From the Guidelines
The recommended approach for healing foot wounds, especially diabetic foot ulcers, is to use sharp debridement and basic wound dressings that maintain a moist wound healing environment, as outlined in the IWGDF Practical Guidelines 1.
Key Recommendations
- Sharp debridement is the preferred method for removing slough, necrotic tissue, and surrounding callus of a diabetic foot ulcer, taking into account relative contraindications such as pain or severe ischemia 1.
- Dressings should be selected based on exudate control, comfort, and cost, and should not contain surface antimicrobial agents with the sole aim of accelerating healing 1.
- Topical antiseptic or antimicrobial dressings should not be used for wound healing of diabetes-related foot ulcers, as the evidence to support their use is inconsistent and of low certainty 1.
Comprehensive Approach
A comprehensive strategy for healing foot wounds, especially diabetic foot ulcers, involves:
- Cleaning the wound daily with saline solution
- Applying appropriate dressings that maintain a moist wound environment, such as hydrocolloids, alginates, or foam dressings
- Pressure offloading using specialized devices like total contact casts, removable cast walkers, or healing sandals
- Infection control with antibiotics, if necessary
- Blood sugar management to promote healing
Debridement and Dressings
Debridement of necrotic tissue is often required and can be performed using sharp debridement, which is the preferred method 1. Dressings should be changed every 1-3 days depending on drainage, and should be selected based on exudate control, comfort, and cost 1.
Adjunctive Therapies
Adjunctive therapies, such as the use of sucrose-octasulfate impregnated dressings or hyperbaric oxygen therapy, may be considered in specific situations, but the evidence to support their use is limited and of low to moderate certainty 1.
From the Research
Recommended Approach for Healing Foot Wounds
The recommended approach for healing foot wounds, especially diabetic foot ulcers, involves a comprehensive management plan that includes:
- Surgical debridement to remove nonviable and necrotic tissue 2, 3, 4
- Dressings to facilitate a moist wound environment and exudate control 2, 5
- Wound off-loading to reduce pressure on the wound 2
- Vascular assessment to ensure adequate blood flow to the wound 2
- Infection and glycemic control to prevent infection and promote healing 2, 6
Debridement Methods
Different debridement methods have been studied, including:
- Hydrogels, which have been shown to be effective in healing diabetic foot ulcers 3
- Larval therapy, which has been shown to result in a significant reduction in wound area compared to hydrogel 3
- Surgical debridement, which has been shown to be beneficial in removing nonviable and necrotic tissue, but the evidence for its role in enhancing healing is deficient 4
Topical Antimicrobial Agents
Topical antimicrobial agents have been used to treat diabetic foot ulcers, including:
- Antimicrobial dressings, which have been shown to increase the number of wounds healed compared to non-antimicrobial dressings 6
- Topical antimicrobial treatments, which have been shown to have low-certainty evidence for their effectiveness in treating diabetic foot ulcers 6
Dressing Selection
The selection of dressings should be guided by the characteristics of the ulcer, the requirements of the patient, and costs 5. Different types of dressings have particular characteristics that aid selection, including: