Is Angiosome-Targeted Angioplasty Effective for Limb Salvage and Wound Healing in Diabetic Foot? : A Meta-Analysis

The role of smoking for wound healing in patients with diabetic foot has been unclear. This meta-analysis examined the relationship between cigarette smoking and diabetic foot wound healing. Observational studies for the association between smoking and diabetic foot wound healing of patients were systematically searched through PubMed and Wanfang Data, published up to June 2018. Healing rates of wounds were recognized as outcomes. Meta-analysis models were chosen by heterogeneity. A total of 3388 eligible studies were identified, of which 18 met all our inclusion criteria. In the smoking group, healing rate had an average of 62.1%, ranging from 20.0% to 89.6%; in the nonsmoking group, healing rate had an average of 71.5%, ranging from 40.2% to 93.8%. A significant association was found between smoking and the healing of diabetic foot wounds ( z = 3.08; P = .002), with an odds ratio (OR) of 0.70 (95% CI = 0.56-0.88), based on a random-effects model. Meta-regression analyses indicated that the heterogeneity did not come from publication year ( t = −0.50, P = .622) or overall healing rate ( t = 0.16, P = .872). The leave-one-out sensitivity analysis was robust; sensitivity analysis for pooled estimate of adjusted ORs had an OR of 0.20 (95% CI = 0.07-0.56; z = 3.08; P = .002). Subgroup analysis had an OR of 0.62 (95% CI = 0.41-0.95; z = 2.21; P = .027) in retrospective cohort studies and had an OR of 0.75 (95% CI = 0.57-0.99; z = 2.02; P = .043) in prospective cohort studies. Our meta-analysis indicated that smoking had an overall negative effect on the wound healing of diabetic foot individuals. This study provides evidence for the harm of smoking to diabetic foot and may help reduce the medical and economic burden on poor healing of diabetic foot.

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Biological effects of amniotic membrane on diabetic foot wounds: a systematic review

Journal of Wound Care ◽

10.12968/jowc.2018.27.sup2.s19 ◽

2018 ◽

Vol 27 (Sup2) ◽

pp. S19-S25 ◽

Cited By ~ 9

Author(s):

André Oliveira Paggiaro ◽

Andriws Garcia Menezes ◽

Alexandra Donizetti Ferrassi ◽

Viviane Fernandes De Carvalho ◽

Rolf Gemperli

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Amniotic Membrane ◽

Diabetic Foot ◽

Biological Effects ◽

Meta Analysis ◽

Healing Process ◽

Intervention Group ◽

Risk Of Bias ◽

Control Group

Objective: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. Method: A systematic review of amniotic membrane's influence was undertaken, using the search terms ‘placenta’ ‘diabetic foot’ ‘amnion’ and biological dressing’, assessing the outcomes ‘wound healing’ and ‘wound healing time’, in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. Results: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. Conclusion: There is statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. In addition, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.

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Successful Revascularization has a Significant Impact on Limb Salvage Rate and Wound Healing for Patients with Diabetic Foot Ulcers: Single-Centre Retrospective Analysis with a Multidisciplinary Approach

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02604-4 ◽

2020 ◽

Vol 43 (10) ◽

pp. 1449-1459

Author(s):

António Proença Caetano ◽

Inês Conde Vasco ◽

Filipe Veloso Gomes ◽

Nuno Vasco Costa ◽

José Hugo Luz ◽

...

Keyword(s):

Wound Healing ◽

Retrospective Analysis ◽

Limb Salvage ◽

Diabetic Foot ◽

Multidisciplinary Approach ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Limb Salvage Rate ◽

Single Centre ◽

Salvage Rate

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Treatment of Diabetic Foot with Autologous Stem Cells: A Meta-Analysis of Randomized Studies

Stem Cells International ◽

10.1155/2020/6748530 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Jiezhi Dai ◽

Chaoyin Jiang ◽

Hua Chen ◽

Yimin Chai

Keyword(s):

Wound Healing ◽

Stem Cell ◽

Cell Therapy ◽

Diabetic Foot ◽

Therapy Group ◽

Controlled Trial ◽

Meta Analysis ◽

Effective Role ◽

Dichotomous Outcomes

Background. This meta-analysis was to evaluate the efficacy of autologous stem cell administration for the treatment of diabetic foot. Methods. The electronic databases included PubMed, EMBASE, BIOSIS, Cochrane central, and Google Scholar internet, last updated on May 30, 2019. Evaluated outcomes included the rate of wound healing and amputation. Dichotomous outcomes were described as risk ratios (RR) with 95% confidence intervals (CIs). Statistical analysis was performed with RevMan 5.0 software and STATA 10.0 software. Results. Eight randomized controlled trial (RCT) studies were included in this study. The meta-analysis showed a lower amputation (RR 0.25, 95% CI 0.11 to 0.54, I2=0) and a higher wound healing rate (RR 2.05, 95% CI 1.67 to 2.51, I2=4) in the cell therapy group compared with control. Conclusion. This meta-analysis supports the effective role of stem cell therapy in promoting wound healing and decreasing rate of amputation in diabetic foot. In the future, more high quality and well-designed studies are need.

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Novel home use of mechanical negative pressure wound therapy in diabetic foot ulcers

Journal of Wound Care ◽

10.12968/jowc.2021.30.12.1006 ◽

2021 ◽

Vol 30 (12) ◽

pp. 1006-1010

Author(s):

Xuxin Lim ◽

Li Zhang ◽

Qiantai Hong ◽

Enming Yong ◽

Shufen Neo ◽

...

Keyword(s):

Wound Healing ◽

Limb Salvage ◽

Negative Pressure ◽

Diabetic Foot ◽

Wound Closure ◽

Negative Pressure Wound Therapy ◽

Length Of Hospital Stay ◽

Wound Therapy ◽

Primary Wound Closure ◽

Mean Cost

Objective: Mechanical negative pressure wound therapy is an ultraportable, light weight and disposable single-use device that has been shown to promote wound healing. This study evaluated home use of a mechanically powered negative pressure wound therapy (NPWT) in diabetic foot wounds. Methods: Patients underwent revascularisation and/or debridement or amputation before starting mechanical NPWT. Wound outcomes and images of the wounds were recorded at each follow-up visit by the wound nurse. Patients were followed up until wound closure or end of therapy. Results: A total of 12 patients (each with one wound) were included in the study. Of the 12 wounds, 33.3% (n=4) of wounds achieved primary wound closure while the remaining 66.6% (n=8) of wounds demonstrated a mean wound size reduction of 37.5±0.13%. Of the closed wounds, mean time to healing was 4.75±2.50 weeks. There was 100% limb salvage with no further debridement or amputations, and no 30-day unplanned readmissions. Mean length of hospital stay before starting home NPWT was 9.75±6.31 days. Mean number of NPWT changes was 8.33±2.67 sessions, while mean duration of therapy was 4.0±1.54 weeks. Mean cost of home NWPT therapy was US$1904±731 per patient. Conclusion: The home use of mechanically powered NPWT in diabetic foot wounds demonstrated excellent wound healing rates and 100% limb salvage, with no complications.

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Efficacy of curcumin for wound repair in diabetic rats/mice: a systematic review and meta-analysis of preclinical studies

Current Pharmaceutical Design ◽

10.2174/1381612827666210617122026 ◽

2021 ◽

Vol 27 ◽

Author(s):

Yuan Li ◽

Sheng Zhao ◽

Leanne Van der Merwe ◽

Wentong Dai ◽

Cai Lin

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Wound Repair ◽

Meta Analysis ◽

Diabetic Rats ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Collagen Formation ◽

Beneficial Effects ◽

Item Checklist

Background: Curcumin possesses multiple bioactivities that have beneficial effects on diabetic foot ulcers. Herein, we aimed to conduct a systematic preclinical review of 9 studies including a total of 262 animals, to assess the possible mechanisms of curcumin for wound healing in diabetic animals. Methods: Five databases were searched from inception to May 12, 2020; Rev-Man 5.3 software was applied for data analyses. Cochrane Collaboration’s tool 10-item checklist was used to evaluate the methodological quality, and data revealed scores of risk of bias ranging from 2 to 5. Results: Meta-analysis indicated that curcumin had significant effects on wound healing rate and blood vessel density when compared with control (P < 0.05). The wound regeneration properties of curcumin for diabetic wounds are thought to mainly work through the possible mechanisms of antioxidation, enhanced cell proliferation, increased collagen formation, and angiogenesis. However, the anti-inflammatory effect on wounds in diabetic animals remains controversial. Conclusions: The findings indicate that more randomized controlled trials should be pursued to obtain more reliable results regarding inflammatory response. Overall, curcumin might be a probable candidate for diabetic foot ulcers and may contribute to future clinical trials.

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Biological effects of amniotic membrane on diabetic foot wounds: a systematic review

Journal of Wound Care ◽

10.12968/jowc.2018.27.2.s19 ◽

2018 ◽

Vol 27 (Sup2) ◽

pp. S19-S25

Author(s):

André Oliveira Paggiaro ◽

Andriws Garcia Menezes ◽

Alexandra Donizetti Ferrassi ◽

Viviane Fernandes De Carvalho ◽

Rolf Gemperli

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Amniotic Membrane ◽

Diabetic Foot ◽

Biological Effects ◽

Meta Analysis ◽

Healing Process ◽

Intervention Group ◽

Risk Of Bias ◽

Control Group

Objective: The amniotic membrane has biological properties that are beneficial to the wound healing process of diabetic foot ulcers (DFU). Our aim is to analyse the scientific evidence found in literature on the use of the amniotic membrane to stimulate DFU healing. Method: A systematic review of amniotic membrane's influence was undertaken, using the search terms ‘placenta’ ‘diabetic foot’ ‘amnion’ and biological dressing’, assessing the outcomes ‘wound healing’ and ‘wound healing time’, in DFU. Following the inclusion and exclusion criteria, randomised controlled trials (RCT) were identified, and the risk of bias was analysed according to the Cochrane risk of bias tool. We conducted a meta-analysis of the two outcomes to evaluate the level of evidence. Results: We identified six clinical trials, with a total of 331 patients. The most common risks of bias in the studies were selection, attrition, and detection biases. From the meta-analysis, the difference of the intervention group (amnion) in relation to the control group was statistically significant. We found that wound healing in the group treated with amniotic membrane occurs 2.32 times more often and is 32 days faster in comparison with the group that used conventional dressings. Conclusion: There is statistical evidence to support the effectiveness of amniotic membrane in comparison with other conventional dressings. In addition, there is a clear tendency for the use of amniotic membrane treatment to result in a larger number of DFUs healing at a quicker rate.

Download Full-text