Chen AC, Lu Y, Hsieh CY, Chen YS, Chang KC, Chang DH, et al.
Advances in wound care. Date of publication 2023 Aug 16;volume ():.
1. Adv Wound Care (New Rochelle). 2023 Aug 16. doi: 10.1089/wound.2023.0024.
Online ahead of print.
Advanced Biomaterials and Topical Medications for Treating Diabetic Foot Ulcers:
A Systematic Review and Network Meta-Analysis.
Chen AC(1), Lu Y(1), Hsieh CY(2), Chen YS(2)(3), Chang KC(2), Chang DH(2)(4)(5).
Author information:
(1)Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
(2)Division of Plastic and Esthetic Surgery, Department of Surgery, Far Eastern
Memorial Hospital, New Taipei City, Taiwan.
(3)School of Medicine, National Taiwan University, Taipei, Taiwan.
(4)Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.
(5)School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Significance: With the increasing diabetic population worldwide, diabetic foot
ulcers (DFUs) are a significant concern. This study aimed to compare the
efficacy of skin substitutes, biomaterials, and topical agents with standard
care. Recent Advances: A meta-analysis was conducted using Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, and
Web of Science were searched using the following keywords: diabetes mellitus AND
skin graft OR tissue replacement OR dressing OR drug. Two independent reviewers
performed data collection and quality assessment of the eligible studies. The
primary outcome was the 12- to 16-week healing rates and the secondary outcome
was recurrence rates. Critical Issues: Thirty-eight randomized controlled
trials, including 3,862 patients, were analyzed. The studies exhibited low
heterogeneity (τ2 = 0.10) without significant asymmetry (Egger's test,
p = 0.8852). After pooling direct and indirect estimates, placenta-based tissue
products exhibited the best wound healing probability (p-score = 0.90), followed
by skin substitutes with living cells (p-score = 0.70), acellular skin
substitutes (p-score = 0.56), and advanced topical dressings (p-score = 0.34)
compared with standard of care. The recurrence analysis showed significant
improvement in the intervention group compared with the control group (11.21%
vs. 15.15%). Future Directions: This network meta-analysis provides the relative
effectiveness and rank of biomaterials and topical dressings in DFU healing. The
results could help clinical decision making.
DOI: 10.1089/wound.2023.0024
PMID: 37395488
