Prospective randomized comparison of controlled release ionic silver hydrophilic dressings and medicated honey-impregnated dressings in treating neuropathic diabetic foot ulcer

Abstract

Background and Aim of the Work: Recent studies proved that ionic silver hydrogel is a cost-effective and clinically effective method of the treatment of wounds and in particular diabetic foot ulcer; in addition, the antibacterial and tissue-healing properties of manuka honey (MH) had been proved by various investigators. This study aimed to compare the effectiveness of the use of controlled release ionic silver hydrophilic dressing with that of MH-impregnated dressings in patients with diabetic neuropathic plantar ulcers. Patients and Methods: This was a prospective, double-blind, randomized comparative clinical trial conducted in diabetic foot care unit at the King Abdul Aziz Specialist Hospital in Taif, Saudi Arabia. Seventy-one patients were enrolled from January 2015 to December 2017. Patients with neuropathic plantar ulcers were included in the study with exclusion of ischemic and neuroischemic ulcers. Patients who met the inclusion criteria of this study were subdivided and randomized into two groups: Group I (honey group) and Group I (silver hydrogel group); in both the groups after drainage of any collection and surgical debridement of hyperkeratotic and necrotic tissues and irrigating the ulcers, in Group I, MH-impregnated dressing containing 35 g of Unique Manuka Factor-13 was applied, and in Group II, controlled release ionic silver hydrophilic dressings were used to cover the ulcer. The mean time required for eradicating infection, hospital length of stay (LOS), and the mean time of complete healing of the ulcers were the primary outcomes. Secondary outcome was to correlate the mean time of ulcer healing with duration of diabetes, hemoglobin A1c, and presence of nephropathy or neuropathy. Results: There was no significant difference in the demographic data, size of the ulcers, mean duration of diabetes, and clinical and laboratory data between both the groups (P > 0.05). The mean time to eradicate infection and hospital LOS were reduced in the silver treatment group compared to honey treatment group, but the difference does not reach a statistical significance (P > 0.05); the table shows also that the mean time required for complete ulcer healing was shorter in MH group than the silver hydrophilic dressing group (P > 0.05, insignificant). In both the groups, the duration of healing was significantly correlated with the patient age, pretreatment level of HbA1c, pretreatment duration of the ulcer, and the ulcer size; however, there was no significant correlation with gender and duration of diabetes. Conclusions: The present study verified the effectiveness of MH-impregnated dressings and the controlled release silver hydrophilic dressings in controlling wound infection and promoting the complete healing of neuropathic ulcers.

Keywords

• Diabetic foot
• manuka honey
• neuropathic plantar ulcer
• silver hydrogel