A Randomized Trial Comparing Weekly With Every Second Week Sharp Debridement in People With Diabetes-Related Foot Ulcers Shows Similar Healing Outcomes: Potential Benefit to Resource Utilization

Nubé, Vanessa L; White, Jessica M.; Brewer, Kate; Veldhoen, Danielle; Meler, Cindy; Frank, Georgina; Carroll, Kate; Featherston, Jill; Batchelor, Jacqueline; Gebski, Val; Alison, Jennifer A.; Twigg, Stephen M.

doi:10.2337/dc21-1454

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…an operating theatre as opposed to clinic/office debridement), 19 and 1 investigating the frequency of sharp debridement. 20…”

Section: Intervention 1: Debridementmentioning

confidence: 99%

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Chen,

Vilorio,

Dhatariya

et al. 2024

Diabetes Metabolism Res

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BackgroundIt is critical that interventions used to enhance the healing of chronic foot ulcers in diabetes are backed by high‐quality evidence and cost‐effectiveness. In previous years, the systematic review accompanying guidelines published by the International Working Group of the Diabetic Foot performed 4‐yearly updates of previous searches, including trials of prospective, cross‐sectional and case‐control design.AimsDue to a need to re‐evaluate older studies against newer standards of reporting and assessment of risk of bias, we performed a whole new search from conception, but limiting studies to randomised control trials only.Materials and MethodsFor this systematic review, we searched PubMed, Scopus and Web of Science databases for published studies on randomised control trials of interventions to enhance healing of diabetes‐related foot ulcers. We only included trials comparing interventions to standard of care. Two independent reviewers selected articles for inclusion and assessed relevant outcomes as well as methodological quality.ResultsThe literature search identified 22,250 articles, of which 262 were selected for full text review across 10 categories of interventions. Overall, the certainty of evidence for a majority of wound healing interventions was low or very low, with moderate evidence existing for two interventions (sucrose‐octasulfate and leucocyte, platelet and fibrin patch) and low quality evidence for a further four (hyperbaric oxygen, topical oxygen, placental derived products and negative pressure wound therapy). The majority of interventions had insufficient evidence.ConclusionOverall, the evidence to support any other intervention to enhance wound healing is lacking and further high‐quality randomised control trials are encouraged.

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“…an operating theatre as opposed to clinic/office debridement), 19 and 1 investigating the frequency of sharp debridement. 20…”

Section: Intervention 1: Debridementmentioning

confidence: 99%

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Chen,

Vilorio,

Dhatariya

et al. 2024

Diabetes Metabolism Res

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“…Do not use pharmacological agents promoting perfusion and angiogenesis to improve wound healing outcomes over standard of care (Strong; Low). 25. Do not use pharmacological agents that supplement vitamins and trace elements to improve wound healing outcomes over standard of care (Strong; Low).…”

Section: List Of Recommendationsmentioning

confidence: 99%

“…14 The type of debridement modality, that is, sharp versus surgical should be made by an experienced clinician based upon clinical severity and the presence or absence of any limbthreatening features. Rationale: We found one RCT 25 at high risk of bias that investigated frequency of sharp debridement, weekly versus fortnightly. This one study, involving 61 participants per group, reported no statistically significant difference in wound healing outcomes, wound closure, or healing times at 12 weeks between groups.…”

Section: Surgical Debridementmentioning

confidence: 99%

“…For types of debridement, we found 10 RCTs that met our prespecified inclusion criteria as described in our systematic review. [16][17][18][19][20][21][22][23][24][25] There were five RCTs [16][17][18][19][20] of enzymatic debridement, 3 RCTs 21-23 of low-frequency ultrasonic debridement, 1 RCT 24 of surgical debridement, and 1 RCT 26 on frequency of sharp debridement. However, we found no RCTs of other types of debridement.…”

Section: Intervention: Debridementmentioning

confidence: 99%

“…Although there is unequivocal consensus amongst experts in support of the need for regular wound debridement to facilitate healing, high‐quality evidence to justify debridement in general, and to identify the best form of debridement is limited. For types of debridement, we found 10 RCTs that met our prespecified inclusion criteria as described in our systematic review 16–25 . There were five RCTs 16–20 of enzymatic debridement, 3 RCTs 21–23 of low‐frequency ultrasonic debridement, 1 RCT 24 of surgical debridement, and 1 RCT 26 on frequency of sharp debridement.…”

Section: Recommendationsmentioning

confidence: 99%

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Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)

Chen,

Vilorio,

Dhatariya

et al. 2023

Diabetes Metabolism Res

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AimsPrinciples of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes‐related foot ulcer. However, the rising incidence and costs of diabetes‐related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes‐related foot ulcers are supported by high‐quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold‐standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence‐based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.Materials and MethodsWe followed the GRADE approach by devising clinical questions and important outcomes in the Patient‐Intervention‐Control‐Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders.ResultsFrom the results of the systematic review and evidence‐to‐decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post‐operative wounds, the use of placental‐derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions.ConclusionsThese wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.

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Contemporary Medical Management of Peripheral Arterial Disease

Cook,

Chung

2023

Cardiovasc Drugs Ther

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A Randomized Trial Comparing Weekly With Every Second Week Sharp Debridement in People With Diabetes-Related Foot Ulcers Shows Similar Healing Outcomes: Potential Benefit to Resource Utilization

Cited by 5 publications

References 3 publications

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: A systematic review

Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)

Contemporary Medical Management of Peripheral Arterial Disease

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