Diabetic Foot Ulcer: Treatment Challenges

Abstract

Wound care professionals face complex challenges in their attempts to achieve healing in patients with a diabetic foot ulcer (DFU).1 Peripheral neuropathy limits sensation, which necessitates consistent offloading of the DFU site. Peripheral arterial, venous, or lymphatic circulation disorders must be diagnosed and addressed. Early diagnosis and management of soft tissue or bone infection is required. Chronic kidney disease, glycemic control, and nutritional needs must be addressed along with counterproductive behavior patterns.2 The use of topical hydrocolloid-based hydrogel dressings3 or honey4 on DFUs facilitates moist wound healing and debridement. Randomized controlled trials (RCTs) indicate that carefully controlling all of these factors helps optimize outcomes for individuals with a DFU. Promising phase 2 clinical studies with stringent inclusion criteria and rigorously applied diagnostic and management procedures are rarely replicated in larger phase 3 RCTs with broader inclusion criteria and less rigorously applied DFU management procedures. Narrow RCT inclusion criteria can limit study applicability for the general DFU population. This installment of Evidence Corner reviews 2 RCTs that use different approaches to address these issues. The first RCT reports interim results of a new autologous skin construct applied to Wagner grade 1 DFUs.5 The second compares the effects of standard wound dressings (SWDs) vs negative pressure wound therapy (NPWT) applied to Wagner grade 2, 3, or 4 DFU according to standard protocols during real-world clinical practice in German patients.6