A Cochrane review [Abstract] 1 included 6 studies; 4 assessed hydrogels, with an additional study evaluating larval therapy against hydrogel, and one evaluated surgical debridement. Pooling the 3 studies which compared hydrogel with gauze or standard care suggested that hydrogels are significantly more effective in healing diabetic foot ulcers (RR 1.84, 95% CI 1.3 to 2.61; NNT 5, 95% CI 2 to 10). Surgical debridement showed no significant benefit over standard treatment. One small trial, available in abstract form only, suggested that larvae resulted in a greater reduction in wound area compared with hydrogel, but this evidence has not been confirmed by publication of full trial results. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes.
Another Cochrane review [Abstract] 2 included 10 RCTs involving 715 participants assessing debridement for venous leg ulcers. 8 RCTs evaluated autolytic debridement (biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze) and 2 RCTs evaluated enzymatic preparations and 1 evaluated biosurgical debridement. No RCTs evaluated surgical, sharp or mechanical methods of debridement, or debridement versus no debridement. One study (n=100) reported that 80% ulcers treated with dextranomer beads and 14% treated with EUSOL achieved complete debridement (RR 5.71, 95% CI 2.84 to 11.52); while the other trial (n=86) reported the number of ulcers completely debrided as 76% for hydrogel versus 45% for paraffin gauze (RR 0.67, 95% CI 0.45 to 0.99). One study (n=48) reported that by 12 weeks, 84% ulcers treated with BWD had achieved a 75% to 100% clean, granulating wound bed versus 26% treated with non-adherent petrolatum emulsion-impregnated gauze. One trial (n=108) reported that 44% ulcers treated with honey healed versus 33% treated with hydrogel (RR (adjusted for baseline wound diameter) 1.38, 95% CI 1.02 to 1.88; P value 0.037). Another trial (n=48) reported that 28% ulcers treated with BWD healed versus 30% treated with non-adherent dressing. Reduction in wound size was assessed in five trials (n=444) in which two autolytic methods were compared.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).
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