New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategies

Abstract

Diabetic foot ulcers occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. Neuropathy, abnormal foot biomechanics, peripheral vascular disease and external trauma are the major contributors to the development of a foot ulcer in the diabetic patient. Therapy today includes repeated debridement, offloading, and dressings, for lower grade ulcers, and broad spectrum antibiotics and occasionally limited or complete amputation for higher grades, requiring a team effort of health care workers from various specialties. The large population affected by diabetic foot ulcers and the high rates of failure ending with amputation even with the best therapeutic regimens, have resulted in the development of new therapies and are the focus of this review. These include new off loading techniques, dressings from various materials, methods to promote wound closure using artificial skin grafts, different growth factors or wound bed modulators and methods of debridement. These new techniques are promising but still mostly unproven and traditional approaches cannot be replaced. New and generally more expensive therapies should be seen as adding to traditional approaches.

Iloprost reduces colonic injury in ischemic colitis in rats

“…Prostaglandins enhance the blood flow in ischemia-reperfusion injury in skeletal muscles 22 . Iloprost had therapeutic effects compared to placebo administratin in patients with diabetic feet ulcers [23][24][25] . The patients complained lesser pain and improved ulcers with clinically proven decrease in the risk of amputation both during the teherapy and also in the 3-6 month follow-up period after the treatment 26 .…”

Diabetic Painful and Insensate Neuropathy: Pathogenesis and Potential Treatments

“…74 In contrast, patients with advanced PDN typically have elevated vibration perception thresholds indicative of sensory loss, a condition ultimately responsible for foot ulceration and amputation. 75,76 Thus, studies of mechanical hyper-and hypoalgesia and development of agents to prevent and treat both disorders have clinical relevance. In experimental studies, mechanical withdrawal thresholds in diabetic rat and mouse models are assessed by paw (rats) and tail (mouse) pressure Randall-Selitto test or with a von Frey aesthesiometer and rigid von Frey filaments.…”

Efficacy of Low Level Laser Therapy on Wound Healing in Patients with Chronic Diabetic Foot Ulcers—A Randomised Control Trial

“…Although the fundamental pathophysiological factors leading to DFUs remain incompletely understood, the triad of neuropathy, ischaemia, and infections is commonly considered the most important [5]. These ulcers show decrease in both angiogenic response and deficient growth factors resulting in delayed healing [6].…”