Elraiyah T, Tsapas A, Prutsky G, Domecq JP, Hasan R, Firwana B, Nabhan M, Prokop L, Hingorani A, Claus PL, Steinkraus LW, Murad MH, et al.
Journal of vascular surgery. Date of publication 2016 Feb 1;volume 63(2 Suppl):46S-58S.e1-2.
1. J Vasc Surg. 2016 Feb;63(2 Suppl):46S-58S.e1-2. doi: 10.1016/j.jvs.2015.10.007.
A systematic review and meta-analysis of adjunctive therapies in diabetic foot
ulcers.
Elraiyah T(1), Tsapas A(2), Prutsky G(3), Domecq JP(3), Hasan R(4), Firwana B(4),
Nabhan M(1), Prokop L(5), Hingorani A(6), Claus PL(7), Steinkraus LW(7), Murad
MH(8).
Author information:
(1)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
(2)Second Medical Department, Aristotle University, Thessaloniki, Greece.
(3)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de
Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
(4)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of
Internal Medicine, University of Missouri, Columbia, Mo.
(5)Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
(6)Department of Surgery, Lutheran Medical Center, Brooklyn, NY.
(7)Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic,
Rochester, Minn.
(8)Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of
Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
Electronic address: murad.mohammad@mayo.edu.
BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound
healing in patients with diabetes and foot ulcers. The aim of this systematic
review is to summarize the best available evidence supporting the use of
hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents
(pentoxifylline, cilostazol, and iloprost) in this setting.
METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled
Trials, Web of Science, and Scopus through October 2011. Pairs of independent
reviewers selected studies and extracted data. Predefined outcomes of interest
were complete wound healing and amputation.
RESULTS: We identified 18 interventional studies; of which 9 were randomized,
enrolling 1526 patients. The risk of bias in the included studies was moderate.
In multiple randomized trials, the addition of HBOT to conventional therapy
(wound care and offloading) was associated with increased healing rate (Peto odds
ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation
rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with
conventional therapy alone. In one small trial, arterial pump devices had a
favorable effect on complete healing compared with HBOT and in another small
trial compared with placebo devices. Neither iloprost nor pentoxifylline had a
significant effect on amputation rate compared with conventional therapy. No
comparative studies were identified for cilostazol in diabetic foot ulcers.
CONCLUSIONS: There is low- to moderate-quality evidence supporting the use of
HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and
potentially prevent amputation. However, there are only sparse data regarding the
efficacy of arterial pump devices and pharmacologic interventions.
Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2015.10.007
PMID: 26804368 [Indexed for MEDLINE]
