From the Guidelines
The initial treatment for a diabetic ulcer should involve sharp debridement of necrotic tissue, if present, and dressing with materials that absorb exudate and maintain a moist wound healing environment, as recommended by the IWGDF guidelines 1. The treatment approach should prioritize the removal of necrotic tissue and the creation of an optimal wound environment for healing.
- Sharp debridement is recommended over other methods of debridement, such as autolytic, biosurgical, hydrosurgical, chemical, or laser debridement, due to its effectiveness and safety profile 1.
- The frequency of sharp debridement should be determined by the clinician based on clinical need, and the wound should be dressed with materials that absorb exudate and maintain a moist wound healing environment, such as hydrogels, alginates, or foam dressings 1.
- Pressure offloading is also crucial in the treatment of diabetic ulcers, and can be achieved through the use of specialized footwear, total contact casts, or removable cast walkers, as recommended by the IWGDF guidelines on offloading foot ulcers in persons with diabetes 1.
- Blood glucose control should be optimized, aiming for HbA1c levels below 7%, and infection should be addressed with appropriate antibiotics if present.
- Vascular assessment is essential, as adequate blood flow is necessary for healing, and regular follow-up appointments are necessary to monitor progress and adjust treatment as needed. Key considerations in the treatment of diabetic ulcers include:
- The use of sharp debridement and dressing with materials that absorb exudate and maintain a moist wound healing environment
- Pressure offloading through the use of specialized footwear, total contact casts, or removable cast walkers
- Optimization of blood glucose control and addressing infection with appropriate antibiotics
- Vascular assessment and regular follow-up appointments to monitor progress and adjust treatment as needed.
From the Research
Initial Treatment for Diabetic Ulcer
The initial treatment for a diabetic ulcer typically involves a multidisciplinary approach, including:
- Debridement: the removal of dead or infected tissue to promote healing 2, 3
- Pressure relief: to reduce pressure on the affected area and promote healing 4
- Infection management: the use of antibiotics to prevent or treat infections 3
- Revascularization: to improve blood flow to the affected area, when indicated 4, 3
Standard of Care
The standard of care for diabetic foot ulcers (DFU) involves four key principles:
- Pressure relief
- Debridement
- Infection management
- Revascularization, when indicated 4 Additionally, offloading, which involves reducing pressure on the affected area, is also a crucial aspect of standard care 5
Adjunctive Therapies
Adjunctive therapies, such as negative pressure wound therapy, hyperbaric oxygen therapy, bioengineered skin substitutes, and growth factors, may also be used to promote healing 4, 5, 6 However, the evidence for these therapies is not always strong, and more research is needed to determine their effectiveness 4, 5
Importance of Early Treatment
Early treatment of diabetic ulcers is crucial to prevent complications, such as amputations, and to promote healing 3 Regular foot examinations, patient education, and prompt treatment of minor injuries can also help to prevent ulcer occurrence 3