Nanosilver Dressings and 12-Week Healing in Diabetic Foot Ulcers: A Retrospective Propensity Score-Matched Study

Diabetic foot ulcers (DFUs) are associated with prolonged morbidity and limb-related complications. This single-center retrospective cohort study compared nanosilver and alginate primary dressing strategies in patients managed within a multidisciplinary diabetic-foot program between January 2020 and December 2023. Among 393 screened patients, 361 formed the unmatched cohort, including 121 treated with nanosilver and 240 with alginate dressings; 1:1 propensity-score matching generated 115 matched pairs. The single primary endpoint was complete wound healing at week 12. Healing occurred in 87 of 115 patients (75.7%) receiving nanosilver and 65 of 115 (56.5%) receiving alginate dressings (matched OR, 2.47; 95% CI, 1.32-4.84; P = 0.003; matched RR, 1.34; 95% CI, 1.11-1.62). At least 50% wound-area reduction at week 4 occurred in 82.6% versus 67.0% (matched OR, 2.80; 95% CI, 1.32-6.46; Holm-adjusted P = 0.015), and median time to complete healing was 45 versus 58 days (HR, 1.58; 95% CI, 1.22-2.05; Holm-adjusted P < 0.004). The primary association remained similar in the extended measured-confounding sensitivity analysis (adjusted OR, 2.31; 95% CI, 1.17-4.56). Other clinical and safety outcomes were exploratory. Nanosilver dressing use was associated with greater 12-week complete healing and shorter time to closure in this matched tertiary-care cohort; prospective multicenter validation is required.