Nonpharmacological Management of Diabetic Foot Ulcers: An Update

Abstract

Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes mellitus that is associated with increased morbidity and mortality, as well as substantial economic burden for the health care system. The standard of care for DFUs includes pressure off-loading, sharp debridement, and wound moisture balance, along with infection control and management of peripheral arterial disease. A variety of advanced modalities that target distinct pathophysiological aspects of impaired wound healing in diabetes are being studied as possible adjunct therapies for difficult to heal ulcers. These modalities include growth factors, stem cells, cultured fibroblasts and keratinocytes, bioengineered skin substitutes, acellular bioproducts, human amniotic membranes, oxygen therapy, negative pressure wound therapy, and energy therapies. Additionally, the use of advanced biomaterials and gene delivery systems is being investigated as a method of effective delivery of substances to the wound bed. In the present narrative review, we outline the latest advances in the nonpharmacological management of DFUs and summarize the efficacy of various standard and advanced treatment modalities.

Fighting Against a sea of Troubles

“…In 2021, the journal has successfully published educational articles, 1,2 as well as articles on all aspects of wound management. 3,4 The present issue is also interesting. Anastasiou et al 5 discuss the evidence on the therapeutic properties of honey for diabetic foot ulcers.…”

Autocuidado Em Diabetes Por Usuários De Um Serviço De Atenção Primária

“…É uma estratégia educativa em saúde amplamente divulgada na atenção básica, pois está atrelada à prevenção de ulcerações e possíveis amputações parciais ou totais do pé 17 , sobretudo em diabéticos com perda de sensação protetora (pela neuropatia) ou doença arterial periférica 18 . Estas complicações estão associadas ao aumento da morbimortalidade e elevados custos financeiros para os sistemas de saúde 19 . Ademais, a presença de deficiência nas estruturas dos membros inferiores pode levar a limitações para realizar as atividades do cotidiano que exigem permanecer em pé ou em mobilidade, além de ter potencial para restringir a participação social 20 .…”

Microvascular Complications of Diabetes Mellitus: Focus on Diabetic Retinopathy (DR) and Diabetic Foot Ulcer (DFU)

“…Off-loading with appropriate footwear and/or casts, debridement of callus and/or necrotic tissue, revascularization (by-pass grafting or intraluminal angioplasty) and infection control are the top priorities [86,96,97]. These may be aided by special dressings, skin substitutes, growth factors and other modalities [111][112][113][114][115][116]. Special care must be taken to recognize and promptly deal with emergencies requiring surgery and other urgent interventions [117].…”