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Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers.

Dumville JC, Soares MO, O'Meara S, Cullum N - Diabetologia (2012)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of York, Area 2, Seebohm Rowntree Building, York YO10 5DD, UK. jo.dumville@york.ac.uk

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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Related in: MedlinePlus

PRISMA overview of study identification and selection process
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Fig1: PRISMA overview of study identification and selection process

Mentions: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart is presented in Fig. 1 (a summary of study characteristics for the 15 included studies is presented in ESM Table 3). All 15 included studies [20–34] reported the number of ulcers healed, while only three [21, 23, 25] reported median time to healing. Thus we focused our analyses on the proportion of ulcers healed. In terms of ulcer severity, four studies reported inclusion of Wagner grades 1 or 2 ulcers [22, 27, 28, 32] and one study specified that ulcers were superficial [23]. A further three studies specified that ulcers involving tendons, joint spaces and/or bone were excluded. Only one study specifically included more severe grade 3 and 4 ulcers [34]. Eight studies clearly excluded those with arterial disease [21, 23, 24, 26, 28, 30–32]. Eight studies excluded participants that had infected or sloughy ulcers [21, 23–27, 30, 32]. Only one study [33], comparing a basic contact wound with a hydrogel dressing, clearly specified the inclusion of people with necrotic and infected wounds. The evidence base therefore overwhelmingly relates to people with less severe and less complex diabetic foot ulceration.Fig. 1


Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers.

Dumville JC, Soares MO, O'Meara S, Cullum N - Diabetologia (2012)

PRISMA overview of study identification and selection process
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369130&req=5

Fig1: PRISMA overview of study identification and selection process
Mentions: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart is presented in Fig. 1 (a summary of study characteristics for the 15 included studies is presented in ESM Table 3). All 15 included studies [20–34] reported the number of ulcers healed, while only three [21, 23, 25] reported median time to healing. Thus we focused our analyses on the proportion of ulcers healed. In terms of ulcer severity, four studies reported inclusion of Wagner grades 1 or 2 ulcers [22, 27, 28, 32] and one study specified that ulcers were superficial [23]. A further three studies specified that ulcers involving tendons, joint spaces and/or bone were excluded. Only one study specifically included more severe grade 3 and 4 ulcers [34]. Eight studies clearly excluded those with arterial disease [21, 23, 24, 26, 28, 30–32]. Eight studies excluded participants that had infected or sloughy ulcers [21, 23–27, 30, 32]. Only one study [33], comparing a basic contact wound with a hydrogel dressing, clearly specified the inclusion of people with necrotic and infected wounds. The evidence base therefore overwhelmingly relates to people with less severe and less complex diabetic foot ulceration.Fig. 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Sciences, University of York, Area 2, Seebohm Rowntree Building, York YO10 5DD, UK. jo.dumville@york.ac.uk

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.

Show MeSH
Related in: MedlinePlus