Table 3Characteristics of included studies

AuthorTotal no. of patientsInterventionsFollow-up periodPrimary outcomes
Debridement
Edwards et al. (2009)46
198
140
Surgical debridement vs. non-surgical management
Hydrogel vs. good wound care
Hydrogel vs. larvae therapy
6 months
12–20 weeks
Not reported
  • Complete wound healing
  • Ulcer recurrence
  • > 50% wound reduction
  • Complications
  • Adverse events
Off-loading
Van de Weg et al. (2008)43TCC + standard care vs. custom-made footwear + standard care
Standard care = standard wound care + debridement
16 weeks
Katz et al. (2005)41TCC + standard care vs. RCW (iTCC) + standard care.
Standard care = standard wound care + debridement
12 weeks
Ganguly et al. (2008)55TCC + standard care vs. simple dressing (mupirocin ointment and sterile gauze) + standard care
Standard care = debridement
Until complete epithelialisation and 6 months after healing.
Armstrong et al. (2001)63TCC + standard care vs. RCW + standard care vs. half shoes + standard care
Standard care = standard wound care + debridement
12 weeks
  • Complete wound healing
  • Mean healing time
Mueller et al. (1989)40TCC + standard care vs. traditional dressing treatment (wet-to-dry saline dressing) + standard care
Standard care = standard protocol
6 weeks
Nube et al. (2006)32Felt deflective padding to the skin + standard care vs. felt deflective padding within the shoe + standard care (control)
Standard care = standard wound care + debridement
4 weeks or until healing
  • Wound size reduction at week 4
Piagessi et al. (2007)40TCC + standard care vs. instant casting (Optima Diab device) + standard care
Standard care = standard wound care + debridement
12 weeks and up to complete re-epithelialisation
Dressings
Piagessi et al. (2001)20Aquacel (carboxyl methyl-cellulose dressing) + debridement vs. saline-moistened gauze + debridement8 weeks or until complete re-epithelisation
Veves et al. (2002)276Promogan (collagen/oxidised regenerated cellulose dressing) +debridement vs. saline-moistened gauze + debridement12 weeks
Jude et al. (2007)134Hydrofiber (ionic silver dressing) + debridement vs. calcium alginate dressing + debridement8 weeks
  • Complete wound healing
  • Wound surface reduction
  • Withdrawal due to AEs
  • Mean healing time
  • Wound-related complications
  • Treatment-related AEs
Foster et al. (1994)30Polyurethane foam dressing + debridement and antibiotics vs. alginate dressing + debridement and antibiotics8 weeks
Shukrimi et al. (2008)30Honey dressing + debridement and antibiotics vs. standard dressing (normal saline cleansing and povidone-soaked gauze) + debridement and antibioticsWound ready for surgical closure or needed further debridement
  • Mean time for wound to be ready for surgical closure
Jeffcoate et al. (2009)317Non-adherent gauze + standard care vs. Inadine (iodine impregnated dressing) + standard care vs. Aquacel (carboxyl methyl-cellulose dressing) + standard care
Standard care = debridement and off-loading with standard wound care
24 weeks
  • Complete wound healing
  • Mean healing time
  • Major and minor amputation
  • Withdrawal due to AEs
  • Complication (infection)

AEs = adverse events; RCW (iTCC) = removable cast walker (rendered irremovable by single roll of fibreglass casting); TCC = total contact casting.

From: 3, Evidence review and recommendations

Cover of Diabetic Foot Problems
Diabetic Foot Problems: Inpatient Management of Diabetic Foot Problems.
NICE Clinical Guidelines, No. 119.
Centre for Clinical Practice at NICE (UK).
Copyright © 2011, National Institute for Health and Clinical Excellence.

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