TDNet Discover

Background: Diabetes is a common condition endured by over 34.2 million individuals in the United States. This disease often leads to development of ulcers and decreased healing compared to nondiabetics. Treatment modalities currently include debridement, antibiotics, and dressing applications, though new therapies are being investigated to promote complete healing at a faster rate. Objective: A full review of the existing literature was conducted in order to determine the best and most effective treatment method available for diabetic ulcers and establish standard of care recommendations. Methods: A systematic review of the literature pertaining to treatment of diabetic ulcers, including relevant case studies, was performed by searching all available abstracts through three databases: PubMed, Medline Complete, and Sage Publications. Final selection of articles was dependent on full text review, adherence to inclusion and exclusion criteria, as well as consensus among three individual researchers. In total, six articles were selected and analyzed according to the National Heart, Lung and Blood Institute quality assessment tool. Resultant data from each article was stratified by treatment outcomes including complete wound closure, time to healing, ulcer recurrence, and adverse reactions. Results: Database research produced six viable articles pertaining to diabetic patients and the treatment of chronic, nonhealing diabetic ulcers. Overall, all six studies found their particular skin graft in addition to standard care superior to standard care alone. The time to healing showed two with statistical significance and the other one suggested a superior trajectory. Only one out of the six studies established preferability for skin graft utilization when considering ulcer recurrence. Three studies found no statistical significance between intervention and control with infection rate. All three studies found statistical significance for improvement with the intervention group in regard to rates of amputation. The incidence of cellulitis was only found to be significant in the skin grafting group. Only two studies examined rates of osteomyelitis as another secondary outcome. Both of these studies found the data to be statistically significant when comparing the intervention and control. Conclusion: A definitive treatment for diabetic ulcers remains elusive. While the incidence of complete wound closure and time to complete healing were both found to be superior with the tissue replacement group, the total cost of treatment was not explored as an outcome. Furthermore, the myriad of different types of skin grafts and tissue replacement available creates considerable variability, whereas standard care such as debridement, antibiotics and dressings are largely standardized. Due to the lack of all relevant outcomes being studied, the focus of existing research being purely chronic ulcers, and the presence of multiple confounding variables, no definitive conclusion can be drawn to confidently recommend one management option over the other. Generally, only patients who have failed standard care or have severe ulcers would be considered for tissue placement.