【Objectives】
Diabetic foot ulcers (DFU) are associated with an increased risk of lower-extremity amputation, which significantly impacts the patient’s quality of life, healthcare burden, and life expectancy. Although there is a wide variety of available treatments, the efficacy of these remedies in healing DFUs is still unclear. The aim of this meta-analysis is to understand the effectiveness of the skin substitutes, biogenic materials, and topical agents in treating DFU.
【Materials and Methods】
A meta-analysis was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, and Web of Science were searched using the following keywords: diabetes mellitus AND skin graft OR tissue replacement OR dressing OR drug. Two independent reviewers performed data collection and quality assessment of the eligible studies. The primary outcome was the 12–16-week healing rates and the secondary outcome was recurrence rates.
【Results】
Thirty-eight randomized controlled trials, including 3862 patients, were analyzed. The studies exhibited low heterogeneity (τ2 = 0.10) without significant asymmetry (Egger’s test, p = 0.8852). After pooling direct and indirect estimates, placenta-based tissue products(PBTP) exhibited the best wound healing probability (P-score = 0.90), followed by skin substitutes with living cells (SSLC, P-score = 0.70), acellular skin substitutes (ASS, P-score = 0.56), and advanced topical dressings (ATD, P-score = 0.34) compared with standard of care(SOC). The recurrence analysis showed significant improvement in the intervention group compared with the control group (11.21% vs. 15.15%).
【Conclusions】
This network meta-analysis provides the information of the relative effectiveness and rank for the use of biomaterials and topical dressings in diabetic foot ulcer healing. In treating small, superficial and neuropathic DFUs, PBTP had the best healing outcome, followed by SSLC, ASS, and ATD when compared with SOC. Future studies should consider costs and patient compliance for better application in the diverse clinical scenarios.

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