# Efficacy and Safety of Biomaterials and Antimicrobial Dressings in the Treatment of Diabetic Foot Ulcers: A Systematic Review and Network Meta-Analysis

## TL;DR

This study compares different wound dressings for diabetic foot ulcers and finds that biomaterials and antimicrobial dressings improve healing time and efficiency.

## Contribution

The study provides a network meta-analysis comparing various wound dressings, identifying the most effective combinations for treating diabetic foot ulcers.

## Key findings

- Novel biomaterials and antimicrobial dressings significantly shorten wound healing time compared to traditional dressings.
- Combinations involving epidermal growth factor or amniotic membrane with hydrogel are more effective for healing efficiency.
- Sensitivity analyses show healing time rankings are unstable, while healing efficiency remains robust.

## Abstract

This systematic review and network meta-analysis is aimed at comparing the efficacy and safety of various wound dressings in the treatment of diabetic foot ulcers, as differences in outcomes among these materials remain unclear. A comprehensive literature search was conducted across major Chinese and international databases up to October 2024, identifying 35 randomized controlled trials involving 2631 patients. Data were extracted and quality-assessed using standardized methods, and a network meta-analysis was performed using appropriate statistical software. The results showed that, compared with traditional dressings, novel biomaterials (e.g., growth factors, amniotic membrane, platelet-rich plasma, and hydrogels) and antimicrobial dressings (e.g., silver ion dressings) combined with basic fibroblast growth factor or hydrogel significantly shortened wound healing time. In terms of healing efficiency, combinations involving epidermal growth factor, amniotic membrane, or platelet-rich plasma with hydrogel were significantly more effective than traditional dressings. The surface under the cumulative ranking curve values indicated that the most effective interventions were antimicrobial dressings (silver ion) combined with basic fibroblast growth factor for wound healing time and epidermal growth factor–based regimens for healing efficiency. Importantly, sensitivity analyses excluding studies at high risk of bias (allocation/blinding) demonstrated that the ranking for ulcer healing time was unstable—attenuated for platelet-rich plasma but more favorable for honey dressings—whereas estimates for healing efficiency remained robust. These findings suggest that conclusions regarding healing time are particularly sensitive to study quality and should be interpreted with caution. No serious adverse events were reported, and most interventions were well tolerated. These findings suggest that biomaterial and antimicrobial dressings, particularly when used in combination with traditional methods, offer clear advantages in the management of diabetic foot ulcers and should be prioritized in clinical practice.

Trial Registration: CRD42024578762