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Meta-Analysis
. 2010 Jan 20;2010(1):CD003556.
doi: 10.1002/14651858.CD003556.pub2.

Debridement of diabetic foot ulcers

Jude Edwards  1 , Sally Stapley
Affiliations
Meta-Analysis

Debridement of diabetic foot ulcers

Jude Edwards et al. Cochrane Database Syst Rev. .

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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Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Surgical debridement compared with conventional nonsurgical management, Outcome 1 Number of ulcers completely healed.
1.2
1.2. Analysis
Comparison 1 Surgical debridement compared with conventional nonsurgical management, Outcome 2 Time to complete healing (days).
1.3
1.3. Analysis
Comparison 1 Surgical debridement compared with conventional nonsurgical management, Outcome 3 Recurrence rates.
1.4
1.4. Analysis
Comparison 1 Surgical debridement compared with conventional nonsurgical management, Outcome 4 Number of complications ‐ Number of adverse events reported.
2.1
2.1. Analysis
Comparison 2 Larvae compared with Hydrogel, Outcome 1 Number of ulcers completely healed.
2.2
2.2. Analysis
Comparison 2 Larvae compared with Hydrogel, Outcome 2 Reduction of wound area by more than 50%.
3.1
3.1. Analysis
Comparison 3 Hydrogel compared with gauze or good wound care (gwc), Outcome 1 Number of ulcers completely healed.
3.2
3.2. Analysis
Comparison 3 Hydrogel compared with gauze or good wound care (gwc), Outcome 2 Number of complications ‐ number of adverse events reported.
3.3
3.3. Analysis
Comparison 3 Hydrogel compared with gauze or good wound care (gwc), Outcome 3 Quality of life / increase in pain.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to studies excluded from this review

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Mulder 1994a {published data only}
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Mulder 1994b {published data only}
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References to studies awaiting assessment

Biliaieva 2009 {published data only}
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