Original Articles

Wound treatment with hyaluronic acid and silver sulfadiazine promote better epithelialization compared to polyurethane and normal saline in diabetic foot ulcer

Made Kurniawan Ardi Saputra , I Nyoman Semadi, I Gde Raka Widiana

Made Kurniawan Ardi Saputra
Surgery Department, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali-Indonesia. Email: kurniaone01@yahoo.com

I Nyoman Semadi
Surgery Department, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali-Indonesia

I Gde Raka Widiana
Internal Medicine Department, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali-Indonesia
Online First: August 01, 2019 | Cite this Article
Saputra, M., Semadi, I., Widiana, I. 2019. Wound treatment with hyaluronic acid and silver sulfadiazine promote better epithelialization compared to polyurethane and normal saline in diabetic foot ulcer. Indonesia Journal of Biomedical Science 13(2). DOI:10.15562/ijbs.v%vi%i.188


Background: Diabetic foot ulcer, one of the chronic complication of diabetes mellitus that has a high morbidity and mortality rate. The primary conventional treatment for diabetic ulcer was debridement, followed by wound treatment as local control to promote healing and epithelization. There are many different methods on wound treatment; however only few types of research compared the efficacy. This study aims to compare the combination of hyaluronic acid and silver sulfadiazine with polyurethane or normal saline in diabetic foot ulcer treatment.

Method: A randomized clinical study was conducted to compare the efficacy of silver sulfadiazine with hyaluronic acid, polyurethane and normal saline in Wagner 3 and 4 diabetic foot ulcer as the main treatment until 3 weeks post debridement. Several variables assessed in this study, such as epithelialization area, granulation percentage, and ankle diameters. Appropriate statistical analysis was conducted with SPSS version 17 with p < 0.05 considered significant.

Result: The median tissue epithelialization area after 3 weeks of wound treatment on normal saline group was 1.62 cm2 (IQR: 0.2 -2.22), on polyurethane group was 2.79 (IQR: 2.39 -3.19 cm2), and silver sulfadiazine with hyaluronic acid group was 3.1 (IQR: 2.1-4.1) cm2 (p<0.05). There was no significant difference in the percentage of granulation (p=0.136) and ankle circumference (p=0.74) among treatment groups.

Conclusion: Silver sulfadiazine with hyaluronic acid promote the wound healing process in Wagner 3 and 4 diabetic foot ulcer after 3 weeks by promoting a better tissue epithelization compared to normal saline and polyurethane.

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