Risk Of Bias Assessment
Two review authors independently assessed each individual included study using the Cochrane Collaboration tool for assessing risk of bias, which addresses six specific domains . Disagreements about risk of bias assessment were resolved by discussion and trial authors contacted where possible when data were missing. We classified trials as being at high risk of bias if they were rated ‘No’ for any of three key criteria .
Silver Colloid Dressings Score Over Conventional Dressings In Diabetic Foot Ulcer: A Randomized Clinical Trial
Rajkumar Sharma, Niraj Gupta, Vipan Kumar, Sanjay Pal, Vishal Kaundal, Vikrant Sharma
Background: Topical silver treatments and silver dressings are increasingly used for the local treatment of contaminated or infected wounds however, there is a lack of clarity regarding the evidence for their effectiveness. To compare the outcome of silver colloidal based dressing in comparison to conventional dressing in management of diabetic foot ulcers.
Methods: This was a single institution prospective randomized controlled trial. Patients with Wagner grade 1and 2 diabetic foot ulcer were enrolled in this study. Patients were assessed on day one and then at two weeks interval for twelve weeks for ulcer size by planimetry.
Results: Out of 25 patients, 13 were randomized to silver colloid group and 12 in conventional dressing group. Age and sex distribution was comparable among two groups. Total 29 ulcers were present in silver colloidal and conventional dressing group. Mean wound area in silver colloidal dressing group and conventional dressing group on admission was 36.8 and 20.46 cm2 respectively. After 12 weeks of dressing mean wound area in silver colloidal dressing group and conventional dressing group decreased by 31.52 and 14.04 and after 12-week complete healing was seen in 11 patients in silver colloidal dressing group and 5 patients in conventional dressing group.
Mertz PM. Cutaneous biofilms: friend or foe. Wounds. 2003 15:129-32.
Why It Is Important To Do This Review
Diabetic foot ulcers are a common consequence of diabetes internationally. Treatment with dressings forms a key part of the treatment pathway when caring for people with diabetic foot ulcers and there are many types of dressings that can be used, which also vary considerably in cost. Guidelines for the treatment of diabetic ulcer maintain that clinical judgement should be used to select a moist wound dressing.
This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of foot ulcers in people with diabetes mellitus. Each review will focus on a particular dressing type which in this review is the alginate dressing. Other reviews have considered hydrocolloid, hydrogel and foam dressings . These reviews will be summarised in an overview of reviews , which will draw together all existing Cochrane review evidence regarding the use of dressings to treat foot ulcers in people with diabetes. While other existing review evidence may also be included in this overview, following Cochrane guidance, this will only occur in the absence of a relevant Cochrane Intervention review .
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Diabetic Foot Ulcer Treatment
The first step in treatment of diabetic foot ulcers is to remove necrotic wound tissue from the wound. It is essential that the method of debridement utilized does not damage nerves, tendons, and blood vessels. Since many people with diabetes don’t feel pain from the wound site, health care practitioners can’t rely on the patient to let them know when sensitive areas are being examined. The debridement will:
- Reduce pressure on the ulcer.
- Stimulate wound healing.
- Allow the healthy underlying tissue to be examined.
- Help the wound to drain.
- Optimize the effectiveness of the wound dressing.
What Is A Foam Dressing
Foam dressings are absorbent, non-adherent padded wound dressings that absorb moisture and provide a barrier from environmental contaminants while protecting intact skin from damage related to pressure and friction.
Foam dressings are made up of fibers with small open cells that form an absorbent, sponge-like material. These open cells draw up drainage and debris from the wound bed, promoting a moist healing environment for natural healing.
Foam dressings are non-adherent and provide thermal insulation while acting as a protective cushion over the healing wound bed. These dressings allow water vapor across the surface of the wound, but block fluids, bacteria, and other contaminants from entering.
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Wet To Dry Dressing Or Simple Saline
This dressing has a good debriding action and helps in wound bed preparation. Wet-to-dry dressings are described in the literature as a means of mechanical debridement. It is very absorptive as well as adherent and one of the cheapest dressings used throughout the world, but requires frequent dressing change based on wound severity. Dressings should be moistened before removal to minimize any chance of bleeding. A gentle cleanser will minimize wound irritation and discomfort. When treating a granulating or epithelizing wound one should soak the dressing thoroughly with normal saline for five minutes to prevent trauma and heavy bleeding.
Reviews For Medvance Silicone Bordered Silicone Foam Dressing 48
John V. Mccall March 10, 2021
Carly Cashman March 10, 2021
Healing of small area of skin breakdown after trauma in an awkward spot by the ankle. This dressing applies easily and adheres to an irregular surface. It stays put for up to three days without wrinkling at the edges.
BB December 3, 2020
I used these for my incision on my upper thigh that would not heal. My skin is so sensitive to tape and these stayed in place. I changed every 24 hrs, took off to shower. Perfect size pad, adhesive section is not too much or too little, and super absorbent as my incision would leak through thinner bandages that were the same size. Definitely recommend!
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Patient Disposition And Baseline Characteristics
A total of 87 patients were screened, of which 71 were deemed eligible and randomised to PVPI foam dressing or foam dressing .1). All 71 patients met the criteria for both the Safety Set and the FAS. Among them, 22 patients withdrew prior to study completion reasons for premature discontinuation included withdrawal of consent , protocol violations , physician’s decision , AEs , and lack of efficacy . The PPS included 40 patients who completed the study without major protocol deviations .
Patient flow through the trial
The mean age of the patients was 62years , and 79% were male. Demographic variables, duration of diabetes, medical history, and baseline ulcer characteristics , except for the leg the ulcer was located on, were comparable between treatment groups .
Quality Assessment Of Mtc Estimates
We have developed and employed a preliminary framework for quality assessment of MTC evidence based on GRADE. In this example, we aimed to assess the feasibility and highlight potential challenges of applying quality assessment to MTC evidence. We note, however, that our modified approach has not been validated and is not recognised by GRADE.
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How The Intervention Might Work
Animal experiments conducted over 40 years ago suggested that an acute wound heals more quickly when its surface is kept moist, rather than left to dry and scab . A moist environment is thought to provide optimal conditions for the cells involved in the healing process, as well as allowing autolytic debridement , which is thought to be an important part of the healing pathway . The desire to maintain a moist wound environment is a key driver for the use of wound dressings. Different wound dressings vary in their level of absorbency, so that a very wet wound can be treated with an absorbent dressing to draw excess moisture away from the wound to avoid skin maceration, whilst a drier wound can be treated with a more occlusive dressing to maintain a moist environment. Alginate dressings contain sodium, or sodium and calcium, salts of alginic acid. These alginate salts are highly hydrophilic and can absorb large volumes of wound exudate.
Diabetic Foot Ulcer As Diabetes Complication
Diabetes mellitus or diabetes is a chronic disease with abnormally high or abnormally high blood sugar levels and can cause serious complications if left untreated. One of the most common risks of complications is a diabetic foot ulcer or diabetic foot. Diabetic foot is a type of wound affecting lower limbs of diabetic patients and as a complication of uncontrolled blood sugar. Long-term high blood sugar may cause accumulation of lipid in blood vessels and hardening of blood vessels resulting blood flow insufficiency including to lower limbs.
Diabetes can cause problems affecting feet, including Diabetic neuropathy, where there is damage in peripheral nervous system due to uncontrolled blood sugar level. In diabetic patient, there is also risk of developing peripheral vascular disease that may affect wound healing. These risk factors may cause formation of callus that further increase risk of developing diabetic foot ulcer.
Risk factors for developing diabetic foot ulcers are previous history of foot ulcer, history of amputation, anatomical foot deformities, peripheral vascular disease, diabetic nephropathy, poor glycemic control, and smoking.
Common symptoms of diabetic foot ulcer are changes in skin color, changes in skin temperature, swelling in the feet or ankles, open foot sores that are hard-to-heal, infected wound, ingrown toenails, or toenails that are infected with fungi, calluses, dry skin cracks, and unusual or persistent foot odor.
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Identifying Diabetic Foot Ulcers
Up to 25% of patients with diabetes will develop foot ulceration in their lifetime. This makes it important that health care professionals regularly check their patients with diabetes for signs of ulceration and identify risk factors. Patients who have had diabetes for an extended duration, those that have had previous ulcerations, those with peripheral arterial disease , those who have lost sensation in their lower extremities, and older adults are at particular risk. Patients presenting with DFUs generally experience pain, swelling, and odor emanating from the foot. Identifying these signs early on can help prevent complications and keep the wound from worsening.2
Data Sources And Searches
The search string for CENTRAL was adapted for use in other databases, all being searched from inception to June 2011: Cochrane Wounds Group Specialised Register, Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL. The Ovid MEDLINE search was combined with the Cochrane Highly Sensitive Search Strategy for identifying randomised trials in MEDLINE: sensitivity- and precision-maximising version . The EMBASE and CINAHL searches were combined with the trial filters developed by the Scottish Intercollegiate Guidelines Network . Reference lists of included studies and previous systematic reviews were also searched. We contacted appropriate manufacturing companies for details of any unpublished studies. Two review authors independently assessed the titles and abstracts of retrieved studies for relevance. After this initial assessment, we obtained all studies felt to be potentially relevant in full. We attempted to contact researchers to obtain any required additional information not contained in the trial reports.
Details of the eligible studies were extracted and summarised using a standardised data extraction sheet. Two review authors extracted data independently with disagreements resolved by discussion. If data were missing from reports, attempts were made to contact the study authors to obtain further information. Studies published in duplicate were included once but a comprehensive dataset was compiled from all publications.
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Chronic Venous Leg Ulcers
Venous leg ulcers are chronic ulcers caused by excessive venous pressure in the lower extremities and abnormal venous blood flow, eventually leading to the formation of an ulcer on the skin of the lower leg . It is one of the clinical manifestations of chronic venous insufficiency at the most severe stage. The underlying causes of the disease are venous valve incompetence and calf muscle pump insufficiency, leading to venous stasis and hypertension . In this case, the local blood circulation is altered, and the blood supply to the local tissue is insufficient . Prolonged care leads to high treatment costs. Moreover, the quality of life of patients with chronic VLU is severely affected .
Figure 4. Modern dressings promoting the healing of VLU. Ulcer areas in patients with infected and non-infected at different time points. Trends in the ulcer area in different patients. Initial state of the wound. Dressing application of cell foam dressing with through holes . Dressing replacement. Reproduced with permission from Harding et al. and McElroy et al. .
Quality Assessment Of Evidence Generated Using Direct Data
The overall quality of evidence surrounding estimates of effect using direct evidence only was assessed using GRADE . GRADE assessment focuses not on individual studies but on a body of evidence and considers issues wider than threats to interval validity, including imprecision, inconsistency, indirectness and publication bias. Problems in any category lead to the quality of the evidence being decreased . In reflecting the quality of an estimate drawn from multiple sources, GRADE aims to help the reader consider how confident we are that an effect estimate is correct . Quality of evidence can be rated as high, moderate, low or very low.
Direct and indirect data: MTC
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References To Studies Excluded From This Review
Palao i Domenech 2008
Van Gils 1999
Diabetic Foot Ulcer: Treatment And Prevention
Estimates are that by 2030 there will be 550 million individuals with diabetes in the world. Because almost a quarter of all people with diabetes will develop a foot ulcer at some point, health care workers need to know the best practices for diabetic foot ulcer prevention and treatment.
Determining which diabetic foot ulcer type is important to determine an effective treatment. Here are the different types of these wounds:
- Neuropathic ulcers arise when the nerve damage from diabetic neuropathy causes the individual with diabetes to not feel pain from an injury, which often leads to the ulcer progressing substantially before the person is even aware of it. Foot and toe deformities, corns, calluses and areas repetitive stress are likely places of injury. Footwear can not only hide these issues, but can exacerbate the injury if the shoe is ill-fitting.
- Ischemic ulcers or arterial ulcers as they are sometimes called may occur due to lack of blood flow to the extremity. When an ulcer occurs as the result of an injury to the extremity, the lack of blood flow makes these ulcers difficult to heal.
- Neuroischemic ulcers occur in individuals with both neuropathy and poor arterial blood flow and are the most difficult to heal.
- Infected wounds occur in about half of patients with a diabetic foot ulcer and require particularly close care.
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Selection Of Appropriate Wound Dressing For Various Wounds
- 1School of Nursing, Jilin University, Changchun, China
- 2Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
- 3Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.