354: Hydrogel may be effective for healing diabetic foot ulcers

June 20, 2012

PEARLS 354: written by Brian R McAvoy.

Clinical question: How effective are debridement interventions on the healing of diabetic foot ulcers?

Bottom line: Compared with gauze dressings or standard care, hydrogel increased the healing rate of diabetic foot ulcers. However, since hydrogel functions by increasing the moisture of the wound environment, it was not clear whether this effect was mediated through debridement per se. There was insufficient evidence (1 small trial, abstract only) of the effects of larval therapy on diabetic foot ulcers, but it did seem to reduce wound area. Surgical debridement showed no significant benefit over standard treatment.

Caveat: In general, the studies were small and of poor methodological qual.ity, resulting in a high risk of bias. There was a diversity of debridement interventions, and no replicating studies. Other debridement methods, such as enzyme preparations or polysaccharide beads, have not been evaluated in the treatment of diabetic foot ulcers.

Context: Foot ulceration is thought to affect 15% of people with diabetes at some time in their lives. Debridement is widely regarded as an effective intervention to speed up ulcer healing. The most effective method is unclear.

Cochrane Systematic Review:  Edwards J and Stapley S. Debridement of diabetic foot ulcers. Cochrane Reviews, 2011, Issue 11. Article No. CD003556. DOI: 10.1002/14651858. CD003556.pub2. This review contains 6 studies involving over 488 participants.

 Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.