Treatment of diabetic foot ulcers: review of the literature with regard to the TIME clinical decision support tool

Abstract

Objective: The aim of this clinically orientated paper is to offer an overview of diabetic foot ulcer (DFU) dressings generally, and more specifically, their use in the treatment of DFUs. Method: The TIME clinical decision support tool (CDST) has been used as a clinical tool that can help clinicians bring together the different aspects of dressings for DFU treatment into a holistic approach to patient care. Results: DFUs are often difficult to heal, are painful and impact negatively on the individual's quality of life. Most DFU dressings are designed to support the healing of hard-to-heal wounds and represent one part of the management of DFUs. Apart from providing a moist environment, absorbing increased exudate, enhancing granulation and assisting in autolysis, the dressings need to be cost-effective. Wound dressing selection is based on clinical knowledge that ensures the dressing is most appropriate for the individual and the wound, taking into account the comorbidities that the individual may have. Conclusion: This paper has highlighted how the use of the TIME CDST model can enhance clinical care and is a further tool clinicians should consider when developing and executing DFU treatment plans. Future research needs to focus on large multicentre studies using robust methodologies, given the current gaps in the evidence, to determine the effectiveness of dressing products for DFUs.

Effect of honey dressing in the management of diabetic foot ulcers: A meta‐analysis

“…Bigger, more homogeneous samples are mandatory for this examination. This was also emphasised in previous studies that employed a related meta‐analysis technique and found equivalent results of the effect 23‐27 …”

“…Honey has an acidic pH range of 3.2 to 4.5. Additionally, an acidic environment might speed up haemoglobin's release of oxygen, which would benefit wound healing 23‐27 …”

“…Since other studies have shown that an alkaline environment is favourable for the growth of microorganisms, the acidity of honey might prevent microbial reproduction. Furthermore, 3 to 6 atm of pressure was beneficial for the growth of bacteria 23‐27 . Honey, on the other hand, is a type of hypertonic solution with an osmotic pressure of roughly 105 atm.…”

“…Additionally, an acidic environment might speed up haemoglobin's release of oxygen, which would benefit wound healing. [23][24][25][26][27] Since other studies have shown that an alkaline environment is favourable for the growth of microorganisms, the acidity of honey might prevent microbial reproduction. Furthermore, 3 to 6 atm of pressure was beneficial for the growth of bacteria.…”

Advances in the Preparation of Nanofiber Dressings by Electrospinning for Promoting Diabetic Wound Healing

“…Debridement is a process for removing non-viable and necrotic tissue. That is, the removal of callus, necrotic tissue and bacterial components at the wound by surgery, hydrogel, biosurgery (i.e., maggots), to promote the release of growth factors and accelerate the transformation of chronic wounds into acute wounds [ 12 , 13 ]. In addition, decompression can be achieved by debridement of the healing tissue.…”