Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Abstract

Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly. The development of foot ulcer in a diabetic patient has been estimated to be 19%-34% through their lifetime. The pathophysiology of diabetic foot ulcer consist of neuropathy, trauma and, in many patients, additional peripheral arterial disease. In particular, diabetic neuropathy leads to foot deformity, callus formation, and insensitivity to trauma or pressure. The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification, surgical debridement, dressing to facilitate wound healing, off-loading, vascular assessment (status and presence of a chance for interventional vascular correction), and infection and glycemic control. Although especially surgical procedures are sometimes inevitable, they are poor predictive factors for the prognosis of diabetic foot ulcer. Different novel treatment modalities such as nonsurgical debridement agents, oxygen therapies, and negative pressure wound therapy, topical drugs, cellular bioproducts, human growth factors, energy-based therapies, and systematic therapies have been available for patients with diabetic foot ulcer. However, it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials. This review aims at evaluating diabetic foot ulcer with regard to all aspects. We will also focus on conventional and novel adjunctive therapy in diabetic foot management.

The efficacy of electroacupuncture in among early diabetic patients with lower limb arteriosclerotic wounds

“…Nevertheless, despite these methods failing to directly target the compromised neovascularization observed in diabetic patients, they might still be inadequate in facilitating the repair process. 18 F I G U R E 2 Secondary outcomes-Wound healing and pain reduction. F I G U R E 1 Primary outcome-Rate of complete wound closure.…”

Analysis of risk factors of infection in diabetic foot patients

“…Therefore, infection management and ulcer repair are essential for preventing adverse outcomes 12 . Ulcers greater than 60 mm 2 in size, purulent discharge from the sinus tract, presence of a sausage toe and ESR greater than 70 mm/h are indicative of the presence of osteomyelitis 15 …”

“…These factors contribute to impaired immune function, delayed wound healing and diminished sensation in diabetic foot patients, thereby increasing their susceptibility to infection 14 . Significant foot‐specific factors contributing to developing diabetic foot infections include foot deformities, peripheral neuropathy, callus formation, ulceration and a history of prior foot infections 15 . Deformities of foot, such as bunions, hammertoes and Charcot arthropathy, increase pressure points and friction, resulting in skin disintegration and ulceration.…”

Comparative analysis of surgical and non‐surgical wound approaches in diabetic foot ulcer treatment: Meta‐analysis and systematic review

“…A wide array of treatment modalities exists for DFUs, encompassing both conservative non-surgical approaches and variety of surgical interventions. [3][4][5] DFU management is complex and frequently necessitates an interdisciplinary approach. As part of standard care, non-surgical interventions such as offloading, advanced wound dressings, glycaemic control and infection management are implemented.…”

“…In addition to imposing significant healthcare burden, such ulcers bear profound negative effect on life of those who are afflicted. A wide array of treatment modalities exists for DFUs, encompassing both conservative non‐surgical approaches and variety of surgical interventions 3–5 …”