Several methods of débridement of diabetic foot ulcers are currently used. The relative efficacy of these methods is not well established.
Methods
This systematic review and meta-analysis was conducted to find the best available evidence for the effect of débridement on diabetic foot wound outcomes. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011 for randomized controlled studies (RCTs) and observational comparative studies.
Results
We identified 11 RCTs and three nonrandomized studies reporting on 800 patients. The risk of bias was moderate overall. Meta-analysis of three RCTs showed that autolytic débridement significantly increased the healing rate (relative risk [RR], 1.89; 95% confidence interval [CI] 1.35-2.64). Meta-analysis of four studies (one RCT) showed that larval débridement reduced amputation (RR, 0.43; 95% CI, 0.21-0.88) but did not increase complete healing (RR, 1.27; 95% CI, 0.84-1.91). Surgical débridement was associated with shorter healing time compared with conventional wound care (one RCT). Insufficient evidence was found for comparisons between autolytic and larval débridement (one RCT), between ultrasound-guided and surgical débridement, and between hydrosurgical and surgical débridement.
Conclusions
The available literature supports the efficacy of several débridement methods, including surgical, autolytic, and larval débridement. Comparative effectiveness evidence between these methods and supportive evidence for other methods is of low quality due to methodologic limitations and imprecision. Hence, the choice of débridement method at the present time should be based on the available expertise, patient preferences, the clinical context and cost.
Cited by (0)
This review was partially funded by a contract from the Society for Vascular Surgery, which had no involvement in the study design; collection, analysis, and interpretation of data; manuscript writing; or the decision to submit the manuscript for publication.
Independent peer review and oversight was provided by members of the Society for Vascular Surgery Document Oversight Committee: Peter Gloviczki, MD (Chair), Martin Bjorck, MD, Ruth Bush, MD, Thomas Forbes, MD, Michel Makaroun, MD, and Gregory Moneta, MD.
Author conflict of interest: none.
Additional material for this article may be found online at www.jvascsurg.org.
