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A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers

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dc.contributor.author Elraiyah, Tarig
dc.contributor.author Tsapas, Apostolos
dc.contributor.author Prutsky, Gabriela
dc.contributor.author Domecq, Juan-Pablo
dc.contributor.author Hasan, Rim
dc.contributor.author Firwana, Belal
dc.contributor.author Nabhan, Mohammed
dc.contributor.author Prokop, Larry
dc.contributor.author Hingorani, Anil
dc.contributor.author Claus, Paul-L.
dc.contributor.author Steinkraus, Lawrence-W.
dc.contributor.author Murad, Mohammad-Hassan
dc.date.accessioned 2019-02-06T14:45:12Z
dc.date.available 2019-02-06T14:45:12Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5058
dc.description.abstract BACKGROUND: Multiple adjunctive therapies have been proposed to accelerate wound healing in patients with diabetes and foot ulcers. The aim of this systematic review is to summarize the best available evidence supporting the use of hyperbaric oxygen therapy (HBOT), arterial pump devices, and pharmacologic agents (pentoxifylline, cilostazol, and iloprost) in this setting. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011. Pairs of independent reviewers selected studies and extracted data. Predefined outcomes of interest were complete wound healing and amputation. RESULTS: We identified 18 interventional studies; of which 9 were randomized, enrolling 1526 patients. The risk of bias in the included studies was moderate. In multiple randomized trials, the addition of HBOT to conventional therapy (wound care and offloading) was associated with increased healing rate (Peto odds ratio, 14.25; 95% confidence interval, 7.08-28.68) and reduced major amputation rate (odds ratio, 0.30; 95% confidence interval, 0.10-0.89), compared with conventional therapy alone. In one small trial, arterial pump devices had a favorable effect on complete healing compared with HBOT and in another small trial compared with placebo devices. Neither iloprost nor pentoxifylline had a significant effect on amputation rate compared with conventional therapy. No comparative studies were identified for cilostazol in diabetic foot ulcers. CONCLUSIONS: There is low- to moderate-quality evidence supporting the use of HBOT as an adjunctive therapy to enhance diabetic foot ulcer healing and potentially prevent amputation. However, there are only sparse data regarding the efficacy of arterial pump devices and pharmacologic interventions. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Journal of Vascular Surgery
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Hyperbaric Oxygenation en_US
dc.subject Aged en_US
dc.subject Cilostazol en_US
dc.subject Diabetic Foot/drug therapy/therapy en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Iloprost/therapeutic use en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Pentoxifylline/therapeutic use en_US
dc.subject Tetrazoles/therapeutic use en_US
dc.subject Treatment Outcome en_US
dc.subject Vasodilator Agents/therapeutic use en_US
dc.title A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.jvs.2015.10.007
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.11
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04
dc.relation.issn 1097-6809


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