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Prosthet Orthot Int. 2015 Feb;39(1):29-39. doi: 10.1177/0309364614534296.

Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine.

Author information

1
Vascular Ulcer/Wound Healing Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA andrews.karen@mayo.edu.
2
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
3
Vascular Ulcer/Wound Healing Clinic, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers.

OBJECTIVE:

To assess the etiology and management of chronic diabetic foot ulcers.

STUDY DESIGN:

Literature review.

METHODS:

Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality.

RESULTS:

Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation.

CONCLUSION:

Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed.

CLINICAL RELEVANCE:

Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

KEYWORDS:

Diabetes; diabetic foot ulcer; neuropathy; wounds

PMID:
25614499
DOI:
10.1177/0309364614534296
[Indexed for MEDLINE]

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