There are a variety of dressings for wound healing. For this reason, research can assist in the choice and proper use of the intervention. This current view of the effectiveness of dressing on diabetic foot ulcers (DFUs) in patients with type 2 diabetes mellitus. This study is a systematic review of clinical trials selected in 4 databases: PubMed, Scopus, Web of Science, and Cochrane. Studies without language restriction, published between 2009 and 2020, were included. The search resulted in the identification of 5651 articles, of which 58 met all inclusion criteria. Among these, 2 biomaterials (D-acellular dermal matrix and keratinocyte) and phenytoin were highlighted for achieving healing rates of 100% and 95.82% ± 2.22%, respectively. The literature presents several alternatives with different actions, cure rates, reduction rates, and varied cost benefits. The growth in the use of biomaterials for the treatment of DFU can be seen in this study.
SBD—Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes: 2019-2020. Clannad; 2019.
2.
ChatterjeeSKhuntiKDaviesMJ. Type 2 diabetes. Lancet. 2017;389(10085):2239-2251.
3.
NevesJMatiasRFormigaA, et al.Diabetic foot with acute infection: treatment in the Portuguese emergency department. Rev Port Cir. 2013;(27):19-36.
4.
BRASIL. Ministério da Saúde. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília, DF, 2016.
5.
ArmstrongDGFisherTKLepowBWhiteMLMillsJL. Pathophysiology and principles of management of the diabetic foot. In: FitridgeRThompsonM, eds. Mechanisms of vascular disease: a reference book for vascular specialists. University of Adelaide Press; 2011:275.
6.
ArmstrongDGBoultonAJMBusSA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-2375.
7.
CubasMRSantosOMRetzlaffEMA, et al.Pé diabético: orientações e conhecimento sobre cuidados preventivos. Fisioter Mov. 2013;26(3):647-655.
8.
HinchliffeRJForsytheROApelqvistJ, et al.Guidelines of the international writing group on the diabetic foot on diagnosis. Diabetes Metab Res Rev. 2020;36(S1):e3276.
9.
SalutiniEBroccoEDa RosRMongeLUccioliLAnichiniR. The complexity of diabetic foot management: from common care to best practice. The Italian expert opinion by Delphi survey. Int J Low Extrem Wounds. 2020;19(1):34-43. doi:10.1177/1534734619890814.
10.
Germany. Institute for Quality and Efficiency in Health Care (IQWiG). What are the treatment options for chronic wounds?Cologne; 2006.
11.
KruseI. Evaluation and treatment of diabetic foot ulcers. Clin Diabetes.2006;24(2):91-93. doi:10.2337/diaclin.24.2.91.
12.
HayesTRSuB. Woodhead publishing series in biomaterials. 1st ed.2011. Elsevier.
MoherDShamseerLClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.
15.
CarvalhoAPVSilvaVGrandeAJ. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração cochrane. Diagn Tratamento. 2013;18(1):38-44.
16.
MotleyTACaporussoJMLangeDLEichelkrautRACargillDIDickersonJE. Clinical outcomes for diabetic foot ulcers treated with clostridial collagenase ointment or with a product containing silver. Adv Wound Care. 2018;7(10):339-348.
17.
AfkhamizadehMAboutorabiRRavariH, et al.Topical propolis improves wound healing in patients with diabetic foot ulcer: a randomized controlled trial. Nat Prod Res. 2018;32(17):2096-2099.
18.
MeimetiETentolourisNManesC, et al.Ointments containing Ceratothoa oestroides extract: evaluation of their healing potential in the treatment of diabetic foot ulcers. Wound Repair Regen. 2019;28(2):234-241.
19.
SuttoSETRoldanYIRMuñozEGC, et al.Efficacy and safety of the combination of isosorbidedinitrate spray and chitosan gel for the treatment of diabetic foot ulcers: a double-blind, randomized, clinical trial. Diab Vas Dis Res. 2018;15(4):348-351.
20.
HamedSBelokopytovMUllmannY, et al.Interim results of the remedied’ or study: a multicenter, single-blind, randomized, controlled trial to assess the safety and efficacy of an innovative topical formulation of erythropoietin for treating diabetic foot ulcers. Adv Wound Care. 2019;8(10):514-521.
21.
GrekCLPrasadGMViswanathanVArmstrongDGGourdieRGGhatnekarGS. Topical administration of a connexin 43-based peptide augments healing of chronic neuropathic diabetic foot ulcers: a multicenter, randomized trial. Wound Rep Reg. 2015;23(2):203-212.
22.
ZiresMJValdesPAWiechersACU, et al. Topical administration of pirfenidone increases healing of chronic diabetic foot ulcers: a randomized crossover study. J Diabetes Res. 2016;2016(2016):7340641.
23.
Gasca-LozanoLELucano-LanderosSRuiz-MercadoH, et al. Pirfenidone accelerates wound healing in chronic diabetic foot ulcers: a randomized, double-blind controlled trial. J Diabetes Res. 2017;2017(2017):3159798.
24.
GallelliGCioneESerraRLeoACitraroRMatricardiP. Nano-hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: a pilot study. Int Wound J. 2020;17(2):485-490.
25.
BergqvistKAlmhöjdUHerrmannIEliassonB. The role of chloramines in treatment of diabetic foot ulcers: an exploratory multicentre randomized controlled trial. Clin Diabetes Endocrinol. 2016;2(6):1-7.
26.
BlumePDriverVRTallisAJ, et al.Formulated collagen gel accelerates healing rate immediately after application in patients with diabetic neuropathic foot ulcers. Wound Rep Reg. 2011;19(3):302-308.
27.
LandsmanAAgnewPParishLJosephRGalianoRD. Diabetic foot ulcers treated with becaplermin and thera gauze, a moisture-controlling smart dressing. J Am Podiatr Med Assoc. 2010;100(3):155-160.
28.
FrykbergRGGibbonsGWWaltersJLWukichDKMilsteinFC. A prospective, multi-centre, open-label, single-arm clinical trial for treatment of chronic complex diabetic foot wounds with exposed tendon and/or bone: positive clinical outcomes of viable cryopreserved human placental membrane. Int Wound J. 2017;14(3):569-577.
29.
ParkKHHanSHHongJP, et al.Topical epidermal growth factor spray for the treatment of chronic diabetic foot ulcers: a phase III multicenter, double-blind, randomized, placebo-controlled trial. Diabetes Res Clin Pract. 2018;142(2018):335-344.
30.
CampitielloFManconeMDella CorteAGuernieroRCanonicoS. To evaluate the efficacy of an acellular flowable matrix in comparison with a wet dressing for the treatment of patients with diabetic foot ulcers: a randomized clinical trial. Updates Surg.2017;69(4):523-529.
31.
YouHJHanSKLeeJWChangH. Treatment of diabetic foot ulcers using cultured allogeneic keratinocytes—a pilot study. Wound Repair Regen. 2012;20(4):491-499.
32.
GudeWHaganDAboodFClausenP. Aurix gel is an effective intervention for chronic diabetic foot ulcers: a pragmatic randomized controlled trial. Adv Skin Wound Care. 2019;32(9):416-426.
33.
EdmondsM. Apligraf in the treatment of neuropathic diabetic foot ulcers. Int J Low Extrem Wounds. 2009;8(1):11-18.
34.
ViswanathanVJuttadaUBabuM. Efficacy of recombinant human epidermal growth factor (Regen-D 150) in healing diabetic foot ulcers: a hospital-based randomized controlled trial. Int J Low Extrem Wounds. 2019;19(2):158-164.
35.
GodaAAMetwallybMEwadabAEweesaH. Platelet-rich plasma for the treatment of diabetic foot ulcer: a randomized, double-blind study. Egypt J Surg. 2018;37(2):178-184.
36.
El-SayedAAE-MHazemEA. Platelet-rich plasma versus conventional dressing: does this really affect diabetic foot wound-healing outcomes?Egypt J Surg. 2018;37(1):16-26.
37.
YangLGaoLYangLVWangJ. Autologous platelet-rich gel for lower-extremity ischemic ulcers in patients with type 2 diabetes. Int J Clin Exp Med. 2017;10(9):13796-13801.
38.
AhmedMReffatSAHassanAEskanderF. Platelet-rich plasma for the treatment of clean diabetic foot ulcers. Ann Vasc Surg. 2017;38(2017):206-211.
39.
KulkarniSRChawlaA. Study of efficacy of platelet rich plasma dressing in management of chronic non-healing leg ulcers. J Evolution Med Dent. 2019;8(16):1307-1309.
40.
ElsaidAEl-SaidMEmileS, et al.Randomized controlled trial on autologous platelet-rich plasma versus saline dressing in treatment of non-healing diabetic foot ulcers. World J Surg. 2020;44(4):1294-1301.
41.
CazzellSMoyerPMSamsellBDorschKMcLeanJMooreMA. A prospective, multicenter, single-arm clinical trial for treatment of complex diabetic foot ulcers with deep exposure using acellular dermal matrix. Adv Skin Wound Care. 2019;32(9):409-415.
42.
ReyzelmanACrewsRTMooreJC, et al.Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. Int Wound J. 2009;6(3):196-208.
43.
ZelenCMOrgillDPSerenaT, et al.A prospective, randomised, controlled, multicentre clinical trial examining healing rates, safety and cost to closure of an acellular reticular allogenic human dermis versus standard of care in the treatment of chronic diabetic foot ulcers. Int Wound J. 2017;14(2):307-315.
44.
WaltersJCazzellSPhamHVayserDReyzelmanA. Healing rates in a multicenter assessment of a sterile, room temperature, acellular dermal matrix versus conventional care wound management and an active comparator in the treatment of full-thickness diabetic foot ulcers. Eplasty. 2016;16:e10.
45.
CazzellSVayserDPhamH, et al.A randomized clinical trial of a human acellular dermal matrix demonstrated superior healing rates for chronic diabetic foot ulcers over conventional care and an active acellular dermal matrix comparator. Wound Rep Reg. 2017;25(3):483-497.
46.
ParkKHKwonJBParkJHShinJCHanSHLeeJW. Collagen dressing in the treatment of diabetic foot ulcer: a prospective, randomized, placebo-controlled, single-center study. Diabetes Res Clin Pract. 2019;156(2019):107861.
ChandlerLAAlvarezOMBlumePAKimPJKirsnerRS. Wound conforming matrix containing purified homogenate of dermal collagen promotes healing of diabetic neuropathic foot ulcers: comparative analysis versus standard of care. Adv Wound Care. 2019;9(2):61-65.
49.
JanWAShahHKhanMFayazMUllahN. Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetic foot ulcers. J Postgrad Med Inst. 2012;26(4):402-407.
50.
MoghazyAMShamsMEAdlyOA, et al.The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract. 2010;89(3):276-281.
51.
KamaratosAVTzirogiannisKNIraklianouSAPanoutsopoulosGIKanellosIEMelidonisAI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2012;11(3):259-263.
52.
TsangKKKwongEWYToTSSChungJWYWongTKS. A pilot randomized, controlled study of nanocrystalline silver, Manuka honey, and conventional dressing in healing diabetic foot ulcer. Evid Based Complement Alternat Med. 2017; 2017:5294890.
53.
MohajeriGSafaeeMSaneiMH. Effects of topical Kiwi fruit on healing of neuropathic diabetic foot ulcer. J Res Med Sci. 2014;19(6):520-524.
54.
ÇetinkalpŞGökçeEHŞimşirI, et al.Comparative evaluation of clinical efficacy and safety of collagen laminin-based dermal matrix combined with resveratrol microparticles (dermalix) and standard wound care for diabetic foot ulcers. Int J Low Extrem Wounds. 2020;1534734620907773. doi:10.1177/1534734620907773.
55.
SerenaTEYaakovRMooreS, et al.A randomized controlled clinical trial of a hypothermically stored amniotic membrane for use in diabetic foot ulcers. J Comp Eff Res. 2020;9(1):23-34.
56.
DriverVRLaveryLAReyzelmanAM, et al.A clinical trial of Integra Template for diabetic foot ulcer treatment. Wound Repair Regen. 2015;23(6):891-900.
57.
LaveryLAFulmerJShebetkaKA, et al.The efficacy and safety of Grafix® for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J. 2014;11(5):554-560.
58.
MujicaVOrregoRFuentealbaRLeivaEZúñiga-HernándezJ. Propolis as an adjuvant in the healing of human diabetic foot wounds receiving care in the diagnostic and treatment centre from the regional hospital of Talca. J Diabetes Res. 2019;12:2507578.
59.
Tchanque-FossuoCNDahleSELev-TovH, et al.Cellular versus acellular matrix devices in the treatment of diabetic foot ulcers: interim results of a comparative efficacy randomized controlled trial. J Tissue Eng Regen Med. 2019;13(8):1430-1437.
60.
AnanianCEDhillonYSVan GilsCC, et al.A multicenter, randomized, single-blind trial comparing the efficacy of viable cryopreserved placental membrane to human fibroblast-derived dermal substitute for the treatment of chronic diabetic foot ulcers. Wound Rep Reg. 2018;26(3):274-283.
61.
HosseiniSEMolaviBGoodarziA, et al.The efficacy of platelet gel derived from umbilical cord blood on diabetic foot ulcers: a double-blind randomized clinical trial. Wound Med. 2020;28(2020):100178.
62.
ZhangYXingSZ. Treatment of diabetic foot ulcers using mepilex lite dressings: a pilot study. Exp Clin Endocrinol Diabetes. 2014;122(04):227-230.
63.
Delgado-EncisoIMadrigal-PerezVMLara-EsquedaA, et al. Topical 5% potassium permanganate solution accelerates the healing process in chronic diabetic foot ulcers. Biomed Rep. 2018;8(2):156-159.
64.
EdmondsMLázaro-MartínezJLAlfayate-GarcíaJM, et al.Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol. 2018;6(3):186-196.
65.
LobmannRAugustinMLawallHTiggesWPotempaCThiemH. Cost-effectiveness of TLC-sucrose octasulfate versus control dressings in the treatment of diabetic foot ulcers. J Wound Care. 2019;28(12):808-815.
66.
SomasundaramURPalanisamyS. Comparative study between various topical agents in wound healing in diabetic foot. J Evolution Med. 2018;7(30):3436-3441.
67.
UdhayasankarVSoundarapandiyanRSrikanthR. Role of topical phenytoin in diabetic foot ulcer care. A randomised control trial. J Evolution Med. 2017;6(4):265-267.
68.
AhmedAAhmedMI. A comparison of efficacy of topical use of phenytoin and vaseline gauze dressing with vaseline gauze dressing alone in healing of diabetic foot ulcers. J Postgrad Med Inst. 2014;28(3):297-302.
69.
MotaweaAAbd El-GawadAEGawadHBorgTMotaweaMTarshobyM. The impact of topical phenytoin loaded nanostructured lipid carriers in diabetic foot ulceration. Foot. 2019;40(2019):14-21.
70.
PatilVPatilRKariholuPLPatilLSShahapurP. Topical phenytoin application in grade I and II diabetic foot ulcers: a prospective study. J Clin Diagn Res. 2013;7(10):2238-2240.
71.
KarimiZBehnammoghadamMRafieiHAbdiNZoladlMTalebianpoorMS. Impact of olive oil and honey on healing of diabetic foot: a randomized controlled trial. Clin Cosmet Investig Dermatol. 2019;12:347-354.
72.
Romero-CereceroOZamilpaATortorielloJ. Effectiveness and tolerability of a standardized extract from Ageratina pichinchensis in patients with diabetic foot ulcer: a randomized, controlled pilot study. Planta Med. 2015;81(4):272-278.
73.
GwakHCHanSHLeeJ, et al.Efficacy of a povidone-iodine foam dressing (betafoam) on diabetic foot ulcer. Int Wound J. 2020;17(1):91-99.
74.
TabataY. Biomaterial technology for tissue engineering applications. J R Soc Interface. 2009;6(3):S311-S324.
75.
StejskalováAAlmquistBD. Using biomaterials to rewire the process of wound repair. Biomater Sci. 2017;5(8):1421-1434.
76.
DasSBakerAB. Biomaterials and nanotherapeutics for enhancing skin wound healing. Front Bioeng Biotechnol. 2016;4:82.
77.
WiegandCHiplerUC. Polymer-based biomaterials as dressings for chronic stagnating wounds. Macromol Symp.2010;294(2):1-13.
78.
SpiekstraSWBreetveldMRustemeyerTScheperRJGibbsS. Wound-healing factors secreted by epidermal keratinocytes and dermal fibroblasts in skin substitutes. Wound Rep Reg. 2007;15(5):708-717.
79.
Bolivar-FloresYJKuri-HarcuchW. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers. Dermatol Surg. 1999;25(8):610-617.
80.
FirminoFAlmeidaAMPSilvaRJGAlvesGSGranadeiroDSPennaLHG. A produção científica acerca da aplicabilidade da fenitoína na cicatrização de feridas. Rev Esc Enferm USP. 2014;48(1):166-173.
81.
SteedDL. Debridement. Am J Cirurgia. 2004;187(5):S71-S74.
82.
HinchliffeRJValkGDApelqvistJ, et al. A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2008;24(Suppl 1):S119-S144.
83.
DumvilleJCSoaresMOO’MearaSCullumN. Systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers. Diabetologia. 2012;55(7):1902-1910.
