Comparison of healing effectiveness of different debridement approaches for diabetic foot ulcers: a network meta-analysis of randomized controlled trials

Peng Ning; Yupu Liu; Jun Kang; Hongyi Cao; Jiaxing Zhang

doi:10.3389/fpubh.2023.1271706

Comparison of healing effectiveness of different debridement approaches for diabetic foot ulcers: a network meta-analysis of randomized controlled trials

Front Public Health. 2023 Dec 11:11:1271706. doi: 10.3389/fpubh.2023.1271706. eCollection 2023.

Authors

Peng Ning¹, Yupu Liu¹, Jun Kang¹, Hongyi Cao¹, Jiaxing Zhang¹

Affiliation

¹ Department of Endocrine and Metabolism, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Geriatric Diseases Institute of Chengdu, Chengdu, China.

Abstract

Objectives: The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in the healing of DFUs remains unclear. This study conducted a network meta-analysis of the relative healing effectiveness of different debridement methods in patients with DFUs.

Methods: We performed a literature search in PubMed, Embase, and Cochrane Library from database inception up to 30 June 2023 for screening randomized controlled trials on the healing effectiveness of debridement in DFUs. Outcome measures included ulcer healing rate and ulcer area reduction rate. The Cochrane Risk Bias Tool, version 2.0, was used to assess the risk of bias in the included trials. R software was used for performing statistical analysis and GraphPad Prism was used for image plotting.

Results: A total of 19 randomized controlled trials were included, and 900 patients with DFUs were assessed in this analysis. The proteolytic fraction from the latex of Vasconcellea cundinamarcensis (P1G10) in enzymatic debridement showed the best ulcer healing rate (SURCA = 0.919) when compared with the standard of care (SOC) group, with a mean difference (MD) and 95% confidence interval (CI) of 1.40 (0.57, 2.36). Kiwifruit extract demonstrated the best effect on the ulcer area reduction rate (SURCA = 0.931), when compared with that in the SOC group, with an MD and 95% CI of 0.47 (0.27, 0.66).

Conclusion: Enzymatic debridement was superior to other debridement methods in terms of ulcer healing rate and ulcer area reduction rate in patients with DFUs. However, as the quality of the included trials is low, enzymatic debridement can be used as a candidate debridement method in addition to sharp-based debridement in clinical practice.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441715.

Keywords: area reduction; debridement; diabetic foot ulcers; healing rate; network meta-analysis; randomized controlled trial.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Debridement / methods
Diabetes Mellitus*
Diabetic Foot* / therapy
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Wound Healing

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This project was supported by the Medical Scientific Research Project of Chengdu (no. 2021272) and the Scientific Research Fund of Chengdu Fifth People’s Hospital (no. GSPZX2022-19).