Abstract：
OBJECTIVE: Principles of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes-related foot ulcer. However, the rising incidence and costs of diabetes-related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes-related foot ulcers are supported by high-quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold-standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.
METHODS: We followed the GRADE approach by devising clinical questions and important outcomes in the Patient-Intervention-Control-Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders.
RESULTS: From the results of the systematic review and evidence-to-decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post-operative wounds, the use of placental-derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions.
CONCLUSIONS: These wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.
METHODS: We followed the GRADE approach by devising clinical questions and important outcomes in the Patient-Intervention-Control-Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders.
RESULTS: From the results of the systematic review and evidence-to-decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post-operative wounds, the use of placental-derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions.
CONCLUSIONS: These wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.
摘要：
目的：伤口处理原则，包括清创,伤口床准备，以及涉及改变伤口生理学以促进愈合的新技术，在试图治愈慢性糖尿病相关的足部溃疡时是最重要的。然而,与糖尿病相关的足部溃疡治疗的发病率和成本不断上升,因此,在与金标准多学科护理的既定方面结合使用时,需要通过高质量的疗效和成本效益证据来支持促进慢性糖尿病相关足部溃疡伤口愈合的干预措施.这是2023年糖尿病足国际工作组（IWGDF）关于伤口愈合干预措施以促进糖尿病足溃疡愈合的循证指南。它是2019年IWGDF指南的更新。
方法：我们遵循GRADE方法，以患者干预控制结果（PICO）格式设计临床问题和重要结果，进行系统审查，制定判断表摘要，并为每个问题编写建议和理由。每个建议都基于系统审查中发现的证据，使用判断项目的等级摘要，包括期望和不期望的效果，证据的确定性,患者价值观,所需资源,成本效益，股本，可行性,和可接受性，我们提出的建议得到了作者的同意,并由独立专家和利益相关者进行了审查.
结果：从系统评价和证据到决策过程的结果来看，我们能够提出29个单独的建议。我们提出了许多有条件的支持性建议，以使用干预措施来改善糖尿病患者足部溃疡的愈合。这些包括使用蔗糖八硫酸酯敷料，使用负压伤口疗法治疗术后伤口，胎盘衍生产品的使用，使用自体白细胞/血小板/纤维蛋白贴片，使用局部氧疗，以及高压氧的使用.尽管在所有情况下都强调，在最佳护理标准无法单独治愈伤口以及有资源进行干预的情况下，应使用这些方法。
结论：这些伤口愈合建议应支持改善糖尿病和足部溃疡患者的预后，我们希望随之而来的是大规模的实施。然而,尽管作为建议基础的许多证据的确定性正在改善，总体上仍然很差。我们不鼓励更多，但是质量更好的试验，包括那些有健康经济分析的试验，进入这个领域。
方法：我们遵循GRADE方法，以患者干预控制结果（PICO）格式设计临床问题和重要结果，进行系统审查，制定判断表摘要，并为每个问题编写建议和理由。每个建议都基于系统审查中发现的证据，使用判断项目的等级摘要，包括期望和不期望的效果，证据的确定性,患者价值观,所需资源,成本效益，股本，可行性,和可接受性，我们提出的建议得到了作者的同意,并由独立专家和利益相关者进行了审查.
结果：从系统评价和证据到决策过程的结果来看，我们能够提出29个单独的建议。我们提出了许多有条件的支持性建议，以使用干预措施来改善糖尿病患者足部溃疡的愈合。这些包括使用蔗糖八硫酸酯敷料，使用负压伤口疗法治疗术后伤口，胎盘衍生产品的使用，使用自体白细胞/血小板/纤维蛋白贴片，使用局部氧疗，以及高压氧的使用.尽管在所有情况下都强调，在最佳护理标准无法单独治愈伤口以及有资源进行干预的情况下，应使用这些方法。
结论：这些伤口愈合建议应支持改善糖尿病和足部溃疡患者的预后，我们希望随之而来的是大规模的实施。然而,尽管作为建议基础的许多证据的确定性正在改善，总体上仍然很差。我们不鼓励更多，但是质量更好的试验，包括那些有健康经济分析的试验，进入这个领域。
