J Yeungnam Med Sci.  2023 Oct;40(4):335-342. 10.12701/jyms.2023.00682.

Management of diabetic foot ulcers: a narrative review

• Kim J
• Nomkhondorj O
• An CY
• Choi YC
• Cho J

• KMID: 2547356
• DOI: http://doi.org/10.12701/jyms.2023.00682

Abstract

Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.

Keyword

Diabetes mellitus; Diabetic foot; Foot ulcer; Wound healing

Figure

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  Fig. 1. Clinical images show differences in wound bed condition (A) before and (B) after surgical debridement.

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  Fig. 2. Computed tomography angiography of a patient with ischemic diabetic foot ulcer. The right proximal to middle superficial femoral artery shows total occlusion (arrows) and the ankle-brachial index (ABI) is 0.38. Left distal superficial femoral and popliteal arteries reveal total occlusion and the ABI is not measurable due to poor vascular status (dotted box).

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  Fig. 3. (A) Total contact cast. (B) Removable ankle-high offloading device.

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  Fig. 4. A 62-year-old male with a history of first-ray amputation. (A) Chronic forefoot plantar ulcer due to repetitive loading is detected and (B) plain radiograph shows osteomyelitis on the second metatarsal head. (C, D) A second metatarsal head resection was performed for offloading.

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  Fig. 5. A 73-year-old male with a 3-month history of diabetic foot ulcer. (A) Computed tomography angiography shows multifocal mild to moderate stenosis at both the superficial femoral artery and popliteal arteries. (B) Ischemic necrosis accompanied by infectious edema is detected on the first to fourth toes. (C) Toe amputation has been performed. (D) The patient has undergone adjuvant hyperbaric therapy both preoperatively for wound demarcation and postoperatively for wound healing. (E) The amputation wound has healed with improved infection and swelling.

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  Fig. 6. Serial images describing negative pressure wound thera­py (NPWT). (A) Before NPWT, the diabetic wound was debrided and (B) NPWT was applied. (C) After NPWT, the wound was ready to close with flap surgery.

Reference

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