Debridement of diabetic foot ulcers

Abstract

Surgical and non-surgical methods of cleaning and removing dead tissue from sores on the feet of people with diabetes. People with diabetes o en develop foot ulcers (open sores on the feet that go through the skin), which are a serious complication and can themselves result in serious consequences such as amputation. Cleaning and removing dead tissue and callus from the ulcers is a common procedure also know as "debridement" and can be done in several ways, including surgery and special dressings and gels (such as hydrogels). The review found that hydrogel results in faster healing than gauze or standard care. The evidence for other debriding strategies is unclear.

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

“…Current study data suggest the use of hydrogels to achieve a higher healing rate in diabetic ulcers [15,18].…”

“…Thus, in order to heal one additional patient with a diabetic ulcer, five patients have to be treated with hydrogels instead of moist compresses or standard therapy measures alone [15]. Further meta-analyses confirmed this result for diabetic ulcers [18]. The choice of hydrogels must still be made critically due to the increased irritation and sensitization potential -particularly in patients with leg ulcers [19,20].…”

“…In a systematic meta-analysis on 140 patients with diabetic ulcers, a significant advantage of maggot therapy for decreasing the wound size was shown as opposed to hydrogels. This does not apply, however, for the rate of complete wound healing after ten days of therapy [18]. For venous leg ulcers and mixed ulcers, a randomized, controlled study comparing maggot therapy with hydrogels showed no difference in the time to complete wound healing, but a significant shortening of the time until achieving complete debridement.…”

“…A disadvantage of this procedure is further a relatively unselective removal of devitalized and granulating tissue. Despite a trend to superiority, this form of debridement demonstrates no statistically significant advantage in a meta-analysis of the Cochrane Database in comparison to combination of conservative topical therapy and pressure relief at least in diabetic ulcers with respect to the wound healing rate after six months [18]. The use of surgical debridement should be oriented on the individual pain sensitivity and risk factors of the patient as well as the infrastructural requirements (inpatient vs. outpatient).…”

“…Mechanical Current data do not allow for a clear statement on the efficacy of mechanical debridement [18].…”