Published online Dec 15, 2022. doi: 10.4239/wjd.v13.i12.1106
Peer-review started: July 21, 2022
First decision: August 20, 2022
Revised: August 21, 2022
Accepted: November 18, 2022
Article in press: November 18, 2022
Published online: December 15, 2022
Processing time: 145 Days and 5.5 Hours
Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly. The development of foot ulcer in a diabetic patient has been estimated to be 19%-34% through their lifetime. The pathophysiology of diabetic foot ulcer consist of neuropathy, trauma and, in many patients, additional peripheral arterial disease. In particular, diabetic neuropathy leads to foot deformity, callus formation, and insensitivity to trauma or pressure. The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification, surgical debridement, dressing to facilitate wound healing, off-loading, vascular assessment (status and presence of a chance for interventional vascular correction), and infection and glycemic control. Although especially surgical procedures are sometimes inevitable, they are poor predictive factors for the prognosis of diabetic foot ulcer. Different novel treatment modalities such as nonsurgical debridement agents, oxygen therapies, and negative pressure wound therapy, topical drugs, cellular bioproducts, human growth factors, energy-based therapies, and systematic therapies have been available for patients with diabetic foot ulcer. However, it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials. This review aims at evaluating diabetic foot ulcer with regard to all aspects. We will also focus on conventional and novel adjunctive therapy in diabetic foot management.
Core Tip: Diabetic foot ulcers (DFU) are one of the most common problems and devastating complications of diabetes, and affect 15% of all diabetic patients and result in significant morbidity, mortality, and financial burdens. The management of DFU is usually complex and challenging to clinicians in clinical practice. This review article aims at summarizing the etiopathogenesis and classification of DFU. It also highlights novel adjunctive treatment modalities as well as conventional management for DFU.