Table 4 Summary of evidence for diabetic ulcer management
From: Seeking effective interventions to treat complex wounds: an overview of systematic reviews
Outcome | Intervention | Systematic reviews with MA | Systematic reviews without MA | ||
|---|---|---|---|---|---|
High-quality* | Low/moderate quality | High-quality** | Low/moderate quality | ||
Wound area/size reduction | Hyperbaric oxygen therapy (systemic + usual care) | NA | NA | NA | – |
Stem cell therapy | NA | NA | NA | + | |
Time to healing or rate of healing (MAs: NA; non-MAs: 3) | Human skin equivalent | NA | NA | NA | + |
Human cultured dermis | NA | NA | NA | – | |
Laser therapy and complex intervention | NA | NA | NA | +/− | |
Platelet derived growth factors (topical) | NA | NA | NA | + | |
|  | Pressure off-loading, felted foam | NA | NA | NA | – |
| Â | Pressure off-loading, total contact or non-removable cast | NA | NA | NA | + |
|  | Stem cell therapy | NA | NA | NA | – |
|  | Skin grafts | NA | NA | NA | – |
|  | Topical negative pressure | NA | NA | – | NA |
Ulcer healing | Chinese herbal medicine + standard therapy | NA | + | NA | NA |
Granulocyte colony-stimulating factor (SC, IV) + antibiotics (oral, IV) | +/− | – | NA | +/− | |
|  | Alginate, foam, hydrogel, hydrocolloid dressings | NA | NA | NA | +/− |
|  | Alginate, hydrogel, hydrocellulose, semi-permeable membrane dressings | NA | NA | NA | – |
|  | Amoxicillin + clavulanic acid (oral), ofloxacin, imipenem/cilastatin, ampicillin/sulbactam (IV) | NA | NA | NA | +/− |
|  | Antibiotics, choice based on bone biopsy (IV, oral) | NA | NA | NA | +/− |
|  | Ayurvedic preparations (oral + topical) | NA | NA | NA | +/− |
|  | Clindamycin, fluoroquinolone, rifampicin, amoxicillin/clavulanic acid (oral, topical) +/− surgical intervention | NA | NA | NA | +/− |
| Â | Compression | NA | NA | NA | + |
|  | Cultured human dermis | NA | NA | NA | +/− |
|  | Dressings + debridement (hydrogel) | NA | NA | NA | + |
|  | Early surgical intervention + antibiotics | NA | NA | NA | +/− |
|  | Electrical stimulation | NA | NA | NA | – |
|  | Endovascular or open bypass revascularization surgery of an ulcerated foot | NA | NA | NA | +/− |
|  | Foot care clinic interventions | NA | NA | NA | +/− |
|  | Growth factors (topical) | NA | NA | NA | – |
|  | Hydrogel, cadexomer iodine ointment, dressings, larval therapy, sugar (topical) systemic antibiotics | NA | NA | NA | +/− |
|  | Hyperbaric oxygen therapy | NA | NA | NA | +/− |
|  | Hyperbaric oxygen therapy (systemic + usual care) | NA | NA | NA | – |
|  | Imipenem/cilastatin, cefazolin, Ampicillin/sulbactam, Linezolid, Piperacillin/tazobactam. Amoxycillin + clavulanic acid, clindamycin hydrochloride (oral), pexiganan cream | NA | NA | – | NA |
|  | Ketanserin (oral, topical) | NA | NA | NA | +/− |
| Â | Larval therapy | NA | NA | NA | + |
| Â | Lyophilized collagen, platelets and derived products (topical) | NA | NA | NA | + |
|  | Magnet and normothermic therapy | NA | NA | NA | – |
|  | Patient education | NA | NA | NA | +/− |
|  | Percutaneous flexor tenotomy | NA | NA | NA | +/− |
|  | Procaine + polyvinylpyrrolidone (IM) | NA | NA | NA | – |
|  | Resection of the complex wound | NA | NA | NA | – |
|  | Sharp debridement | NA | NA | NA | +/− |
| Â | Skin grafts | NA | NA | NA | + |
| Â | Stem cell therapy | NA | NA | NA | + |
|  | Superoxidized water and soap, povidone iodine (topical) | NA | NA | NA | +/− |
|  | Therapeutic footwear | NA | NA | NA | +/− |
|  | Thrombin-induced human platelet growth factor, recombinant platelet derived growth factor, recombinant basic fibroblast growth factor,arginine-glycine-aspartic acid peptide matrix (topical) | NA | NA | NA | +/− |
| Â | Topical negative pressure | NA | NA | NA | + |
| Â | Negative pressure therapy | NA | NA | NA | + |
|  | Total contact casting | NA | NA | NA | +/− |
|  | Ultrasound | NA | NA | NA | – |
| Â | Zinc oxide tape | NA | NA | NA | + |
No healing improvement/non-healed wounds (MAs: 5) | Chinese herbal medicine | NA | + | NA | NA |
Hyaluronic acid-based scaffold and keratinocytes | – | NA | NA | NA | |
| Â | Hyaluronic acid-based derivative | + | NA | NA | NA |
| Â | Low frequency low intensity noncontact ultrasound | + | NA | NA | NA |
Proportion of patients with healed wounds | Alginate dressing | – | NA | NA | NA |
Artificial skin graft and standard care | NA | + | NA | NA | |
Chinese herbal medicine plus standard treatment | NA | + | NA | NA | |
Skin graft (Dermagraft) | NA | – | NA | NA | |
|  | Fibrous-hydrocolloid (hydrofibre) dressing | – | NA | NA | NA |
Foam dressing | – | NA | NA | NA | |
|  | Granulocyte colony-stimulating factor (SC, IV) + antibiotics (oral, IV) | + | + | NA | NA |
Hyaluronic acid-based scaffold and keratinocytes | – | NA | NA | NA | |
| Â | Hydrogel dressing | + | + | NA | NA |
Hyperbaric oxygen therapy | – |  | NA | NA | |
| Â | Platelet-rich plasma | NA | + | NA | NA |
Skin replacement therapy (keratinocyte allograft, meshed skin autograft, split thickness autograft) | NA | + | NA | NA | |