Conservative surgery versus standard care in treating neuropathic plantar forefoot ulcers. A meta-analysis of comparative studies

Abstract

Diabetic foot ulcers (DFUs) is a complication of diabetes that can impose great risk of morbidity and mortality. Classically, DFU treatment is based on local debridement, topical agents and non-surgical offloading. When compared to SC, conservative surgery (CS) has been reported to yield better results for neuropathic wounds. We systematically reviewed studies published from inception to Oct 2018, assessed the methodological quality, and collate quantitative evidence on the outcomes of CS versus SC. Nine studies (2 randomized and 7 retrospective comparative) were included totalizing 436 ulcers (216 and 220 DFUs treated with SC and CS, respectively). Overall meta-analytical results showed significant better healing, recurrence and amputation/revision surgery rates following CS compared to SC. Subgroup analysis of infected ulcers (2 studies) reproduced the same for the first and last outcomes. Subgroup analysis for non-infected ulcers (7 studies) generated significant better results in favor of CS in all outcomes but transfer rate. This review demonstrated the superiority of conservative surgery over standard care in treating forefoot neuropathic wounds.