Outcomes of Different Wound Dressings and Offloading Combinations in Diabetic Foot Ulcers: A Systematic Review

Both wound dressings and offloading are important in managing diabetic foot ulcer (DFU). However previous systematic reviews only evaluate the effectiveness of each intervention separately. Therefore, we would like to provide an insight of the combined effectiveness of both wound dressing and offloading techniques. This systematic review is carried out in compliance with the Preferred Reporting in Systematic Reviews and Meta-Analyses (PRISMA) and was registered to PROSPERO (registration number: CRD42024624203) prior to starting the review. Four databases were utilised for the review: PubMed, ScienceDirect, Sage Journals and Web of Science. Keywords included “diabetic foot ulcer”, “wound dressing” and “offloading”. Randomised controlled trials between 2015 to 2024 that specified the type of dressing and type of offloading were included. Data extraction focused on the type of dressings, offloading and healing outcomes of DFUs. 21 studies were included. All studies showed that the combination of dressing and offloading created good healing outcomes in terms of healing time, reduction in wound size and other factors such as quality of life. The highest rate of complete healing (90%) was achieved by using silver hydrogel and orthotic shoes; while the shortest healing time was achieved by using honey and hydrogel alternatively with orthotic shoes (p=0.004). It is clear that the combination of wound dressings together with offloading positively impacts the healing process of DFU. However, as the clinical heterogeneity limitations such as different mean ulcer sizes, number of patients, it is hard to determine the best combination of dressings and offloading.