Current status and progress in research on dressing management for diabetic foot ulcer

Abstract

Diabetic foot ulcer (DFU) is a major complication of diabetes and is associated with a high risk of lower limb amputation and mortality. During their lifetime, 19%–34% of patients with diabetes can develop DFU. It is estimated that 61% of DFU become infected and 15% of those with DFU require amputation. Furthermore, developing a DFU increases the risk of mortality by 50%–68% at 5 years, higher than some cancers. Current standard management of DFU includes surgical debridement, the use of topical dressings and wound decompression, vascular assessment, and glycemic control. Among these methods, local treatment with dressings builds a protective physical barrier, maintains a moist environment, and drains the exudate from DFU wounds. This review summarizes the development, pathophysiology, and healing mechanisms of DFU. The latest research progress and the main application of dressings in laboratory and clinical stage are also summarized. The dressings discussed in this review include traditional dressings (gauze, oil yarn, traditional Chinese medicine, and others), basic dressings (hydrogel, hydrocolloid, sponge, foam, film agents, and others), bacteriostatic dressings, composite dressings (collagen, nanomaterials, chitosan dressings, and others), bioactive dressings (scaffold dressings with stem cells, decellularized wound matrix, autologous platelet enrichment plasma, and others), and dressings that use modern technology (3D bioprinting, photothermal effects, bioelectric dressings, microneedle dressings, smart bandages, orthopedic prosthetics and regenerative medicine). The dressing management challenges and limitations are also summarized. The purpose of this review is to help readers understand the pathogenesis and healing mechanism of DFU, help physicians select dressings correctly, provide an updated overview of the potential of biomaterials and devices and their application in DFU management, and provide ideas for further exploration and development of dressings. Proper use of dressings can promote DFU healing, reduce the cost of treating DFU, and reduce patient pain.

Foam dressing and micropower vacuum dressing promote diabetic foot ulcer wound healing by activating the PI3K/AKT/mTOR pathway in rats

“…Current dressings for DFU include a range of options such as traditional dressings, basic dressings, bacteriostatic dressings, composite dressings, nano dressings, and bioactive dressings. 10 Patients with DFUs should choose wound dressings based on particular features (such as wound appearance, depth, exudate, infection, compliance, and economic situation), as well as the cost and comfort of the dressings. Basic dressings promote cell proliferation, differentiation, and epithelial cell migration while inhibiting cross-infection and the injury to new granulation tissue.…”

“…9 Currently, wet dressings include hydrogels, hydrocolloids, films, alginates, and foams. 10 Foam dressing (FD) as an alternative to hydrocolloid dressings is applied in wound with pressure, exudation or excessive granulation. 11 FD, composed of polyurethane or silicone resins, are semi-permeable with hydrophilic or hydrophobic properties, serving as a bacterial barrier.…”

Curcumin Promotes Diabetic Foot Ulcer Wound Healing by Inhibiting miR-152-3p and Activating the FBN1/TGF-β Pathway

“…DFU affects approximately 18.6 million people worldwide each year and is associated with increased rates of amputation, which increases the risk of death [ 27 ]. Studies have shown that in diabetic patients with foot wounds, strict blood sugar control reduces the chance of amputation [ 28 ]. In addition, DFU status is worsened by peripheral vascular disease and decreased blood flow.…”

Advanced multifunctional hydrogels for diabetic foot ulcer healing: Active substances and biological functions

“…Besides, the most widely used dressings in clinical practice, including skimmed cotton gauze and petroleum jelly gauze, cannot be loaded with drugs or mimic ECM, as well as prevent microbial invasion. 12 Therefore, it is necessary to seek for more effective and suitable dressings based on the pathogenesis of DFU.…”