and devices in the treatment of DFU: a critical review of evidence

Gottrup, Finn and Apelqvist, Jan LU (2012) In Diabetes/Metabolism Research Reviews 28(Suppl. 1). p.64-71
Abstract
Management of foot ulcer in individuals with diabetes remains a major therapeutic challenge throughout the world. We performed a critical review of evidence of present and new techniques and devices in the treatment of diabetic foot ulcer. The golden standard for optimal evidence in the Cochrane system is level I randomized controlled trials, and meta-analyses of several randomized controlled trials. Available evidence on different types of wound debridement; use of antimicrobials; use of dressings in wounds; topical negative pressure, hyperbaric oxygen treatment; electrical, electromagnetic, laser, shockwave, and ultrasound therapies; growth and cell biology factors; cell products and tissue engineering; bioengineered skin and skin... (More)
Management of foot ulcer in individuals with diabetes remains a major therapeutic challenge throughout the world. We performed a critical review of evidence of present and new techniques and devices in the treatment of diabetic foot ulcer. The golden standard for optimal evidence in the Cochrane system is level I randomized controlled trials, and meta-analyses of several randomized controlled trials. Available evidence on different types of wound debridement; use of antimicrobials; use of dressings in wounds; topical negative pressure, hyperbaric oxygen treatment; electrical, electromagnetic, laser, shockwave, and ultrasound therapies; growth and cell biology factors; cell products and tissue engineering; bioengineered skin and skin grafts; and adjuvant therapies were evaluated. The results of this review show that there is limited evidence on the highest level to justify a change in routine clinical practice. There is a paucity of high-quality evidence, because the studies are often based on inadequate sample size, short follow-up, nonrandom allocation to treatment arms, nonblinded assessment of outcomes, poor description of control, and concurrent intervention. The heterogeneity of the population (of both people and ulcers), with multiple factors contributing to both ulcer onset and failure to heal, makes the trial design difficult in this field. Another fundamental reason for the lack of evidence is the general use of the outcome measure complete healing. In conclusion, when the results of this updated review are taken together with those of the earlier reports, they provide limited evidence to justify a change in routine clinical practice. For this reason, there is an urgent need to increase the quality of clinical studies. A re-evaluation of which type of research is acceptable for producing evidence in the wound area may be important in the future. Copyright (C) 2012 John Wiley & Sons, Ltd. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
diabetic foot ulcers, wound treatment techniques, wound devices, evidence, RCTs, outcomes
in
Diabetes/Metabolism Research Reviews
volume
28
issue
Suppl. 1
pages
64 - 71
publisher
John Wiley & Sons
external identifiers
  • wos:000299377700013
  • scopus:84856189250
ISSN
1520-7552
DOI
10.1002/dmrr.2242
language
English
LU publication?
yes
id
b4161aff-1d07-4fb4-b519-8c2afe76aacd (old id 2348794)
date added to LUP
2012-03-01 11:24:31
date last changed
2017-05-21 03:03:32
@article{b4161aff-1d07-4fb4-b519-8c2afe76aacd,
  abstract     = {Management of foot ulcer in individuals with diabetes remains a major therapeutic challenge throughout the world. We performed a critical review of evidence of present and new techniques and devices in the treatment of diabetic foot ulcer. The golden standard for optimal evidence in the Cochrane system is level I randomized controlled trials, and meta-analyses of several randomized controlled trials. Available evidence on different types of wound debridement; use of antimicrobials; use of dressings in wounds; topical negative pressure, hyperbaric oxygen treatment; electrical, electromagnetic, laser, shockwave, and ultrasound therapies; growth and cell biology factors; cell products and tissue engineering; bioengineered skin and skin grafts; and adjuvant therapies were evaluated. The results of this review show that there is limited evidence on the highest level to justify a change in routine clinical practice. There is a paucity of high-quality evidence, because the studies are often based on inadequate sample size, short follow-up, nonrandom allocation to treatment arms, nonblinded assessment of outcomes, poor description of control, and concurrent intervention. The heterogeneity of the population (of both people and ulcers), with multiple factors contributing to both ulcer onset and failure to heal, makes the trial design difficult in this field. Another fundamental reason for the lack of evidence is the general use of the outcome measure complete healing. In conclusion, when the results of this updated review are taken together with those of the earlier reports, they provide limited evidence to justify a change in routine clinical practice. For this reason, there is an urgent need to increase the quality of clinical studies. A re-evaluation of which type of research is acceptable for producing evidence in the wound area may be important in the future. Copyright (C) 2012 John Wiley & Sons, Ltd.},
  author       = {Gottrup, Finn and Apelqvist, Jan},
  issn         = {1520-7552},
  keyword      = {diabetic foot ulcers,wound treatment techniques,wound devices,evidence,RCTs,outcomes},
  language     = {eng},
  number       = {Suppl. 1},
  pages        = {64--71},
  publisher    = {John Wiley & Sons},
  series       = {Diabetes/Metabolism Research Reviews},
  title        = {Present and new techniques and devices in the treatment of DFU: a critical review of evidence},
  url          = {http://dx.doi.org/10.1002/dmrr.2242},
  volume       = {28},
  year         = {2012},
}