A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes
A systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes
复制标题
DOI：
10.1002/dmrr.2246
复制
发表时间：
2012-02-01
影响因子：
8
通讯作者：
Jeffcoate, W. J.
中科院分区：
文献类型：
--
作者：
Game, F. L.;Hinchliffe, R. J.;Jeffcoate, W. J.
糖尿病足溃疡的治疗结果不佳，并且关于最佳治疗方法仍存在不确定性。正是由于这些原因，2006年，糖尿病足国际工作组（IWGDF）伤口愈合工作组对证据进行了系统性审查，以告知常规护理方案，并强调应考虑进一步研究的领域。同一工作组现在通过考虑2006年12月至2010年6月期间发表的关于改善慢性溃疡愈合的干预措施的论文更新了这一审查。所选研究的方法学质量由两名评审员使用苏格兰校际指南网络标准进行独立评估。选定的研究分为以下10类：尖锐清创和用幼虫和水疗法准备创面;使用防腐剂、敷剂和敷料产品准备创面;切除慢性创面;高压氧疗法;加压或负压疗法;旨在纠正与受损创面愈合有关的创面生物化学和细胞生物学方面的产品;细胞的应用，包括血小板和干细胞;生物工程皮肤和皮肤移植;电、电磁、激光、冲击波和超声波;不属于上述类别的其他全身疗法。研究的异质性阻碍了结果的汇总分析。在1322篇论文中，43篇被选择进行全文审查后的分级。本报告是对早期IWGDF系统性综述的更新，但结论相似：除了HBOT和可能的负压伤口治疗外，几乎没有发表的证据证明使用新疗法是合理的。这与最近科克伦综述和英国国家健康与临床卓越指南委员会进行的系统综述的结论相呼应。在这一领域，证据分析存在相当大的困难，特别是因为对照研究很少，大多数方法学质量较差。版权所有（C）2012约翰威利父子有限公司
The outcome of management of diabetic foot ulcers is poor, and there is continuing uncertainty concerning optimal approaches to management. It was for these reasons that in 2006 the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing undertook a systematic review of the evidence to inform protocols for routine care and to highlight areas which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between December 2006 and June 2010. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network criteria. Selected studies fell into the following ten categories: sharp debridement and wound bed preparation with larvae and hydrotherapy; wound bed preparation using antiseptics, applications and dressing products; resection of the chronic wound; hyperbaric oxygen therapy (HBOT); compression or negative pressure therapy; products designed to correct aspects of wound biochemistry and cell biology associated with impaired wound healing; application of cells, including platelets and stem cells; bioengineered skin and skin grafts; electrical, electromagnetic, lasers, shockwaves and ultrasound; other systemic therapies which did not fit in the above categories. Heterogeneity of studies prevented pooled analysis of results.Of the 1322 papers identified, 43 were selected for grading following full text review. The present report is an update of the earlier IWGDF systematic review, but the conclusion is similar: that with the exception of HBOT and, possibly, negative pressure wound therapy, there is little published evidence to justify the use of newer therapies. This echoes the conclusion of a recent Cochrane review and the systematic review undertaken by the National Institute for Health and Clinical Excellence Guidelines Committee in the UK. Analysis of evidence presents considerable difficulties in this field particularly as controlled studies are few and the majority are of poor methodological quality. Copyright (C) 2012 John Wiley & Sons, Ltd.