School of Medicine, Ningbo University, Ningbo, China.
Department of Hepatobiliary and Pancreatic Surgery, Ningbo First Hospital, Ningbo, China.
Adv Wound Care (New Rochelle). 2023 Jan;12(1):28-37. doi: 10.1089/wound.2021.0162. Epub 2022 Apr 11.
Diabetic foot ulcer (DFU) causes high amputation rates owing to its aberrant wound healing. Traditional dressings cannot effectively contribute to DFU healing. Functional hydrogels have been proposed as a promising novel dressing to treat DFU in future, but the evidence for various hydrogels to heal DFU is still ambiguous. In accordance with PRISMA and CONSORT guidelines, a meta-analysis was performed to evaluate the efficacy of functional hydrogels. Four electronic databases and one website were used for data searching. Twenty-four animal studies and six clinical trials met the inclusion criteria with a total of 399 diabetic murine models and 278 patients with DFU. Functional hydrogels accelerated the healing progress for DFU and relieved symptoms in patients. According to their characteristics, the functional hydrogels were divided into antioxidant hydrogel (AOH), antibacterial hydrogel (ABH), multifunctional hydrogel (MFH), proangiogenic hydrogel, and hydrogel promoting proliferation (PPH). By network meta-analysis, AOH and MFH were considered the premium options for treating wounds of diabetic patients at whole stage. Functional hydrogels effectively accelerate healing rates in wounds of diabetic animals. Hydrogels of AOH and MFH might become the ideal candidates for clinical trials on DFU treatment, based on the meta-analyses from the reported work. Early treatment with AOH followed a week later with ABH, which might become an advanced strategy for DFU in future. This information is very important for researchers or/and physicians in taking consideration for alternate application of hydrogel dressings. The treatment of DFU imposes a huge burden on medical workers. If DFU is not treated properly, patients will have to suffer from amputation and from spiritual agony. Although various topical dressings have been designated for DFU, the healing ability of those dressings is still unknown well. In this review and meta-analysis, we quantitatively evaluated the reported outcomes of functional hydrogels, pure scaffolds, and controls in 2-week interval. Healing ability of various kinds of functional hydrogels was also assessed in different stages of wound, aiming to screen promising candidates for DFU treatment. This information is valuable in designing smart dressings for researchers or/and physicians in future. Considering many external factors like formation of bacterial film and internal factors like hyperglycemia, the progress during DFU healing could involve many biochemical aspects. Persistent inflammation, oxidation stress, and impaired angiogenesis lead to prolonged wound healing and even lethal outcomes. Thus, improvement of topical conditions and inhibition of adverse factors will lead to the alleviated morbidity and even mortality. DFU brings about great burden on patients and medical staffs because of high morbidity and poor prognosis. Improper and powerless treatment might induce high rates of amputation and mortality. Functional hydrogels, mimicking extracellular matrices, would provide the tissue with suitable media and functions to promote DFU healing. The application of various types of hydrogels could be a promising solution to heal DFU and reduce adverse events and costs.
糖尿病足溃疡(DFU)由于其异常的伤口愈合导致高截肢率。传统敷料不能有效地促进 DFU 愈合。功能性水凝胶已被提议作为一种有前途的新型敷料,用于未来治疗 DFU,但各种水凝胶治疗 DFU 的证据仍存在争议。根据 PRISMA 和 CONSORT 指南,进行了荟萃分析以评估功能性水凝胶的疗效。使用四个电子数据库和一个网站进行数据搜索。符合纳入标准的 24 项动物研究和 6 项临床试验共纳入 399 例糖尿病小鼠模型和 278 例 DFU 患者。功能性水凝胶加速了 DFU 的愈合进程并缓解了患者的症状。根据其特点,功能性水凝胶分为抗氧化水凝胶(AOH)、抗菌水凝胶(ABH)、多功能水凝胶(MFH)、促血管生成水凝胶和促进增殖水凝胶(PPH)。通过网络荟萃分析,AOH 和 MFH 被认为是治疗糖尿病患者整个伤口阶段的优质选择。功能性水凝胶可有效提高糖尿病动物伤口的愈合率。基于报告的工作,AOH 和 MFH 水凝胶可能成为 DFU 治疗临床试验的理想候选物。早期使用 AOH,一周后使用 ABH,这可能成为未来 DFU 的一种先进策略。对于研究人员或/和医生来说,这对于考虑替代水凝胶敷料的应用非常重要。DFU 给医务人员带来了巨大的负担。如果 DFU 治疗不当,患者将不得不面临截肢和精神痛苦。尽管已经指定了各种局部敷料用于 DFU,但这些敷料的愈合能力仍不清楚。在本综述和荟萃分析中,我们以 2 周为间隔定量评估了功能性水凝胶、纯支架和对照组的报告结果。还评估了各种功能性水凝胶在伤口不同阶段的愈合能力,旨在筛选出用于 DFU 治疗的有前途的候选物。这一信息对于未来研究人员或/和医生设计智能敷料非常有价值。考虑到形成细菌膜等许多外部因素和高血糖等内部因素,DFU 愈合过程可能涉及许多生化方面。持续的炎症、氧化应激和受损的血管生成导致伤口愈合延长甚至致命结果。因此,改善局部状况和抑制不利因素将降低发病率甚至死亡率。DFU 给患者和医务人员带来了巨大的负担,因为其发病率高且预后不佳。不适当和无效的治疗可能导致高截肢率和死亡率。模仿细胞外基质的功能性水凝胶将为组织提供合适的介质和功能,以促进 DFU 愈合。各种类型的水凝胶的应用可能是治疗 DFU 并减少不良事件和成本的有前途的解决方案。
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