Tratamiento de heridas con presión negativa para el tratamiento de las heridas del pie en los pacientes con diabetes mellitus
Information
- DOI:
- https://doi.org/10.1002/14651858.CD010318.pub3Copy DOI
- Database:
-
- Cochrane Database of Systematic Reviews
- Version published:
-
- 17 October 2018see what's new
- Type:
-
- Intervention
- Stage:
-
- Review
- Cochrane Editorial Group:
-
Cochrane Wounds Group
- Copyright:
-
- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article metrics
Altmetric:
Cited by:
Authors
Contributions of authors
Zhenmi Liu: co‐ordinated the review update; extracted data; checked the quality of data extraction; analysed or interpreted data; undertook and checked quality assessment; performed statistical analysis; checked the quality of the statistical analysis; produced the first draft of the review update; contributed to writing or editing the review update; advised on the review update; secured funding; performed previous work that was the foundation of the current review update; wrote to study authors, experts and companies; performed economic analysis; performed translations; approved the final review update prior to submission; and is a guarantor of the review update.
Jo Dumville: conceived the review; designed and co‐ordinated the review update; extracted data; checked the quality of data extraction; analysed or interpreted data; undertook and checked quality assessment; checked the quality of the statistical analysis; contributed to writing or editing the review update; advised on the review update; secured funding; performed previous work that was the foundation of the current review update and approved the final review update prior to submission.
Robert Hinchliffe: co‐ordinated the review update; advised on the review update; performed previous work that was the foundation of the current review update and approved the final review update prior to submission.
Nicky Cullum: co‐ordinated the review update; advised on the review update; performed previous work that was the foundation of the current review update and approved the final review update prior to submission.
Fran Game: co‐ordinated the review update; advised on the review update; performed previous work that was the foundation of the current review update and approved the final review update prior to submission.
Nikki Stubbs: co‐ordinated the review update; advised on the review update and performed previous work that was the foundation of the current review update.
Michael Sweeting: co‐ordinated the review update; advised on the review update and performed previous work that was the foundation of the current review update.
Frank Peinemann: co‐ordinated the review update; advised on the review update and performed previous work that was the foundation of the current review update.
Contributions of editorial base
Joan Webster (Editor): edited the review and the update, advised on methodology, interpretation and content and approved the final version for publication.
Sally Bell‐Syer and Gill Rizzello (Managing Editors): co‐ordinated the editorial process. Advised on interpretation and content. Edited the review and the update respectively.
Ruth Foxlee and Naomi Shaw (Information Specialists): designed and edited the search strategy, edited the methods section and ran the searches for the review and update respectively.
Rachel Richardson (Methodologist): edited the review.
Ursula Gonthier (Editorial Assistant): edited the Plain language summary and the reference sections.
Sources of support
Internal sources
-
Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK, UK.
External sources
-
National Institute for Health Research (NIHR), UK.
This project was supported by the NIHR, via Cochrane Infrastructure and Cochrane Programme Grant funding (NIHR Cochrane Programme Grant 13/89/08 ‐ High Priority Cochrane Reviews in Wound Prevention and Treatment) to Cochrane Wounds. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, the NIHR, the NHS or the Department of Health.
-
NIHR Manchester Biomedical Research Centre (BRC), UK.
This research was co‐funded by the NIHR Manchester BRC. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
-
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Greater Manchester, UK.
Nicky Cullum and Jo Dumville's work on this project was partly funded by the NIHR CLAHRC, Greater Manchester. The funder had no role in the decision to publish, or preparation of the manuscript. However, the review may be considered to be affiliated to the work of the NIHR CLAHRC Greater Manchester. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health.
-
National Institute for Health Research (NIHR) Systematic Review Fellowships (NIHR‐RMFI‐2015‐06‐52 Zhenmi Liu), UK.
Declarations of interest
Zhenmi Liu: my employment at the University of Manchester was supported by a grant from the National Institute for Health Research (NIHR) UK (NIHR Systematic Review Fellowships).
Jo Dumville: received research funding from the National Institute for Health Research (NIHR) UK for the production of systematic reviews focusing on high priority Cochrane Reviews in the prevention and treatment of wounds. This research was co‐funded by the NIHR Manchester Biomedical Research Centre and partly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester.
Robert Hinchliffe: none known.
Nicky Cullum: received research funding from the National Institute for Health Research (NIHR) UK for wounds‐related research and systematic reviews focusing on high priority Cochrane Reviews in the prevention and treatment of wounds. This research was co‐funded by the NIHR Manchester Biomedical Research Centre and partly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester.
Fran Game: grant funding was provided to Derby Teaching Hospitals NHS FT for a researcher led, NHS sponsored trial into a device for wound healing for the diabetic foot by the manufacturer of the device, Reapplix ApS Denmark. Grant funding was also provided to Derby Teaching Hospitals NHS FT for an investigator led, NHS sponsored trial into wound healing, using Omnigen by the manufacturers of the product, NuVision.
Nikki Stubbs: has received payments for Cogora, a healthcare marketing agency and expenses for conference attendance. She has received funding from pharmaceutical companies to support non product‐related training and education events in the UK National Health Service that were unrelated to the subject matter of this systematic review.
Michael Sweeting: none known.
Frank Peinemann: none known.
Acknowledgements
The review authors would like to acknowledge the contributions of peer reviewers to the previously published version of this review: Andrew Jull, Janet Gunderson and Gill Worthy, and to thank Kurinchi Gurusamy and Sharon Van Wicklin for their comments on this update. They would also like to thank Elizabeth Royle for copy editing the review and Anne Lawson for copy editing this update.
Version history
| Published | Title | Stage | Authors | Version |
| 2018 Oct 17 | Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus | Review | Zhenmi Liu, Jo C Dumville, Robert J Hinchliffe, Nicky Cullum, Fran Game, Nikki Stubbs, Michael Sweeting, Frank Peinemann | |
| 2013 Oct 17 | Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus | Review | Jo C Dumville, Robert J Hinchliffe, Nicky Cullum, Fran Game, Nikki Stubbs, Michael Sweeting, Frank Peinemann | |
| 2013 Jan 31 | Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus | Protocol | Jo C Dumville, Robert J Hinchliffe, Nicky Cullum, Fran Game, Nikki Stubbs, Michael Sweeting | |
Differences between protocol and review
We have populated sections of the 'Methods' and 'Discussion' which were previously not available in the older version of Review Manager as follows: Assessment of reporting biases; Overall completeness and applicability of evidence.
Description of the condition: we added additional information to the 'Background' section.
Types of outcome measures: we removed 'change (and rate of change) in wound size' as this is not 'complete wound healing.' We also made a post hoc decision to assess 'cost‐effectiveness' rather than 'resource use.' This is an important outcome from both clinical and practical perspective and negative pressure wound therapy (NPWT) is used widely but very expensive. We also added 'number of wounds closed or covered with surgery' and 'time to closure or coverage surgery' as secondary outcomes as they are clinically relevant outcomes, differing from the outcome of 'complete wound healing.'
Summary of findings: we decided to downgrade when the 'Risk of bias' assessment for selection bias or blinding was unclear. We also added these outcomes: number of wounds closed or covered with surgery; adverse events; cost‐effectiveness and wound recurrence to the 'Summary of findings' tables.
Due to the new included studies which included various types of dressings, we carried out a post hoc subgroup analysis based on the type of dressings.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICOs
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Negative pressure wound therapy (NPWT) compared with dressings in postoperative wounds, Outcome 1 Proportion of wounds healed.
Comparison 1 Negative pressure wound therapy (NPWT) compared with dressings in postoperative wounds, Outcome 2 Time to healing.
Comparison 1 Negative pressure wound therapy (NPWT) compared with dressings in postoperative wounds, Outcome 3 Amputations.
Comparison 1 Negative pressure wound therapy (NPWT) compared with dressings in postoperative wounds, Outcome 4 Number of wounds closed or covered with surgery.
Comparison 1 Negative pressure wound therapy (NPWT) compared with dressings in postoperative wounds, Outcome 5 Adverse events.
Comparison 2 NPWT compared with dressings in diabetic foot ulcers, Outcome 1 Proportion of wounds healed.
Comparison 2 NPWT compared with dressings in diabetic foot ulcers, Outcome 2 Amputations.
Comparison 2 NPWT compared with dressings in diabetic foot ulcers, Outcome 3 Number of wounds closed or covered with surgery.
Comparison 2 NPWT compared with dressings in diabetic foot ulcers, Outcome 4 Wound recurrence.
Comparison 3 Low compared with high pressure of NPWT in diabetic foot ulcers, Outcome 1 Number of wounds closed or covered with surgery.
Comparison 3 Low compared with high pressure of NPWT in diabetic foot ulcers, Outcome 2 Adverse events.
| NPWT compared with dressings for postoperative wounds | ||||||
| Patient or population: treating foot wounds in people with diabetes mellitus Setting: hospital Intervention: NPWT Comparison: dressings | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with placebo | Risk with NPWT compared with dressings | |||||
| Proportion of wounds healed Follow‐up: 16 weeks | Study population | RR 1.44 | 162 (1 study) | ⊕⊕⊝⊝ Lowa,b | — | |
| 388 per 1000 | 559 per 1000 | |||||
| Time to healing Follow‐up: 16 weeks | Study population | HR 1.91 | 162 (1 study) | ⊕⊕⊝⊝ Lowa,b | — | |
| 388 per 1000 | 609 per 1000 | |||||
| Amputations Follow‐up: 16 weeks or unspecified | Study population | RR 0.38 | 292 (2 studies) | ⊕⊝⊝⊝ Very lowa,c | — | |
| 60 per 1000 | 23 per 1000 | |||||
| Number of wounds closed or covered with surgery | 954 per 1000 | 1000 per 1000 | RR 1.02 | 130 (1 study) | ⊕⊝⊝⊝ Very lowa,c | — |
| Adverse events Follow‐up: 16 weeks | Study population | RR 0.96 | 162 (1 study) | ⊕⊝⊝⊝ Very lowa,c | — | |
| 541 per 1000 | 520 per 1000 | |||||
| Cost‐effectiveness | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | — |
| Wound recurrence | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | — |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NPWT: negative pressure wound therapy; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to risk of bias: some blinded outcome assessment, but not sure the potential impact of non‐blinded decisions regarding the use of further surgery and the risk of performance bias. | ||||||
| NPWT compared with dressings for diabetic foot ulcers | ||||||
| Patient or population: treating foot wounds in people with diabetes mellitus Setting: hospital Intervention: NPWT Comparison: dressings | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with placebo | Risk with NPWT compared with dressings | |||||
| Proportion of wounds healed Follow‐up: unclear for 4 studies and 8–16 weeks for the other 3 studies | Study population | RR 1.40 | 486 | ⊕⊕⊝⊝ Lowa,b | — | |
| 406 per 1000 | 540 per 1000 | |||||
| Time to healing Follow‐up: unclear for 2 studies and 16 weeks for the other study | Study population | — | 468 (3 studies) | ⊕⊕⊝⊝ Lowa,b | 3 studies reported HR, median and mean (1 each) and we were unable to pool any data for this comparison. | |
| See comment | See comment | |||||
| Amputations Follow‐up: unclear for 4 studies and 16 weeks for the other study | Study population | RR 0.33 | 441 | ⊕⊕⊝⊝ Lowa,b | — | |
| 114 per 1000 | 38 per 1000 | |||||
| Number of wounds closed or covered with surgery Follow‐up: unclear | Study population | RR 1.02 | 129 | ⊕⊕⊝⊝ Lowa,b | — | |
| 714 per 1000 | 729 per 1000 | |||||
| Adverse events | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | — |
| Cost‐effectiveness | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | — |
| Wound recurrence Follow‐up: 6–10 months | Study population | RR 0.50 (0.10 to 2.53) | 60 | ⊕⊝⊝⊝ Very lowa,c | — | |
| 133 per 1000 | 66 per 1000 | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NPWT: negative pressure wound therapy; HR: hazard ratio; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to risk of bias (no blind outcome assessment). | ||||||
| Low‐pressure compared with high‐pressure NPWT for diabetic foot ulcers | ||||||
| Patient or population: treating foot wounds in people with diabetes mellitus Setting: hospital Intervention: low‐pressure NPWT (75 mmHg) Comparison: high‐pressure NPWT (125 mmHg) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with placebo | Risk with low compared with high pressure of NPWT | |||||
| Proportion of wounds healed | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | ‐ |
| Time to ulcer healing | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | ‐ |
| Amputation | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | ‐ |
| Number of wounds closed or covered with surgery Follow‐up: 4 weeks | Study population | RR 0.83 | 40 | ⊕⊝⊝⊝ Very lowa | ‐ | |
| 600 per 1000 | 498 per 1000 | |||||
| Adverse events Follow‐up: 4 weeks | Study population | RR 1.50 | 40 | ⊕⊝⊝⊝ Very lowa | ‐ | |
| 100 per 1000 | 150 per 1000 | |||||
| Cost‐effectiveness | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | ‐ |
| Wound recurrence | Not estimable | Not estimable | Not estimable | Not estimable | Not estimable | ‐ |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NPWT: negative pressure wound therapy; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded three levels: once for risk of bias (some blinded outcome assessment, but not sure the potential impact of non‐blinded decisions regarding the use of further surgery and the risk of performance bias); twice for very serious imprecision with a small sample size and limited reported information to quantify imprecision. | ||||||
| Study | Wound characteristics | Comparison | Length of follow‐up | NPWT pathways | Time to healing | Number of wounds completely healed | Amputation | Number of wounds closed or covered with surgery | Time to closure or coverage surgery | Adverse events | Health‐related quality of life | Cost‐effectiveness | Wound recurrence |
| Diabetic foot amputation to trans‐metatarsal level | Group A: NPWT (V.A.C. system), dressing changes every 48 h. Treatment conducted until wound closure or completion of 112‐day assessment (n = 77) Group B: moist wound therapy with alginates, hydrocolloid, foam or hydrogel dressings (n = 85) | 16 weeks | After amputation (close/open wounds; if open wounds, secondary intention), NPWT delivered through the V.A.C. system; or standard care with moist wound therapy. | Kaplan‐Meier median time to healing Group A: 56 days (IQR 26 to 92) Group B: 77 days (IQR 40 to 122) Log‐rank taken as P = 0.005 There was no difference noted in time to healing for acute or chronic wounds. | Group A: 43/77 (55.8%) Group B: 33/85 (38.8%) Of healed wounds –healed by secondary intention (without primary/surgical wound closure) Group A: 31/43 (72.1%) Group B: 25/33 (75.8%) Remaining wounds were closed following surgery. | Number of participants undergoing further amputation Group A: 2/77 (2.3%) Major = 0 Minor = 2 Group B: 9/85 (10.6%) Major = 5 Minor = 4 | Not reported | Not reported | Participants who had ≥ 1 adverse events Group A: 40/77 (51.9%) Group B: 46/85 (54.1%) Participants who had ≥ 1 treatment‐related adverse events Group A: 9/77 (11.7%) 1 classified serious Group B: 11/85 (12.9%) 5 classified as serious | Not reported | Not reported | Not reported | |
| Ulceration of the foot in people with diabetes | Group A: NPWT (V.A.C. system), applied according to manufacturer’s instructions (n = 172) Group B: advanced moist wound therapy dressings used according to guidelines/local protocols (n = 169) | 16 weeks | NPWT was continued until ulcer closure. | Kaplan‐Meier median time to healing Group A: 96 days (95% CI 75.0 to 114.0) Group B: could not be estimated Log‐rank taken as P = 0.001 | Group A: 3/172 (42.4%) Group B: 8/169 (28.4%) (6 participants excluded in paper as did not receive treatment, added back into denominator here; ITT 172/169) | Number of participants undergoing amputation* Group A: 7/172 (4.1%) Major = 5 Minor = 2 Group B: 17/169 (10.1%) Major = 4 Minor = 13 | Not reported | Not reported | Limited data: not extracted | Not reported | Not reported | Not reported | |
| Infected open amputations or surgical dehiscence of minor amputations in people with diabetes | Group A: V.A.C. therapy following surgical debridement (n = 65) Group B: advanced dressings following surgical debridement (n = 65) | Not specified. End of therapy was defined as complete coverage of the wound with epithelial tissue. | Duration of therapy depended on the functional parameters of the wound area. | Not reported | Not reported | Number of participants undergoing further amputation (major) Group A: 3/65 (4.6%) Group B: 5/65 (7.7%) | Group A: 63/65 (96.9%) Group B: 62/65 (95.4%) | Group A (n = 65): 65 days (SD 16) Group B (n = 65): 98 days (SD 45) P = 0.005 These data reported as time to "complete closure of the wound" was reached. Unclear if it is mean or median; unclear if "complete closure" means "time to healing of grafted wound" or "time to surgical closure;" unclear if it is a valid measure as not sure all ulcers have healed. Author contacted – waiting for response. | Not reported | Not reported | Not reported | Not reported | |
| Diabetic foot ulcers | Group A: NPWT (V.A.C. system) (n = 30) Group B: conventional wound care treatment: based on text in report taken to be dry gauze (n = 37) | Not specified. Last assessment 1 month after healing | Not specified | Median time to healing Group A: 4.4 weeks Group B: 3.9 weeks Mean value presented but not extracted. No specific P value presented (< 0.05) | Not reported | Not reported | Not reported | Not reported | Not reported | SF‐36: data not presented | Not reported | Not reported | |
| Diabetic foot wounds, after incision and drainage | Group A: NPWT with Group B: 125 mmHg of pressure | 4 weeks | NPWT was continued for 4 weeks | Not reported | Not reported | Not reported | Group A: 10/20 (50%) Group B: 12/20 (60%) | Not reported | Group A: study related 2/20 (10%); non‐study related 1/20 (5%) Group B: study related 1/20 (5%); non‐study related 1/20 (5%) | Not reported | Not reported | Not reported | |
| Diabetic foot ulcers | Group A: locally constructed NPWT (n = 6) Group B: wet‐to‐dry gauze (n = 9) | Not specified: until healing or loss to follow‐up | People receiving TNP only in hospital | Not reported | By secondary intention: Group A: 1/6 (16.6%) Group B: 1/9 (11.0%) | Not reported | By delayed primary closure: Group A: 0/6 (0%) Group B: 3/9 (33%) | Not reported | Not reported | Not reported | Not reported | Not reported | |
| Diabetic foot ulcers | Group A: negative pressure dressing (n = 15) | 8 weeks | Ulcers were treated until the wound was closed surgically or spontaneously, or until completion of the 56 days (8 weeks) assessment whichever was earlier. | Not reported | Group A: 12/15 (80%) Group B: 9/15 (60%) | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |
| Complicated diabetic foot ulcers | Group A: NPWT (n = 7) Group B: dressings (moist) (n = 12) Group C: classic gauze (n = 8) | 8 weeks | Treatment was monitored for the first 2 months. | Not reported | Group A: * could not be calculated (90%) Group B: 9/12* (75%) Group C: 4/8* (50%) *Figure calculated by review author We obtained data (only proportions) from the study author but were unable to use these to calculate number of healed wounds. It seemed this outcome was measured but was not able to use the data in meta‐analysis. | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |
| Diabetic foot wound | Group A: NPWT (n = 30) | Not specified | Interventions discontinued for participants in whom failure or complications | Not reported | Not reported | Data for alternative therapy or amputation: Group A: 3/30 (10%) Group B: 7/30 (23.3%) | Wounds were ready for either skin grafting or secondary suturing (end point) Group A: 27/30 (90%) Group B: 23/30 (67.7%) | Not reported properly – not all ulcers reached this point | Not reported | Not reported | Limited data: not extracted | Not reported | |
| Chronic diabetic ulcers | Group A: vacuum sealing drainage (n = 20) Group B: gauze dressing (n = 20) | Not reported | Interventions were administered in hospital | Not reported | Group A: 17/20 (85%) Group B: 13/20 (65%) | Group A: 1/20 (5%) Group B: 2/20 (10%) | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | |
| Diabetic foot wounds | Group A: vacuum sealing drainage (n = 30) | Not reported Follow‐up to 6–10 months for wounds recurrence | Vacuum sealing drainage administered when necessary at several time points | Not reported properly – not all ulcers healed | Group A: 7/30 (23%) Group B: 5/30 (17%) | Group A: 0 Group B: 6/30 (20%) | Of healed wounds by secondary surgery (skin/flap grafting): Group A: 23/30 Group B: 19/24 | Not reported properly – not all ulcers reached this point | Not reported | Not reported | Not reported | Group A: 2 Group B: 4 Follow‐up time: 6–10 months | |
| h: hour; IQR: interquartile range; ITT: intention to treat; n: number of participants; NPWT: negative pressure wound therapy; SF‐36: 36‐item Short Form; TNP: topical negative pressure. | |||||||||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Proportion of wounds healed Show forest plot | 1 | 162 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.44 [1.03, 2.01] |
| 2 Time to healing Show forest plot | 1 | 162 | Hazard Ratio (Fixed, 95% CI) | 1.91 [1.21, 2.99] |
| 3 Amputations Show forest plot | 2 | 292 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.38 [0.14, 1.02] |
| 4 Number of wounds closed or covered with surgery Show forest plot | 1 | 130 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.95, 1.09] |
| 5 Adverse events Show forest plot | 1 | 162 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.72, 1.28] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Proportion of wounds healed Show forest plot | 5 | 486 | Risk Ratio (IV, Fixed, 95% CI) | 1.40 [1.14, 1.72] |
| 1.1 Advanced dressings | 1 | 341 | Risk Ratio (IV, Fixed, 95% CI) | 1.49 [1.11, 2.01] |
| 1.2 Basic contact dressings | 2 | 45 | Risk Ratio (IV, Fixed, 95% CI) | 1.34 [0.83, 2.16] |
| 1.3 Anti‐microbial dressings | 2 | 100 | Risk Ratio (IV, Fixed, 95% CI) | 1.32 [0.93, 1.87] |
| 2 Amputations Show forest plot | 3 | 441 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.15, 0.70] |
| 3 Number of wounds closed or covered with surgery Show forest plot | 3 | 129 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.85, 1.24] |
| 4 Wound recurrence Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.5 [0.10, 2.53] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of wounds closed or covered with surgery Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.83 [0.47, 1.47] |
| 2 Adverse events Show forest plot | 1 | 40 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.5 [0.28, 8.04] |
