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

F. L. Game, R. J. Hinchliffe, J. Apelqvist, David G Armstrong, K. Bakker, A. Hartemann, M. Löndahl, P. E. Price, W. J. Jeffcoate

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

The outcome of management of diabetic foot ulcers is poor, and there is continuing uncertainty concerning optimal approaches to management. It was for these reasons that in 2006 the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing undertook a systematic review of the evidence to inform protocols for routine care and to highlight areas which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between December 2006 and June 2010. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network criteria. Selected studies fell into the following ten categories: sharp debridement and wound bed preparation with larvae and hydrotherapy; wound bed preparation using antiseptics, applications and dressing products; resection of the chronic wound; hyperbaric oxygen therapy (HBOT); compression or negative pressure therapy; products designed to correct aspects of wound biochemistry and cell biology associated with impaired wound healing; application of cells, including platelets and stem cells; bioengineered skin and skin grafts; electrical, electromagnetic, lasers, shockwaves and ultrasound; other systemic therapies which did not fit in the above categories. Heterogeneity of studies prevented pooled analysis of results. Of the 1322 papers identified, 43 were selected for grading following full text review. The present report is an update of the earlier IWGDF systematic review, but the conclusion is similar: that with the exception of HBOT and, possibly, negative pressure wound therapy, there is little published evidence to justify the use of newer therapies. This echoes the conclusion of a recent Cochrane review and the systematic review undertaken by the National Institute for Health and Clinical Excellence Guidelines Committee in the UK. Analysis of evidence presents considerable difficulties in this field particularly as controlled studies are few and the majority are of poor methodological quality.

Original languageEnglish (US)
Pages (from-to)119-141
Number of pages23
JournalDiabetes/Metabolism Research and Reviews
Volume28
Issue numberSUPPL. 1
DOIs
StatePublished - Feb 2012

Fingerprint

Foot Ulcer
Diabetic Foot
Hyperbaric Oxygenation
Wounds and Injuries
Wound Healing
Hydrotherapy
Guidelines
Negative-Pressure Wound Therapy
Skin
Local Anti-Infective Agents
Electromagnetic Phenomena
National Institutes of Health (U.S.)
Debridement
Bandages
Biochemistry
Ulcer
Uncertainty
Larva
Cell Biology
Lasers

Keywords

  • Diabetes
  • Diabetic foot
  • Dressing
  • Ulcer
  • Wound healing

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Game, F. L., Hinchliffe, R. J., Apelqvist, J., Armstrong, D. G., Bakker, K., Hartemann, A., ... Jeffcoate, W. J. (2012). A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes/Metabolism Research and Reviews, 28(SUPPL. 1), 119-141. https://doi.org/10.1002/dmrr.2246

A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. / Game, F. L.; Hinchliffe, R. J.; Apelqvist, J.; Armstrong, David G; Bakker, K.; Hartemann, A.; Löndahl, M.; Price, P. E.; Jeffcoate, W. J.

In: Diabetes/Metabolism Research and Reviews, Vol. 28, No. SUPPL. 1, 02.2012, p. 119-141.

Research output: Contribution to journalArticle

Game, FL, Hinchliffe, RJ, Apelqvist, J, Armstrong, DG, Bakker, K, Hartemann, A, Löndahl, M, Price, PE & Jeffcoate, WJ 2012, 'A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes', Diabetes/Metabolism Research and Reviews, vol. 28, no. SUPPL. 1, pp. 119-141. https://doi.org/10.1002/dmrr.2246
Game, F. L. ; Hinchliffe, R. J. ; Apelqvist, J. ; Armstrong, David G ; Bakker, K. ; Hartemann, A. ; Löndahl, M. ; Price, P. E. ; Jeffcoate, W. J. / A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. In: Diabetes/Metabolism Research and Reviews. 2012 ; Vol. 28, No. SUPPL. 1. pp. 119-141.
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