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Review
. 2013 Jul 12;2013(7):CD009101.
doi: 10.1002/14651858.CD009101.pub3.

Hydrogel dressings for healing diabetic foot ulcers

Jo C Dumville  1 , Susan O'Meara, Sohan Deshpande, Katharine Speak
Affiliations
Review

Hydrogel dressings for healing diabetic foot ulcers

Jo C Dumville et al. Cochrane Database Syst Rev. .

Abstract

Background: Foot ulcers in people with diabetes are a prevalent and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from including hydrogel dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.

Objectives: To assess the effects of hydrogel wound dressings compared with alternative dressings or none on the healing of foot ulcers in people with diabetes.

Search methods: For this first update, in April 2013, we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.

Selection criteria: Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrogel with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes.

Data collection and analysis: Two review authors independently performed study selection, risk of bias assessment and data extraction.

Main results: We included five studies (446 participants) in this review. Meta analysis of three studies comparing hydrogel dressings with basic wound contract dressings found significantly greater healing with hydrogel: risk ratio (RR) 1.80, 95% confidence interval (CI) 1.27 to 2.56. The three pooled studies had different follow-up times (12 weeks, 16 weeks and 20 weeks) and also evaluated ulcers of different severities (grade 3 and 4; grade 2 and grade unspecified). One study compared a hydrogel dressing with larval therapy and found no statistically significant difference in the number of ulcers healed and another found no statistically significant difference in healing between hydrogel and platelet-derived growth factor. There was also no statistically significant difference in number of healed ulcers between two different brands of hydrogel dressing. All included studies were small and at unclear risk of bias and there was some clinical heterogeneity with studies including different ulcer grades. No included studies compared hydrogel with other advanced wound dressings.

Authors' conclusions: There is some evidence to suggest that hydrogel dressings are more effective in healing (lower grade) diabetic foot ulcers than basic wound contact dressings however this finding is uncertain due to risk of bias in the original studies. There is currently no research evidence to suggest that hydrogel is more effective than larval therapy or platelet-derived growth factors in healing diabetic foot ulcers, nor that one brand of hydrogel is more effective than another in ulcer healing. No RCTs comparing hydrogel dressings with other advanced dressing types were found.

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Conflict of interest statement

Susan O'Meara and Jo Dumville receive funding from the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme. This review presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (RP‐PG‐0407‐10428). The views expressed in this presentation are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Sohan Deshpande and Katherine Speak: none declared.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Hydrogel dressing compared with larval therapy, Outcome 1 Number of ulcers healed.
2.1
2.1. Analysis
Comparison 2 Hydrogel dressing compared with platelet‐derived growth factor, Outcome 1 Number of ulcers healed.
3.1
3.1. Analysis
Comparison 3 Hydrogel dressing compared with basic wound contact dressing, Outcome 1 Number of ulcers healed.
3.2
3.2. Analysis
Comparison 3 Hydrogel dressing compared with basic wound contact dressing, Outcome 2 Adverse events.
3.3
3.3. Analysis
Comparison 3 Hydrogel dressing compared with basic wound contact dressing, Outcome 3 Quality of life.
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References

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Veves 2001 {published data only}
    1. Veves A, Falanga V, Armstrong DG, Sabolinski ML. Graftskin, a human skin equivalent, is effective in the management of neuropathic diabetic foot ulcers. Diabetes Care 2001;24(2):290‐5. - PubMed
Veves 2002 {published data only}
    1. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4‐week period is a robust predictor of complete healing in a 12‐week prospective trial. Diabetes Care 2003;26(6):1879‐82. - PubMed
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    1. Veves A, Sheehan P, Pham HT. A randomized controlled trial of Promogran (a collagen / oxidised regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. Archives of Surgery 2002;137:822‐7. - PubMed
Woo 2010 {published data only}
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Yao 2007 {published data only}
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Zimny 2003 {published data only}
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References to studies awaiting assessment

Wang 2012 {published data only}
    1. Wang F, Yuan N, Wang Y, Wang C, Wang A, Yu T, Liu G, Xu Z, Ran X. Clinical study on topical bismuth subgallate/borneol (Suile) dressing for treatment of diabetic foot ulcers]. [Chinese] . Zhongguo xiu fu chong jian wai ke za zhi [Chinese journal of reparative and reconstructive surgery] 2012;26(8):955‐960. - PubMed

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References to other published versions of this review

Gottrup 2002, 23‐25 May
    1. Gottrup F, Hahn TW, Thomsen JK. Cost‐effectiveness of hydrogel treatment in diabetic foot ulcers. 12th Conference of the European Wound Management Association. Granada, Spain, 2002, 23‐25 May.

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