WHS guidelines update: Diabetic foot ulcer treatment guidelines

Lavery, Lawrence A.; Davis, Kathryn E.; Berriman, Sandra; Braun, Liza R.; Nichols, Adam; Kim, Paul J.; Margolis, David J.; Peters, Edgar J.G.; Attinger, Chris

doi:10.1111/wrr.12391

Cited by 192 publications

(153 citation statements)

References 159 publications

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“…7 Building on these principles, the pillars of treatment today include the following: local wound care with surgical debridement, dressings promoting a moist wound environment, wound off-loading, vascular assessment, treatment of active infection, and glycemic control (Table 1). [8][9][10] In addition to these principles, multidisciplinary diabetic foot care is now becoming a mainstay of therapy.…”

Section: Standard Of Carementioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

616

403

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Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

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Section: Standard Of Carementioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

616

403

View full text Add to dashboard Cite

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“…Pathological impairment of wound healing response causes persistent ulceration, as seen in diabetic patients or in subjects with vasculopathy, leading to a poor quality of life and a higher risk to develop infections . To date, the therapeutic approaches include surgical debridement (for local wound care), dressings promoting, a moist wound environment, wound off‐loading, vascular assessment, treatment of active infection, and glycemic control . Full thickness skin grafts are commonly used to cover the fingertip soft tissue defects and in some case the use of autologous growth factor blood derivatives is mandatory .…”

Section: Introductionmentioning

confidence: 99%

Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study

Gallelli

Cione

Serra

et al. 2019

International Wound Journal

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Wound healing, especially diabetic ones, is a relevant clinical problem, so it is not surprising that surgical procedures are often needed. To overcome invasive procedures, several strategies with drugs or natural compound are used. Recently, in an experimental study, we described an increase in keratinocyte proliferation after their exposition to quercetin plus oleic acid. In the present clinical study, we evaluated both the clinical efficacy and the safety of nano‐hydrogel embedded with quercetin and oleic acid in the treatment of lower limb skin wound in patients with diabetes mellitus (DM). Fifty‐six DM patients (28 men and 28 women, mean age 61.7 ± 9.2 years) unsuccessfully treated with mechanical compression were enrolled and randomised to receive an add on treatment with hyaluronic acid (0.2%) or nano‐hydrogel embedded with quercetin and oleic acid. The treatment with nano‐hydrogel embedded with quercetin and oleic acid significantly (P < .01) reduced the wound healing time, in comparison to hyaluronic acid (0.2%) without developing of adverse drug reactions, suggesting that this formulation could be used in the management of wound healing even if other clinical trials must be performed in order to validate this observation.

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“…Infected foot ulcers in patients that suffer from diabetes mellitus (DM) is a common, complex, and costly complication associated to prolonged hospital stay . In Mexico, according to data from the 2012 National Survey of Health and Nutrition from the Ministry of health the prevalence of DM in adults was estimated in 9.2%, affecting 6.4 million people and foot problems in diabetic patients remain a major public health issue worldwide . The World Health Organization (WHO) defines diabetic foot as an infection, ulceration and destruction of deep tissues in the extremity associated to neurologic alterations and several degrees of peripheral arterial disease (PAD) .…”

mentioning

confidence: 99%

Impact of the bacteriology of diabetic foot ulcers in limb loss

Hinojosa

Boyer-Duck

Anaya‐Ayala

et al. 2016

Wound Repair Regeneration

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Infections in feet of patients with diabetes mellitus is common, complex and costly. The aim of this study to investigate the isolated microorganisms in infected diabetic foot ulcers, and the impact of these infectious agents in limb loss in a tertiary medical center in Mexico City. We conducted a retrospective review in diabetic patients with infected foot ulcers from 1997 to 2014. Diabetic foot was defined according to the World Health Organization (WHO), the bacteriology of wound cultures and the impact of microorganisms in limb loss (major amputation) was studied. Patient's demographics, comorbidities, wound characteristics, and other factors associated in clinical outcomes were determined. A total of 165 subjects with soft tissue infections and/or osteomyelitis and positive cultures were included. One hundred and five (64%) were male, with a mean age of 60 year old +/- 15. One hundred fifty-nine (96%) had Type 2 diabetes mellitus, 68 (41%) history of peripheral arterial disease (PAD) and 97 (59%) patients had osteomyelitis. In 89 patients (54%), cultures were polymicrobial and one single organism was isolated in 76 cultures (46%). During the follow up, 96 (58%) patients preserved their limbs and 69 (42%) required major amputation (above or below knee). Sixty percent of patients that suffered from limb loss had polymicrobial culture (p = 0.13). Growth of Escherichia coli and Enterococcus faecium (p = 0.03) and E. coli and Morganella morgagnii (p = 0.03) was associated to limb loss. Among monomicrobial cultures, infections associated with Proteous mirabilis had higher rate of progression to limb loss (p = 0.03). PAD was associated to limb loss (p = 0.001). Management of diabetic foot requires a multimodality approach. In this study, in patients that received appropriate antibiotic therapy and optimal surgical management, we observed that history of PAD, polymicrobial and isolated P. mirabilis infections were variables associated with higher rate of limb loss.

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WHS guidelines update: Diabetic foot ulcer treatment guidelines

Cited by 192 publications

References 159 publications

Update on management of diabetic foot ulcers

Update on management of diabetic foot ulcers

Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study

Impact of the bacteriology of diabetic foot ulcers in limb loss

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