Table 2.
Efficacy of adjuvant therapies.
| Therapy | Wound healing benefit compared to standard of care | Level of evidence (SIGN) |
|---|---|---|
| Non-surgical debridement | ||
| Hydrogels | Apparent benefit, but RCTs have high risk of bias | 1− |
| Clostridial collagenase ointment | Unclear benefit; few, small RCTs with variable results | 1− |
| Maggot/larval rherapy | Unclear benefit; few, small RCTs with variable results | 1− |
| Hydrosurgery | No apparent benefit, but data limited to one RCT | 1− |
| Dressings and topical agents | ||
| Various dressing types | No apparent benefit for a particular dressing type except for hydrogel | 1− |
| Honey | Apparent benefit, but RCTs have high risk of bias | 1− |
| Other topical antimicrobials | Unclear benefit; few, small RCTs with variable results | 1− |
| Oxygen therapies | ||
| Topical oxygen | Unclear benefit; few, small RCTs with variable results | 1− |
| Hyperbaric oxygen therapy | No apparent benefit in long-term healing, but RCTs have high risk of bias | 1− |
| Negative-pressure wound therapy | ||
| Negative-pressure wound therapy | Apparent benefit, but RCTs have high risk of bias | 1− |
| Acellular bioproducts | ||
| Acellular bioproducts | Apparent benefit, but RCTs have high risk of bias | 1− |
| Human growth factors | ||
| Fibroblast growth factor | Unclear benefit; few, small RCTs with variable results | 1− |
| Epidermal growth factor | Unclear benefit; few, small RCTs with variable results | 1− to 1+ |
| Vascular endothelial growth factor | Apparent benefit, but data limited to one RCT | 1++ |
| Granuclotye colony-stimulating factor | No apparent benefit, but studies were not designed to evaluate wound healing | 1− to 1++ |
| Platelet-derived growth factor | Apparent benefit, but RCTs have high risk of bias | 1− |
| Skin graft and bioengineered skin | ||
| Skin graft and bioengineered skin | Apparent benefit, but RCTs have high risk of bias | 1− |
| Energy-based therapies | ||
| Electrical stimulation | Unclear benefit; few, small RCTs with variable results | 1− |
| Shockwave therapy | Unclear benefit; few, small RCTs with variable results | 1− |
| Electromagnetic therapy | No apparent benefit, but data limited to few small RCTs | 1− |
| Laser therapy | Unclear benefit; few, small RCTs with variable results | 1− |
| Phototherapy | Apparent benefit, but RCTs have high risk of bias | 1− |
| Systemic therapies | ||
| Insulin therapy | Apparent benefit, but RCTs are lacking | 2+ |
| Other systemic therapies | Unclear benefit; few, small RCTs with high bias, some with variable results | 1− |