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Diabetic Foot Ulcer: An Evidence-Based Treatment Update

  • Evidence-Based Review
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

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.

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Acknowledgments

No sources of funding were used to prepare this review. Robert Kirsner has received consulting fees or honorarium from Organogenesis, Shire, and KCI. Dr. Isseroff, Dr. Lev Tov, Ms. Braun, and Ms. Fisk have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA

    Liza R. Braun & Robert S. Kirsner

  2. Department of Dermatology, University of California-Davis, Sacramento, CA, USA

    Whitney A. Fisk & Roslyn R. Isseroff

  3. Division of Dermatology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Hadar Lev-Tov

  4. VA Northern California Health Care System, Mather, USA

    Roslyn R. Isseroff

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  1. Liza R. Braun
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  2. Whitney A. Fisk
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  3. Hadar Lev-Tov
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  4. Robert S. Kirsner
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  5. Roslyn R. Isseroff
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Corresponding author

Correspondence to Hadar Lev-Tov.

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L. R. Braun and W. A. Fisk contributed equally.

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Braun, L.R., Fisk, W.A., Lev-Tov, H. et al. Diabetic Foot Ulcer: An Evidence-Based Treatment Update. Am J Clin Dermatol 15, 267–281 (2014). https://doi.org/10.1007/s40257-014-0081-9

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