Dressing and Diabetic Foot Ulcers: A Current Review of the Evidence

NewsBot · Aug 25, 2016

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Dressing and Diabetic Foot Ulcers: A Current Review of the Evidence.
Game FL, Jeffcoate WJ
Plast Reconstr Surg. 2016 Sep;138(3S Current Concepts in Wound Healing: Update 2016):158S-164S.

BACKGROUND:
The outcome of ulcers of the foot in diabetes is generally poor with around 1 in 10 resulting in the loss of a limb. There is an urgent need for the development of interventions to improve the outcome for patients. To date, however, the evidence base to support many of the interventions in common use, including wound dressings, is poor.
METHODS:
This article summarizes the findings of systematic reviews of the subject published between 2006 and 2014 and covers all relevant articles in any language, as well as comments on certain newer publications.
RESULTS:
The 3 consecutive systematic reviews selected a total of 207 articles that met the predefined criteria from a total of 5,632 identified. These included articles on a very wide range of interventions designed to be applied to ulcers of the foot in diabetes to promote wound healing.
CONCLUSIONS:
The available data suggest that although some newer therapies show promise, few published studies were of high quality, and the majority were susceptible to bias. More work is needed to substantiate the role of available dressings and wound care products in day-to-day clinical practice. Future work will require studies to be performed to a higher standard than many of those reviewed here and should establish not just clinical effectiveness but cost-effectiveness. The conclusions drawn from the studies of diabetic foot ulcers (DFUs) might apply to the management of other types of chronic wounds.
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NewsBot · Sep 20, 2016

Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: a systematic review and meta-analysis examining how to dress for success.
Saco M, Howe N, Nathoo R, Cherpelis B.
Dermatol Online J. 2016 Aug 15;22(8). pii: 13030/qt7ph5v17z.

Diabetic foot ulcers and venous leg ulcers are chronic wounds frequently encountered by dermatologists. Choosing appropriate wound dressings can effectively promote wound healing and potentially reduce morbidity and financial burden experienced by patients. The objective of our systematic review and meta-analysis was to evaluate wound healing efficacies of synthetic active dressings in diabetic foot ulcer and venous leg ulcer management. For data collection, PubMed, Embase, Cochrane Library, CINAHL, and clinicaltrials.gov online databases were searched from database inception to 10 May 2015. Fixed and random effects modeling were used to calculate pooled risk ratios for complete ulcer healing from pairwise dressing comparisons. The results of our review showed moderate-quality level evidence that hydrogels were more effective in healing diabetic foot ulcers than basic wound contact dressings (RR 1.80 [95% CI, 1.27-2.56]). The other dressing comparisons showed no statistically significant differences between the interventions examined in terms of achieving complete diabetic foot ulcer healing. Non-adherent dressings were more cost-effective than hydrofiber dressings for diabetic foot ulcers in terms of mean total cost per patient of the dressings themselves. All venous leg ulcer pairwise dressing comparisons showed equivalent dressing efficacies in terms of promoting complete ulcer healing. Overall, most synthetic active dressings and traditional wound dressings are equally efficacious in treating diabetic foot ulcers and venous leg ulcers. For treating diabetic foot ulcers, hydrogels are more efficacious than basic wound contact dressings, and non-adherent dressings are more cost-effective than hydrofiber dressings. Ultimately, dressing choice should be tailored to the wound and the patient.
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NewsBot · Jul 21, 2021

Fluid management and strength postsimulated use of primary and secondary dressings for treating diabetic foot ulcers: Robotic phantom studies
Adi Lustig, Amit Gefen
Int Wound J. 2021 Jun 16

Non-offloaded diabetic heel ulcers and the wound dressings used to treat them may be subjected to considerable bodyweight forces. A novel robotic foot phantom with a diabetic heel ulcer was designed and constructed to test the combined performances of applied primary and secondary dressings, in simulated non-offloaded (standing) and offloaded (supine) postures. We specifically compared the performances of the primary Exufiber dressing (Mölnlycke Health Care) combined with the secondary Mepilex Border Flex dressing (Mölnlycke) against a corresponding pair from an alternative manufacturer. Fluid retention and distribution between the primary and secondary dressings of each pair were determined using weight tests, and mechanical strength of the primary dressings was further measured postsimulated use through tensile testing. The Exufiber and Mepilex Border Flex pair performed similarly in the two simulated postures (retention = ~97%), whereas the comparator pair exhibited a 13%-decrease in retention for a supine to standing transition. Furthermore, the Exufiber dressing delivered up to 2-times more fluid to its paired secondary dressing and endured 1.7-times greater strain energy than the corresponding primary dressing before failure occurred. The present robotic foot phantom and associated methods are versatile and suitable for testing any dressing, in consideration of the relevant clinical factors and practice.
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