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Debridement of diabetic foot ulcers
1Department of Podiatry, Selby & York NHS Primary Care Trust, Diabetes Centre, York District Hospital, Wigginton Road, York, North Yorkshire, YO31 7HE, UK. Judith.A.Smith@EXCHA.YHS-TR.NORTHY.NHS.UK
Background:
Foot ulceration is thought to affect 15% of people with diabetes at some time in their lives.
Objectives:
The aim of this review is to assess the evidence for the effectiveness of debridement as a treatment for diabetic foot ulcers.
Search Strategy:
Searches of electronic databases, hand searching journals, bibliographies and identification of unpublished work by written communication with recognised experts in the diabetic foot.
Selection Criteria:
Randomised controlled trials evaluating a method of debridement in the treatment of diabetic foot ulcers. The outcome had to include either complete healing or rate of healing. There was no restriction on articles/trials based on language or publication status.
Data Collection And Analysis:
Data extraction and assessment of study quality were undertaken by one reviewer and checked by an Editor of the Wounds Group.
Main Results:
5 RCTs of debridement were identified; 3 RCTs assessed the effectiveness of a hydrogel as a debridement method, 1 RCT evaluated surgical debridement and 1 RCT evaluated larval therapy. Pooling the 3 hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers (absolute risk difference 0.23; 95% CI: 0.10,0.36). Surgical debridement and larval therapy showed no significant benefit in these small trials. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes.
Reviewer'S Conclusions:
There is evidence to suggest that hydrogel increases the healing rate of diabetic foot ulcers. More research is needed to evaluate the effects of a range of widely used debridement methods and of debridement per se.