A systematic review 1 including 35 RCTs with a total of subjects was abstracted in DARE. No RCTs were found that evaluated the effectiveness of surgical debridement, larval therapy, or that compared debridement with no debridement. Dextranomer polysaccharide beads or paste versus traditional of control treatments (9 trials) found a difference favouring dextranomer in 3 studies and traditional treatment in 2 studies. Cadexomer iodine polysaccharide beds or paste (9 trials) was beneficial in 3 trials.
Of enzymatic agents versus traditional of control treatment, none of the 5 trials found benefit of enzymatic treatment for wound closure. One trial showed an increase in wound size in both enzyme collagenase and control groups, but the increase was less in the enzyme-treated group. In one trial, adhesive zinc oxide tape was more effective in eradicating or reducing by more than 50% of the necrotic area of diabetic foot ulcers than a hydrocolloid dressing. One trial showed a benefit from hydrogel compared to dextranomer.
Comment: The quality of evidence is downgraded by severe study limitations and indirectness of evidence (few direct comparisons).
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