Comparative efficacy of advanced therapeutic modalities for diabetic foot ulcers: a systematic review and meta-analysis including NPWT, stem cells, ESWT, and bioengineered treatments

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Diabetic foot ulcers (DFUs) are highly debilitating and often necessitate cutting-edge treatments apart from the usual care. This systematic review and meta-analysis have compared the efficacy of Negative Pressure Wound Therapy (NPWT)/VAC, cell-based therapies (MSC-based therapies), artificial skin, extracorporeal shockwave therapy (ESWT), and platelet-rich plasma (PRP) interventions in promoting healing of difficult wounds, as well as healing by other means. Methods The extensive search identified 49 randomized controlled trials. For data analysis, a random-effects model with inverse-variance weighting was used to obtain standardized mean differences (SMDs) with 95% confidence intervals (CIs). The presence of publication bias was determined using funnel plots and Egger's test, while the quality of the studies was assessed by means of Jadad scores and risk of bias tools. GRADE was employed to assess the certainty of the evidence. Results Sub-group analysis revealed that NPWT significantly accelerated wound closure compared to standard care SMD of -0.39 (95% CI: 0.57 to -0.21; I 2 = 49%), indicating faster healing times, used days to measure time showed an SMD of -0.94 (95% CI: 1.07 to -0.80; I 2 = 0%) which showed that patients healed at a faster rate. The comparison of different devices and techniques showed an SMD of 0.98 (95% CI: 0.75-1.21; I 2 = 0%), indicating t

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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