Based upon: The consensus
report: The effectiveness of
interventions to enhance the
healing of chronic ulcers of
the foot in diabetes - an
evidence based guideline - Interventions
The
principles of care of a
chronic diabetic foot ulcer
are:
treatment of any
associated infection.
revascularisation if
possible and feasible.
off-loading in order
to minimise trauma to
the ulcer site.
management of the
wound and wound bed in
order to promote
healing.
The most important
principles of wound and
wound bed management are the
most simple:
regular inspection.
cleansing.
removal of surface
debris.
protection of the
regenerating tissue from
the environment.
The International Working
Group on the Diabetic Foot
has recently conducted a
systematic review of the
evidence available to
support the use of any
particular approach which
may enhance wound healing.
The review searched for
published controlled trials
or cohort studies in which
the response to the
intervention being tested
was compared with a control
group. The results of this
search are included in the
current guidelines.
Wound
management of diabetic foot
ulcers can be addressed with
a set of simple
interventions:
The wound should be
cleaned regularly with
clean water or saline.
Exudate should be
controlled in order to
maintain a moist wound
environment; usually a
sterile, inert
protective dressing is
sufficient.
In addition to
regular debridement with
a scalpel, other agents
may be used to attempt
to clean the wound bed.
The best evidence
supports the use of
hydrogels (although
contraindication should
be considered, such as
infection, excessive
exudate or critical limb
ischemia), but other
debriding agents may
also be effective.
Plantar neuropathic
ulcers which do not heal
readily with appropriate
off-loading can be
considered (provided the
arterial blood supply is
adequate) for management
by excision of the whole
ulcer bed and (if
indicated to reduce
abnormal pressure
loading) of underlying
bone. However, there are
currently insufficient
data regarding the long
term outcome of these
bony resections, such as
re-ulceration and the
development of transfer
ulcers.
Negative pressure
therapy, by using vacuum
devices, may hasten
healing of
post-operative wounds
but the effectiveness
and cost-effectiveness
of the approach remains
to be established in
chronic diabetic foot
ulcers.
There
are currently no data to
indicate that the use of the
other treatments (including
silver-containing dressings
or other antiseptic
products) enhances ulcer
healing, although
There is limited
evidence that systemic
(as opposed to topical)
hyperbaric oxygen
therapy (HBO) may reduce
ulcer area, but further
(especially blinded)
studies are required, as
well as studies of
cost-effectiveness;
Various early
studies of the
effectiveness of the
supernatant of platelet
suspensions have
suggested benefit but
there are no recent
data;
There are a limited
number of reports
suggesting that
bioengineered skin
products might hasten
wound healing, but
further evidence to
justify their routine
use is required,
including evidence of
cost-effectiveness;
Evidence justifying
the use of
platelet-derived growth
factor (PDGF,
becaplermin) remains to
be confirmed.
