Assessment of Dressing Method (Self-dressing vs. Nurse-led dressing) on Healing Outcomes in Diabetic Foot Ulcers: A...

Diabetic foot ulcers (DFUs) are a major cause of morbidity and amputation. Professional wound care is standard, but patient self-dressing could be an alternative in resource-limited settings. Direct comparisons between self-dressing and nurse-led dressing are lacking. We compared their effects on healing outcomes in DFUs.

This prospective, randomized, controlled trial enrolled 60 adults (≥18 years) with type 1 or type 2 diabetes and Wagner grade 1-2 DFUs, ankle-brachial index ≥0.7, sufficient cognitive and motor skills for self-care, and ability to attend follow-up. Patients were randomized 1:1 to either a structured self-dressing protocol after standardized training (group A, n=30) or nurse-led dressing (group B, n=30). All received standardized offloading, debridement, and a sodium hyaluronate dressing changed every 2-3 days. The primary outcome was time to complete healing (weeks). Secondary outcomes included healing rate, infection, amputation, and number of dressing days. Follow-up for healing outcomes was 14 weeks. Analysis used intention-to-treat, with post-hoc logistic regression adjusting for baseline imbalances.

Baseline characteristics were similar except for higher chronic kidney disease prevalence and foot infection score in the self-dressing group (P<0.05). After adjusting for these factors, the dressing type remained independently associated with complete healing (adjusted OR 0.12, 95% CI 0.02-0.68, P=0.016). Healing of surface area and wound volume was significantly slower in the self-dressing group at all time points from 2 to 14 weeks (P<0.001). Complete healing occurred in 80.0% (24/30) of the self-dressing group vs. 100% (30/30) of the nurse-led group (P=0.032). Time to complete healing was longer with self-dressing (mean 17.7±4.1 vs. 9.8±2.1 weeks; P<0.001). Dressing days (124.8±28.2 vs. 67.7±15.3; P<0.001), infection rate (23.3% vs. 0%; P=0.011), and minor amputations (17.9% vs. 0%; P=0.021) were significantly higher in the self-dressing group. Limb salvage and major amputations did not differ significantly.

In patients with uncomplicated DFUs, nurse-led dressing achieved faster healing, fewer infections, and fewer minor amputations compared with structured patient self-dressing. Self-dressing cannot be recommended as a substitute for professional wound care in this population.