Comparison of Offloading Dressing with Conventional Dressing in Healing of Plantar Diabetic Foot Ulcers: A Randomised Clinical Trial

Abstract

Introduction: The first ever description of Diabetic Foot Ulcers (DFUs), made in the literature was in the mid-19th century. The management principles for it were laid by late 19th century and are still being followed. For a chronic DFU to heal, offloading of pressure, surgical debridement, correction of hyperglycaemia, the use of antibiotics are the corner stone of management. Offloading is an essential modality of prevention and treatment of recurrent plantar DFU. Aim: To compare offloading dressing to conventional dressing in promoting healing of diabetic plantar ulcers. Materials and Methods: This randomised clinical trial was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry between January 2019 to June 2020 among the patients with DFU coming to the Department of General Surgery. A total of 44 patients were included in the study, 22 of these patients underwent offloading dressing and 22 underwent conventional dressing and these patients were followed-up for a duration of 6 weeks and compared on 2nd, 4th and 6th weeks. The patients were compared according to age, gender, duration of diabetes, glycaemic control, risk factors, previous surgery such as wound debridement or previous toe amputation, vascular assessment and site of ulcer, reduction in size of ulcer. The ulcers in both the groups were classified according to the Wagener’s grading of ulcer classification. All data collected was entered into Microsoft Excel 2016 and analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 (IBM SPSS, US) software. A p-value less than 0.05 was considered as statistically significant. Results: Among 44 patients, there was equal number of males and females in both the groups, with the total mean age 53.97±10.10 years. The majority of the study population belonged to the 5th decade (51-60 years), where the youngest patient was of 29 years and oldest was of 72 years. There were 22 patients in offloading group and 24 patients in conventional dressing group as one patient had bilateral plantar ulcers and one patient had two separate ulcers on the plantar aspect of the foot. Total of 45.45% in conventional group and 31.82% of the study population in offloading group had diabetes for 5-10 years of duration. Bad glycaemic control was seen in 40.90% of offloading population and 50% in conventional population. The size reduction percentage of ulcers on comparing both the groups was found to be significant for 2nd week review (p-value=0.03) and was nearly significant for the 6th week review (p-value=0.05). Conclusion: Summarising the above conducted study, offloading dressing was found to be a more efficacious alternative to the conventional dressing as there was greater difference observed in the reduction of the size of ulcer and the patients in the conventional group needed more number of dressings and the duration of healing in the two groups.