Diabetic Foot Wounds: Managing the Disease State and Advanced Treatment

Diabetic foot complications are a major threat to public health. Loss of protective sensation from peripheral neuropathy and arterial insufficiency, among many other factors, can cause diabetic foot ulcers (DFU). Wound healing can be improved by various treatments, but many dynamics need to be considered before proceeding with appropriate therapy selection. Early patient and wound assessment along with aggressive treatment by a multidisciplinary team represent the best approach to managing high-risk diabetic patients. Examining the patient as a whole is necessary to evaluate and correct causes of tissue damage. My purpose is to review fundamentals of good clinical wound care for managing patients with DFUs and present cases using 3 advanced treatment options. Patient 1 was a 42-year-old male who presented with a necrotic foot. Following debridement and amputation of the third digit, negative pressure wound therapy was applied for 20 days. After sufficient granulation tissue formation, patient returned to surgery for an amputation of the fourth digit and a split-thickness skin graft. At 1-year follow-up, the foot was fully recovered, plantigrade, and functional. Patient 2 was a 70-year-old male who presented with a non-healing DFU. Extensive debridement was performed, followed by application of a collagen/oxidized regenerated cellulose/silver matrix dressing and offloading. At 3-month follow up, DFU was fully closed. Patient 3 was a 65-year-old male who presented with a DFU caused by a complication from previous surgery. Silver nitrate was used to address hypergranulation tissue, and then epidermal grafts harvested with an epidermal harvesting system were applied over the DFU. At 3 weeks post-grafting, DFU was reepithelialized with no complications. In all 3 cases, use of advanced therapies in conjunction with good wound care positively affected closure of these difficult wounds.