Eldor R, Raz I, Ben Yehuda A, Boulton AJ. Diabet Med. 2004;21:1161-1173.
Although diabetic foot ulcers are largely preventable, they occur in approximately 15% of individuals with diabetes―14% to 20% of whom will require amputation―and are one of the most common causes of hospitalization among patients with diabetes. Treatment of diabetic foot ulcers can be prolonged and may involve dressings, repeated debridement, off-loading, and revascularization of ischemic limbs. Antibiotics may be required if infection is present, and partial or major amputation may be necessary for higher grade ulcers. Although there are many new treatments for diabetic foot ulcers, very little evidence-based data are available. The purpose of this review is to give an overview of emerging treatment modalities for diabetic foot ulcers and the currently available data.
The use of an irremovable off-loading device for all low grade uninfected wounds was recommended. The most established off-loading device is the Total Contact Cast, which decreases pressure on a wound and allows patients to remain mobile. Many wound dressings are available, and although their importance in foot care is well established, the optimal characteristics of wound dressings are not well known. As well, significant superiority of one type of dressing over another has not yet been demonstrated. Debridement should be carried out using standard surgical techniques and may be facilitated using hydrogel or maggot debridement therapy, which have shown promising results in randomized controlled trials.
When ulcers do not heal using standard treatment methods, alternative treatments may be necessary for the promotion of wound closure such as skin grafts, growth factors, or wound healing modulators. Although a number of new techniques have been developed, they can be expensive, may have limited benefits, and may have only been studied in less chronic cases. No experimental therapy has been fully validated for more serious, higher grade ulcers. Systemic hyperbaric oxygen therapy or Iloprost, particularly in high grade ulcers with significant ischemia, may be considered.
New treatment methods for diabetic foot ulcers are promising; however, further study of the efficacy of these treatments is needed and they should not replace established treatment approaches.
