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Debridement of diabetic foot ulcers

2002; Cochrane; Linguagem: Inglês

10.1002/14651858.cd003556

1469-493X

Jude Edwards,

Pressure Ulcer Prevention and Management

Background 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. Objectives The aim of this review is to assess the evidence for the effectiveness of debridement as a treatment for diabetic foot ulcers. Search methods We searched the Cochrane Wounds Group Specialised Register (May 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2007). We performed hand searches of journals and reference lists. Selection criteria Randomised controlled trials evaluating a method of debridement in the treatment of diabetic foot ulcers and measuring complete healing or rate of healing. There was no restriction on articles/trials based on language or publication status. Data collection and analysis Data extraction and assessment of study quality were undertaken by one author and checked by an Editor of the Wounds Group. Main results Six RCTs of debridement were identified; three RCTs assessed the effectiveness of hydrogel for debridement, one RCT evaluated surgical debridement, one RCT compared two different hydrogels and one RCT evaluated larval therapy. Pooling the three hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers (Relative Risk 1.84, 95% Confidence Interval (CI)1.3 to 2.61). Surgical debridement and larval therapy showed no significant benefit over standard treatment and hydrogel respectively in these small trials. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in diabetic foot ulcers. Authors' conclusions There is evidence to suggest that hydrogel increases the healing rate of diabetic foot ulcers compared with gauze dressings or standard care. More research is needed to evaluate the effects of a range of widely used debridement methods and of debridement per se.