A systematic review and meta-analysis of treatment modalities and their impact on the healing progression of diabetic foot ulcers

Abstract

Background: The diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, which occurs in 15-25% of diabetic patients at some point in their lives. However, most of the Diabetic foot ulcers (DFUs) do not heal with conventional methods of wound care and progress to become chronic, non-healing ulcers with high morbidity, mortality, and economic stakes. Some of the recent techniques in the management of ulcers include Systemic Hyperbaric Oxygen Therapy (s-HBOT), Platelet-Rich Plasma (PRP), Vacuum-Assisted Closure (VAC) Therapy, and Negative Pressure Wound Therapy (NPWT) that aim at improving the ulcer healing rate and minimize the risks of amputation.

Objective: This work intends to conduct a comprehensive meta-analysis of the effectiveness, healing time and effect on amputation of these advanced treatment modalities on management of DFUs.

Methods: The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the reporting of systematic reviews and meta-analysis of randomized controlled trials. Information was obtained from 10 researches that considered different types of DFU treatment. The major end-points studied were rates of ulcer healing, time to heal and frequency of lower extremity amputations. The meta-analysis was conducted using R statistical software and the synthesis of results was done using forest and funnel plots.

Results: The pooled analysis showed that NPWT significantly improved ulcer healing rates (OR = 2.07, 95% CI: 1.09-3.05) and reduced time to healing (Mean Diff = -22 days, 95% CI: -41.60 to -2.40). HBOT, particularly s-HBOT, demonstrated a substantial reduction in amputation rates (OR = 0.08, 95% CI: -0.11-0.28). PRP also showed promise, especially in reducing healing time (Mean Diff = -25 days, 95% CI: -34.80 to -15.20), though with more variability across studies.

Conclusion: The results of NPWT were found to be significantly superior for ulcer closure and reduced healing time making it the treatment of choice for DFUs. Compared to controls, both HBOT and s-HBOT were strikingly effective in averting amputations. PRP had the possibility of being used as supplementary treatment especially in treatment with regard to the aspect of promotion of healing. Collectively, these results suggest that it is possible to use such advanced therapies to enhance the treatment of DFU; however, more effort is required to refine the protocols of such therapies and determine the sources of a differential response.

Keywords: Diabetic foot ulcers (DFU); amputation; hyperbaric oxygen therapy (HBOT); meta-analysis; negative pressure wound therapy (NPWT); platelet-rich plasma (PRP); vacuum-assisted closure (VAC) therapy; wound healing.

Figure 1

PRISMA Flow diagram of included studies.

Figure 2

Forest plot of efficacy of different interventions in the treatment of DFUs.

Figure 3

Forest plot of time to heal duration of different interventions in DFUs.

Figure 4

Forest plot representing the amputation rate among different interventions.

Figure 5

Funnel plot representing the publication bias of included studies.