***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidence s to justify it benefits in the treatment of diabetic foot ulcers . We conducted a prospect i ve study to compare the effect of honey dressing  for  Wagner 's grade -II diabetic foot ulcers  with controlled dressing group ( povidone iodine followed by normal saline ) . Surgical debridement and appropriate antibiotics were prescribed in all patients . There were 30 patients age between 31 to 65-years-old ( mean of 52.1 years ) . The mean healing time in the st and ard dressing group was 15.4 days ( range 9 - 36 days ) compared to 14.4 days ( range 7 - 26 days ) in the honey group ( p < 0.005 ) . In conclusion , ulcer healing was not significantly different in both study groups . Honey dressing is a safe alternative dressing for Wagner grade -II diabetic foot ulcers Basic fibroblast growth factor ( bFGF ) has been shown to promote wound healing . The present trial evaluated the clinical efficacy of bFGF for diabetic ulcer , a type of refractory skin ulcer , and the dose-response relationship . This was design ed as a r and omized , double-blind , dose-ranging , placebo-controlled trial . A total of 150 patients with non-ischaemic diabetic ulcers measuring 900 mm2 or less were r and omized into a placebo group ( n = 51 ) , a 0.001 % bFGF group ( n = 49 ) and a 0.01 % bFGF group ( n = 50 ) , and 148 of these patients received treatment for 8 weeks or less . The efficacy evaluation was carried out on 139 patients who met the protocol in this trial . The primary outcome was the percentage of patients showing 75 % or greater reductions in the area of ulcer . The area of ulcer decreased by 75 % or more in 57.5 % ( 27/47 ) , 72.3 % ( 34/47 ) , and 82.2 % ( 37/45 ) in the placebo , 0.001 % bFGF and 0.01 % bFGF groups , respectively , and differences were significant between the 0.01 % bFGF and placebo groups ( p = 0.025 ) . The cure rate was 46.8 % ( 22/47 ) , 57.4 % ( 27/47 ) , and 66.7 % ( 30/45 ) in the placebo , 0.001 % bFGF and 0.01 % bFGF groups , respectively . The findings obtained in this trial showed wound healing accelerating effects of bFGF on diabetic ulcers This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers .  Fifty-one patients with chronic diabetic foot ulcers were managed as out patients at the Democritus University Hospital of Alex and roupolis and followed up for 8 weeks . All target ulcers were > or = 2.5 cm in any one dimension and had been previously treated only with moist gauze .  Patients were r and omly allocated in three groups of 17 patients each : Group A was treated only with the oxidized regenerated cellulose/collagen bio material ( Promogran , Johnson & Johnson , New Brunswick , NJ ) , Group B was treated only with autologous growth factors delivered by Gravitational Platelet Separation System ( GPS , Biomet ) , and Group C was managed by a combination of both . All ulcers were digitally photographed at initiation of the study and then at change of dressings once weekly . Computerized planimetry ( Texas Health Science Center ImageTool , Version 3.0 ) was used to assess ulcer dimensions that were analyzed for homogeneity and significance using the Statistical Package for Social Sciences , Version 13.0 . Post hoc analysis revealed that there was significantly greater reduction of all three dimensions of the ulcers in Group C compared to Groups A and B ( all P<.001 ) . Although reduction of ulcer dimensions was greater in Group A than in Group B , these differences did not reach statistical significance . It is concluded that protease-modulating dressings act synergistically with autologous growth factors and enhance their efficacy in diabetic foot ulcers OBJECTIVES To determine the comparative effectiveness and cost-effectiveness of three dressing products , N-A , Inadine and Aquacel , for patients with diabetic foot ulcers , as well as the feasibility and consequences of less frequent dressing changes by health-care professionals . DESIGN A multicentre , prospect i ve , observer-blinded , parallel group , r and omised controlled trial , with three arms . SETTING Established expert multidisciplinary clinics for the management of diabetic foot ulcers across the UK . PARTICIPANTS Patients over age 18 with type 1 or type 2 diabetes with a chronic ( present for at least 6 weeks ) full-thickness foot ulcer ( on or below the malleoli ) not penetrating to tendon , periosteum or bone , and with a cross-sectional area between 25 and 2500 mm(2 ) . INTERVENTIONS Participants were r and omised 1:1:1 to treatment with one of N-A ( a non-adherent , knitted , viscose filament gauze ) , Inadine ( an iodine-impregnated dressing ) , both traditional dressings , or Aquacel , a newer product . MAIN OUTCOME MEASURES The primary outcome measure was the number of ulcers healed in each group at week 24 . Secondary measures included time to healing , new ulcerations , major and minor amputations , and episodes of secondary infection . RESULTS A total of 317 patients were r and omised . After 88 withdrawals , 229 remained evaluable . A greater proportion of smaller ( 25 - 100 mm(2 ) ulcers healed within the specified time ( 48.3 % versus 37.3 % ; p = 0.048 ) . There was , however , no difference between the three dressings in terms of percentage healed by 24 weeks , or in the mean time to healing , whether analysed on the basis of intention to treat ( Inadine 44.4 % , N-A 38.7 % , Aquacel 44.7 % ; not significant ) or per protocol ( Inadine 55.2 % , N-A 59.4 % , Aquacel 63.0 % ; not significant ) . There was no difference in the quality of healing , as reflected in the incidence of recurrence within 12 weeks . Likewise , there was no difference in the incidence of adverse events , although a greater proportion of those r and omised to the non-adherent dressings were withdrawn from the study ( 34.9 % versus 29.1 % Aquacel and 19.4 % Inadine ; p = 0.038 ) . The only statistically significant difference found in the health economic analysis was the cost associated with the provision of dressings ( mean cost per patient : N-A 14.85 pounds , Inadine 17.48 pounds , Aquacel 43.60 pounds ) . The higher cost of Aquacel was not offset by the fewer dressings required . There was no difference in measures of either generic or condition-specific measures of quality of life . However , there was a significant difference in the change in pain associated with dressing changes between the first and second visits , with least pain reported by those receiving non-adherent dressings ( p = 0.012 ) . There was no difference in the costs of professional time , and this may relate to the number of dressing changes undertaken by non-professionals . Fifty-one per cent of all participants had at least one dressing change undertaken by themselves or a non-professional carer , although this ranged from 22 % to 82 % between the different centres . CONCLUSIONS As there was no difference in effectiveness , there is no reason why the least costly of the three dressings could not be used more widely across the UK National Health Service , thus generating potentially substantial savings . The option of involving patients and non-professional carers in changing dressings needs to be assessed more formally and could be associated with further significant reductions in health-care costs . TRIAL REGISTRATION Current Controlled Trials IS RCT N78366977 OBJECTIVE  Chronic diabetic foot ulcers  are a source of major concern for both patients and health care systems . The aim of this study was to evaluate the effect of hyperbaric oxygen therapy ( HBOT ) in the management of  chronic diabetic foot ulcers .  RESEARCH DESIGN AND METHODS The Hyperbaric Oxygen Therapy in Diabetics with Chronic Foot Ulcers ( HODFU ) study was a r and omized , single-center , double-blinded , placebo-controlled clinical trial . The outcomes for the group receiving HBOT were compared with those of the group receiving treatment with hyperbaric air . Treatments were given in a multi-place hyperbaric chamber for 85-min daily ( session duration 95 min ) , five days a week for eight weeks ( 40 treatment sessions ) . The study was performed in an ambulatory setting . RESULTS Ninety-four patients with Wagner grade 2 , 3 , or 4 ulcers , which had been present for > 3 months , were studied . In the intention-to-treat analysis , complete healing of the index ulcer was achieved in 37 patients at 1-year of follow-up : 25/48 ( 52 % ) in the HBOT group and 12/42 ( 29 % ) in the placebo group ( P = 0.03 ) . In a sub- analysis of those patients completing > 35 HBOT sessions , healing of the index ulcer occurred in 23/38 ( 61 % ) in the HBOT group and 10/37 ( 27 % ) in the placebo group ( P = 0.009 ) . The frequency of adverse events was low . CONCLUSIONS The HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes BACKGROUND Chronic diabetic patients with wounds have deficient growth factors and impaired local and systemic cellular immunity . Treatment with growth factors is expensive with risk of infection transmission and these factors may not achieve optimum wound concentration . We evaluated the role of generalized immunomodulation in diabetic ulcers by using Tinospora cordifolia as an adjuvant therapy and studied its influence on parameters/determinants of healing , on bacterial eradication and on polymorphonuclear phagocytosis . MATERIAL S AND METHODS A prospect i ve double-blind r and omized controlled study lasting for over 18 months in 50 patients . The ulcer was classified by wound morphology and severity with Wound Severity Score ( Pecoraro-Reiber system ) . Mean ulcer area , depth and perimeter were measured and swabs taken for culture . Blood was collected to assess polymorphonuclear % phagocytosis ( PMN function by Lehrer-Cline C. albicans method ) . Medical therapy , glycemic control , debridement , wound care were optimized . At 4 weeks , parameters were reassessed . PMN function was review ed at 3 months . RESULTS AND ANALYSIS Forty-five patients completed the trial : study group - 23 ( M : F = 17:1 ; mean age = 56.3 years ; mean ulcer duration = 21.1 days ) ; control group 22 ( M : F = 19:3 ; mean age = 56.3 years ; mean ulcer duration = 30.4 days ) . Net improvement was seen in 17 patients ( 73.9 % ) in the study group ; while in the control group , in 13 patients ( 59.1 % ) ; P = 0.292 . Specific parameters included rate of change of ulcer area - cm(2 ) /day ( study - 0.15 ; control - 0.07 ; P = 0.145 ) ; rate of change of ulcer perimeter - mm/day ( study - 0.09 ; control = - 0.07 ; P = 0.089 ) ; change of depth - mm ( study - 2.2 ; control - 1.4 ; P = 0.096 ) ; change of wound score ( study - 14.4 ; control - 10.6 ; P = 0.149 ) ; total number of debridements ( study - 1.9 ; control - 2.5 ; P = 0.03 ) and change in % phagocytosis ( study - 3.9 ; control - 2.3 ; P = 0.048 ) . CONCLUSION Diabetic patients with foot ulcers on T. cordifolia  as an adjuvant therapy showed significantly better final outcome with improvement in wound healing . Reduced debridements and improved phagocytosis were statistically significant , indicating beneficial effects of immunomodulation for ulcer healing Background Diabetes is becoming one of the most common chronic diseases , and ulcers are its most serious complication . Beginning with neuropathy , the subsequent foot wounds frequently lead to lower extremity amputation , even in the absence of critical limb ischemia . In recent years , some research ers have studied external shock wave therapy ( ESWT ) as a new approach to soft tissue wound healing . The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers . Methods We design ed a r and omized , prospect i ve , controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies . One group was treated with st and ard care and shock wave therapy . The other group was treated with only st and ard care . The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization . Results After 20 weeks of treatment , 53.33 % 
    Output:
    
The present report is an up date of the earlier IWGDF systematic review , but the conclusion is similar : that with the exception of HBOT and , possibly , negative pressure wound therapy , there is little published evidence to justify the use of newer therapies .