OBJECTIVE: to assess the effects of advanced wound dressings (AWD) commonly used in the treatment of predominantly neuropathic diabetic foot ulcers (DFU) The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS).
METHODS: A Medline and Embase search were performed up to April 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with DFU comparing AWD with placebo/standard of care (SoC), with a duration of at least 12 weeks. Prespecified endpoints were: ulcer healing (principal), time-to-healing, frequency of dressings change, major and minor amputation, pain, and all-cause mortality. AWD assessed were: alginates; foam, hydrocolloids, hydrogels, hyaluronic acid, hemoglobin spray, silver-impregnated, sucrose octasulfate-impregnated, honey-impregnated, micro-organism-binding, and protease-modulating matrix dressings. Mantel-Haenzel Odds ratios and 95% confidence intervals (MH-OR, 95% CIs) were either calculated or extracted directly from the publications. Weighted mean differences (WMD) and 95% CIs were calculated for continuous variables.
RESULTS: Fifteen studies fulfilled all inclusion criteria. Participants treated with AWD had a significantly higher ulcer healing rate and shorter time-to-healing in comparison with SoC/placebo (MH-OR 1.50 [0.80, 2.79], p = 0.20 and WMD:: - 24.38 [- 42.90, - 5.86] days, p = 0.010). No other significant effect on the above reported prespecified endpoints were observed. For the primary endpoint, the quality of evidence was rated as \"moderate\".
CONCLUSIONS: In conclusion, AWD, particularly sucrose-octasulfate, hydrogels, hyaluronic acid, and honey dressings, can actively promote wound healing and shortening time-to-healing in patients with DFU.

BACKGROUND: Diabetic foot ulcers (DFUs) are one of the major complications of diabetes, representing a leading cause of hospitalization and non-traumatic lower limb amputations. Clinical practice guidelines (CPGs) are statements that include recommendations intended to improve patients\' outcomes by providing recommendations for key clinical issues with alternative care options. The aim of this study is to systematically review CPGs on DFUs care and generate an evidence-map for visualizing research trends and gaps in the CPGs.
METHODS: A search of the PubMed, Embase, and Web of Science, guideline databases and website of diabetes society was performed to include the diabetic CPGs. We exacted the basic information, methodological quality and reporting quality of CPGs, recommendations for DFUs care by the Excel 2016. Four researchers evaluated the methodological and reporting quality of diabetic foot CPGs by AGREE Ⅱ instrument and RIGHT checklist. The bubble plot format of evidence map was reduced by R (3.5.1) software.
RESULTS: 22 CPGs proved eligible, which included 10 diabetic foot guidelines and 12 comprehensive diabetes guidelines. According to the recommendations of diabetic CPGs, current standard of care for DFUs care mainly involves offloading of pressure, wound care, choice of shoes and adjunctive treatment. Recommendations on offloading of pressure and wound care were consistent in 22 CPGs. However, there were some conflicts on adjunctive treatment recommendations and recommendations for choice of shoes were not accurate.
CONCLUSIONS: There is mixed quality evidence of CPGs for DFUs care, and some recommendations are inconsistent. This evidence map could provide new perspectives in presentation of evidence and help us know the need for future research to address the current gaps, as well as areas of opportunity for CPG development.

Ilizarov first reported the tibial transverse transport (TTT) for limb regeneration and functional reconstruction. The law of tension-stress could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis process, but he did not apply this technique purposely to reconstruct microcirculation. Chinese orthopedic surgeons first used the TTT to treat lower extremity vascular lesions and diabetic foot ulcers. At present, some small sample clinical studies showed that the TTT could reconstruct microvascular network in the lower limbs of diabetic foot and promote the healing of foot ulcers. The use of TTT could significantly reduce the overall risk of diabetic foot complication especially the amputation risk. This expert consensus is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS), Taskforce Group of Tibial Cortex Transverse Transport Technique for the Treatment of Diabetic Foot Ulcers. This expert consensus provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe diabetic foot ulcers.
胫骨横向骨搬移（tibial transverse transport，TTT）技术源自俄罗斯医学专家 Ilizarov 创立的肢体再生与功能重建理论。在张力-应力法则作用下，组织再生能力被激活、加强，通过给予一定应力性牵拉，骨骼及其附着的肌肉、筋膜、血管、神经会同步生长。虽然 Ilizarov 医生发现了牵拉成骨过程中血管网新生的现象, 但未将该技术深入应用于微循环重建的领域。中国骨科医师在世界上首先将 TTT 技术用于治疗下肢血管性病变及糖尿病足，研究结果初步显示该技术可诱导糖尿病足下肢微血管网再生，促进足部溃疡愈合、避免截肢，降低糖尿病足的整体风险。为进一步促进 TTT 技术在糖尿病足治疗中的应用，中国医师协会骨科医师分会中国骨搬移糖尿病足学组组织专家编撰了专家共识，对 TTT 技术的适应证、禁忌证、手术方法以及围术期管理等提出了明确建议。.

Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing.
A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts.
In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus.
This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.