Table 1

Comparison of systematic reviews on debridement of diabetic foot ulcers

Study	Review	Studies included in the SR (n)	Study type included in the SR	Total sample size in the SR	F/U period in the SR	Study period in the SR	Type of wounds in studies included in the SR	Participant types in studies included in the SR	Intervention types in studies included in the SR	Outcomes in studies included in the SR	Cochrane review	Authors’ conclusions
1	Edwards et al83	6 (3/6 pooled)	6 RCTs	488	10 days–24 weeks	1995–2001	DFU	DM type 1/2	4 comparisons. Hydrogel vs gauze (pooled). Larva. Surgical debridement.	Ulcers healed. Time to complete healing. Recurrence. Adverse events.	Yes	Low evidence.
2	Mason et al77	10 total	8 RCTs (not pooled), 2 non-randomized	202	4 weeks–2 months	Unclear	DFU	DM type 2	Film. Alginate.	Ulcers healed. Mean time to healing.	No	Low evidence: ‘evidence base for treating infections and dressing wounds is poor’, summarized studies.
3	Game et al78	5	4 RCTs (not pooled), 1 non-randomized	149	12 weeks–6 months	1998–2007	100 DFU, 30 ischemic, 19 venous	DM type 1/2, ischemic, venous	Sharp debridement. Aquacel. Larva. Hydrotherapy.	Ulcers healed. Time to healing. Infection. Amputation.	No	Low evidence: ‘scientific evidence to confirm the benefit of sharp debridement was not strong’, ‘weak evidence to support the use of hydrogels’, and ‘no benefit in larva and hydro-therapy’.
4	Hinchliffe et al79	10	6 RCTs (not pooled), 4 non-randomized	575	5–20 weeks	1989–1998	DFU	DM type 1/2	Hydrogel. Alginates. Carboxymethyl cellulose. Polymeric semipermeable membranes.	Ulcers healed. Healing time.	No	Low evidence: evidence to underpin the use of sharp debridement and debriding agents is not strong; evidence is urgently needed to substantiate role of larvae, topical antiseptics and all dressing products. No data were available to support the current widespread use of silver-containing dressings.
5	Dumville et al20 (see	6 (2/6 studies pooled for alginate vs BWCD and 2 pooled for alginate vs foam)	6 RCTs	375	4–8 weeks	1992–2004	DFU	DM type 1/2	Alginate vs BWCD. Alginate vs foam. Silver fibrous-hydrocolloid dressing vs alginate.	Ulcers healed (3). HRQoL. Adverse events.	Yes	Low evidence: ‘no research evidence to suggest that alginate wound dressings are more effective in healing diabetic foot ulcers than other types of dressing’.
6	Dumville et al84	6 (4/6 studies pooled)	6 RCTs	157	8–24 weeks	1993–2001	DFU	DM type 1/2	Foam vs BWCD. Foam vs alginate. Foam vs hydrocolloid.	Ulcers healed (4). Adverse events.	Yes	Low evidence: ‘no research evidence to suggest that foam wound dressings are more effective in healing diabetic foot ulcers than other types of dressing’.
7	Dumville et al85 (hydrocolloid)	5 (2/5 studies pooled)	6 RCTs	535	8–24 weeks	1995–2007	DFU	DM type 1/2	Fibrous-hydrocolloid. Hydrofiber vs BWCD. Foam. Alginate.	Ulcers healed. HRQoL. Adverse events.	Yes	Moderate evidence: ‘no research evidence that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other dressings’.
8	Dumville et al20 (hydrogel)	5 (3/5 pooled)	5 RCTs	446	10 days–20 weeks	1997–2001	DFU	DM type 1/2	Hydrogel vs BWCD. Larva. PDGF. Purilon/Intrasite hydrogel.	Ulcers healed.	Yes	‘Moderate evidence for efficacy hydrogel vs BWCD uncertain due to risk of bias. Other comparisons, low evidence’.
9	Voigt et al86	8 (5 studies pooled)	8 RCTs (2 pooled), 1 study discernible on DFU, others of mixed wound etiology	178	2 weeks	2006	DFUs, subgroups of venous ulcers, DFU outcomes not discerned	DM type not specified	Low-frequency ultrasound vs sharp.	Complete healing. Wound size reduction.	No	‘No difference demonstrated in complete healing between LFHICU and sharps debridement in patients with diabetic foot ulcers, quality of the evidence as it relates to biases was poor’.
10	Tian et al87	4	1 RCT, 3 non-randomized (pool of RCTs and non-RCTs was done)	356	10 days	1998	DFU	DM type not specified	MDT vs hydrogel. MDT vs conventional. MDT vs sharp. MDT vs SWC.	Complete healing. Time to healing. Amputation. Incidence of infection.	No	’No evidence between healing rates for MDT vs standard treatment. MDT resulted in greater proportion of patients to achieve complete healing vs control group. MDT more effective than standard treatment decreasing time to healing, rate of amputation for DFUs; however, no evidence that MDT reduces infection vs standard care’.

The data were adapted from 10 SR studies. Please see citations and the corresponding references for a complete list.
BWCD, basic wound contact dressing; DFU, diabetic foot ulcer; DM, diabetes mellitus; F/U, follow-up; HRQoL, health-related quality of life; LFHICU, low-frequency high-intensity contact ultrasound; MDT, maggot debridement therapy; PDGF, platelet-derived growth factor; RCT, randomized controlled trial; SR, systematic review; SWC, standard wound care.