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Systematic review and meta‐analysis of skin substitutes in the treatment of diabetic foot ulcers: Highlights of a Cochrane systematic review
Author(s) -
Santema T. B. Katrien,
Poyck Paul P. C.,
Ubbink Dirk T.
Publication year - 2016
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/wrr.12434
Subject(s) - medicine , meta analysis , relative risk , confidence interval , diabetic foot , randomized controlled trial , amputation , surgery , clinical trial , foot (prosody) , systematic review , medline , diabetes mellitus , political science , law , linguistics , philosophy , endocrinology
Skin substitutes are increasingly used in the treatment of various types of acute and chronic wounds. The aim of this study was to perform a systematic review and meta‐analysis to evaluate the effectiveness of skin substitutes on ulcer healing and limb salvage in the treatment of diabetic foot ulcers. Randomized clinical trials were searched and assessed following the methodology of The Cochrane Collaboration. We included 17 trials, totaling 1655 randomized participants. Risk of bias was variable among included trials. Thirteen trials compared the skin substitutes with standard care. The pooled results showed that that skin substitutes can, in addition to standard care, increase the likelihood of achieving complete ulcer closure compared with standard care alone after 6–16 weeks (risk ratio 1.55, 95% confidence interval [CI] 1.30–1.85). Four of the included trials compared two types of skin substitutes but no particular product showed a superior effect over another. Two trials reported on total incidence of lower limb amputations. Pooling the results of these two trials yielded a statistically significantly lower amputation rate among patients treated with skin substitutes (risk ratio 0.43, 95% CI 0.23–0.81), although the absolute risk difference was small (−0.06, 95% CI −0.10 to −0.01). This systematic review provides evidence that skin substitutes can, in addition to standard care, increase the likelihood of achieving complete ulcer closure compared with standard care alone in the treatment of diabetic foot ulcers. However, effectiveness on the long term, including lower limb salvage and recurrence, is currently lacking and cost‐effectiveness is unclear.