Diabetic foot ulcer: An evidence-based treatment update

Liza R. Braun, Whitney A. Fisk, Hadar Lev-Tov, Robert Kirsner, Roslyn R. Isseroff

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: Diabetic foot ulcers (DFUs) are extremely debilitating and difficult to treat. Multidisciplinary management, patient education, glucose control, debridement, offloading, infection control, and adequate perfusion are the mainstays of standard care endorsed by most practice guidelines. Adjunctive therapies represent new treatment modalities endorsed in recent years, though many lack significant high-powered studies to support their use as standard of care. Objective: This update intends to identify recent, exclusively high level, evidence-based evaluations of DFU therapies. Furthermore, it suggests a direction for future research. Methods: PubMed, Embase, Ovid Technologies, CINAHL, Cochrane, and Web of Science databases were systematically searched for recent systematic reviews published after 2004, and randomized controlled trials published in 2012-2013 that evaluated treatment modalities for DFUs. These papers are reviewed and the quality of available evidence is discussed. Results: A total of 34 studies met inclusion criteria. Studied therapies include debridement, off-loading, negative pressure therapy, dressings, topical therapies, hyperbaric oxygen therapy, growth factors, bioengineered skin substitutes, electrophysical therapy, and alternative therapy. Good-quality evidence is lacking to justify the use of many of these therapies, with the exception of standard care (offloading, debridement) and possibly negative pressure wound therapy. Limitations: There is an overall lack of high-level evidence in new adjunctive management of DFU. Comparison of different treatment modalities is difficult, since existing studies are not standardized. Conclusions: Many therapeutic modalities are available to treat DFU. Quality high-level evidence exists for standard care such as off-loading. Evidence for adjunctive therapies such as negative pressure wound therapy, skin substitutes, and platelet-derived growth factor can help guide adjunctive care but limitations exist in terms of evidence quality.

Original languageEnglish
Pages (from-to)267-281
Number of pages15
JournalAmerican Journal of Clinical Dermatology
Volume15
Issue number3
DOIs
StatePublished - Jan 1 2014

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Diabetic Foot
Negative-Pressure Wound Therapy
Debridement
Therapeutics
Standard of Care
Artificial Skin
Hyperbaric Oxygenation
Platelet-Derived Growth Factor
Patient Education
Complementary Therapies
Infection Control
Practice Guidelines
PubMed
Intercellular Signaling Peptides and Proteins
Randomized Controlled Trials
Perfusion

ASJC Scopus subject areas

  • Dermatology

Cite this

Diabetic foot ulcer : An evidence-based treatment update. / Braun, Liza R.; Fisk, Whitney A.; Lev-Tov, Hadar; Kirsner, Robert; Isseroff, Roslyn R.

In: American Journal of Clinical Dermatology, Vol. 15, No. 3, 01.01.2014, p. 267-281.

Research output: Contribution to journalArticle

Braun, Liza R. ; Fisk, Whitney A. ; Lev-Tov, Hadar ; Kirsner, Robert ; Isseroff, Roslyn R. / Diabetic foot ulcer : An evidence-based treatment update. In: American Journal of Clinical Dermatology. 2014 ; Vol. 15, No. 3. pp. 267-281.
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