Literature review on the management of diabetic foot ulcer

Table 1 Different kind of debridement for patients with diabetic foot ulcer

Method	Explanation	Advantages	Disadvantages
Surgical or Sharp	Callus and all nonviable soft tissues and bone remove from the open wound with a scalpel, tissue nippers, curettes, and curved scissors. Excision of necrotic tissues should extend as deeply and proximally as necessary until healthy, bleeding soft tissues and bone are encountered[59]	Only requires sterile scissors or a scalpel, so is cost-effective[55]	Requires a certain amount of skill to prevent enlarging the wound[55]
Mechanical	This method includes wet to dry dressings, high pressure irrigation, pulsed lavage and hydrotherapy[76], and commonly used to clean wounds prior to surgical or sharp debridement[76]	Allows removal of hardened necrosis	It is not discriminating and may remove granulating tissue It may be painful for the patients[55]
Autolytic	This method occurs naturally in a healthy, moist wound environment when arterial perfusion and venous drainage are maintained[18]	It’s cost-effective[55] It is suitable for an extremely painful wound[18]	It’s time consuming and may require an equivocal time for treatment[18]
Enzymatic	The only formulation available in the United Kingdom contains Streptokinase and Streptodornase (Varidase Topical® Wyeth Laboratories). This enzyme aggressively digests the proteins fibrin, collagen and elastin, which are commonly found in the necrotic exudate of a wound[77,78]	They can be applied directly into the necrotic area[55]	Streptokinase can be systemically absorbed and is therefore contraindicated in patients at risk of an MI It’s expensive[55]
Biological	Sterile maggots of the green bottle fly (Lucilia sericata) are placed directly into the affected area and held in place by a close net dressing. The larvae have a ferocious appetite for necrotic material while actively avoiding newly formed healthy tissue[79,80]	They discriminate between the necrotic and the granulating tissue[79]	There may be a reluctance to use this treatment by patients and clinicians It’s expensive[79,80]