Article

Hydrocolloid dressings for healing diabetic foot ulcers

Department of Health Sciences, University of York, York, UK. .
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2012; 2(2):CD009099. DOI: 10.1002/14651858.CD009099.pub2
Source: PubMed

ABSTRACT Foot ulcers in people with diabetes are a prevalent and serious global health issue. Wound dressings are regarded as important components of ulcer treatment, with clinicians and patients having many different types to choose from including hydrocolloid dressings. There is a range of different hydrocolloids available including fibrous-hydrocolloid and hydrocolloid (matrix) dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.
To compare the effects of hydrocolloid wound dressings with no dressing or alternative dressings on the healing of foot ulcers in people with diabetes.
We searched The Cochrane Wounds Group Specialised Register (searched 4 January 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (1950 to December Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, January 03, 2012); Ovid EMBASE (1980 to 2011 Week 52); and EBSCO CINAHL (1982 to 30 December 2011). There were no restrictions based on language or date of publication.
Published or unpublished randomised controlled trials (RCTs) that have compared the effects on ulcer healing of hydrocolloid with alternative wound dressings or no dressing in the treatment of foot ulcers in people with diabetes.
Two review authors independently performed study selection, risk of bias assessment and data extraction.
We included four studies (511 participants) in the review: these compared hydrocolloids with basic wound contact dressings, foam dressings and alginate dressings. Meta-analysis of two studies indicated no statistically significant difference in ulcer healing between fibrous-hydrocolloids and basic wound contact dressings: risk ratio 1.01 (95% CI 0.74 to 1.38). One of these studies found that a basic wound contact dressing was more cost-effective than a fibrous-hydrocolloid dressing. One study compared a hydrocolloid-matrix dressing with a foam dressing and found no statistically significant difference in the number of ulcers healed. There was no statistically significant difference in healing between an antimicrobial (silver) fibrous-hydrocolloid dressing and standard alginate dressing; or an antimicrobial dressing (iodine-impregnated) and a standard fibrous hydrocolloid dressing.
Currently there is no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing. Decision makers may wish to consider aspects such as dressing cost and the wound management properties offered by each dressing type e.g. exudate management.

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    • "Moura et al. / Acta Biomaterialia 9 (2013) 7093–7114 7097 one week [74]. However, there are contradictory studies on whether hydrocolloid-type wound dressings can be used in diabetic foot wounds in the case of superficial wounds, if there are no signs of infection, or if few or moderate wound exudates are present [78]. (2) Hydrogels—these systems are mostly used to maintain highly moist wound environments and are comprised of single or mixed hydrated polymers (i.e. in the form of a gel) presenting at least 20% of their weight in retained water [73] [79]. "
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    ABSTRACT: Diabetic foot ulcer (DFU) is a chronic, non-healing complication of diabetes that leads to high hospital costs and, in extreme cases, to amputation. Diabetic neuropathy, peripheral vascular disease, abnormal cellular and cytokine/chemokine activity are among the main factors that initiate impaired diabetic wound repair. DFUs represent a current and important challenge in the development of novel and efficient wound dressings. In general, an ideal wound dressing should be able to provide a moist wound environment, to protect from secondary infections, to remove wound exudate and to promote tissue regeneration. However, no existing dressing fulfills all the requirements associated to DFU treatment and the choice of the correct dressing depends on the wound type and stage, injury extension, patient condition and involved tissues. Presently, there are different types of commercially available wound dressings that can be used for DFU treatment which differ on their application modes, materials, shape and on the methods employed for production. Dressing materials can include natural, modified and synthetic polymers, as well as their mixtures or combinations, processed in the form of films, foams, hydrocolloids and hydrogels. Moreover, wound dressings may be employed as medicated systems, through the delivery of healing enhancers and therapeutic substances (drugs, growth factors, peptides, stem cells and/or other bioactive substances). This work reviews the state-of-the-art and the most recent advances on the development of wound dressings for DFU treatment. Special emphasis is given to systems employing new polymeric biomaterials, to the latest and innovative therapeutic strategies and delivery approaches.
    Acta biomaterialia 03/2013; 9(7). DOI:10.1016/j.actbio.2013.03.033 · 5.68 Impact Factor
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    • "However, the application of hydrocolloid dressings in strongly infected wounds has been questioned due to the possible hypoxic and excessively moist environment that could potentiate autolysis of necrotic tissue and therefore increase the risk of infection at the wound site [77] [78]. Hydrocolloids are usually applied to granulating and epithelializing wounds and therefore they may be also used for necrotic wounds in order to promote wound debridement [76]. In average, these materials can be maintained on DFUs for more than Other Nicotine db/db diabetic mice Accelerated healing and increased wound angiogenesis Jacobi et al, 2002 [279] Simvastatin db/db diabetic mice Increased VEGF mRNA and protein expression. "
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    ABSTRACT: Diabetic foot ulcers (DFUs) are a chronic, non-healing complication of diabetes that lead to high hospital costs and, in extreme cases, to amputation. Diabetic neuropathy, peripheral vascular disease, abnormal cellular and cytokine/chemokine activity are among the main factors that hinder diabetic wound repair. DFUs represent a current and important challenge in the development of novel and efficient wound dressings. In general, an ideal wound dressing should provide a moist wound environment, offer protection from secondary infections, remove wound exudate and promote tissue regeneration. However, no existing dressing fulfills all the requirements associated with DFU treatment and the choice of the correct dressing depends on the wound type and stage, injury extension, patient condition and the tissues involved. Currently, there are different types of commercially available wound dressings that can be used for DFU treatment which differ on their application modes, materials, shape and on the methods employed for production. Dressing materials can include natural, modified and synthetic polymers, as well as their mixtures or combinations, processed in the form of films, foams, hydrocolloids and hydrogels. Moreover, wound dressings may be employed as medicated systems, through the delivery of healing enhancers and therapeutic substances (drugs, growth factors, peptides, stem cells and/or other bioactive substances). This work reviews the state of the art and the most recent advances in the development of wound dressings for DFU treatment. Special emphasis is given to systems employing new polymeric biomaterials, and to the latest and innovative therapeutic strategies and delivery approaches
    Acta Biomaterialia 03/2013; 9(7):7093. DOI:10.1016/j.actbio.2013.03.033. · 5.68 Impact Factor
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    ABSTRACT: Impaired wound healing is a frequent and very severe problem in patients with diabetes mellitus, yet little is known about the underlying pathomechanisms. In this paper we review the biology of wound healing with particular attention to the pathophysiology of chronic wounds in diabetic patients. The standard treatment of diabetic ulcers includes measures to optimize glycemic control as well as extensive debridement, infection elimination by antibiotic therapy based on wound pathogen cultures, the use of moisture dressings, and offloading high pressure from the wound bed. In this paper we discuss novel adjuvant therapies with particular reference to the use of autologous skin transplants for the treatment of diabetic foot ulcers which do not respond to standard care.
    04/2013; 2013:385641. DOI:10.1155/2013/385641
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