DOI QR코드

DOI QR Code

Management of diabetic foot ulcers: a narrative review

  • Jahyung Kim (Department of Orthopaedic Surgery, Armed Forces Yangju Hospital) ;
  • Otgonsaikhan Nomkhondorj (Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Chi Young An (Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital) ;
  • Ye Chan Choi (Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University) ;
  • Jaeho Cho (Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University)
  • 투고 : 2023.06.26
  • 심사 : 2023.08.10
  • 발행 : 2023.10.31

초록

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.

키워드

과제정보

This study was supported by the Hallym University Research Fund.

참고문헌

  1. van Netten JJ, Bus SA, Apelqvist J, Chen P, Chuter V, Fitridge R, et al. Definitions and criteria for diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev 2023;e3654.
  2. Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med 2017;376:2367-75. https://doi.org/10.1056/NEJMra1615439
  3. Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg 2020;71:1433-46. https://doi.org/10.1016/j.jvs.2019.08.244
  4. Naves CC. The diabetic foot: a historical overview and gaps in current treatment. Adv Wound Care (New Rochelle) 2016;5: 191-7. https://doi.org/10.1089/wound.2013.0518
  5. Lavery LA, Davis KE, Berriman SJ, Braun L, Nichols A, Kim PJ, et al. WHS guidelines update: diabetic foot ulcer treatment guidelines. Wound Repair Regen 2016;24:112-26. https://doi.org/10.1111/wrr.12391
  6. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54:e132-73. https://doi.org/10.1093/cid/cis346
  7. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev 2023;e3657.
  8. Braun L, Kim PJ, Margolis D, Peters EJ, Lavery LA; Wound Healing Society. What's new in the literature: an update of new research since the original WHS diabetic foot ulcer guidelines in 2006. Wound Repair Regen 2014;22:594-604. https://doi.org/10.1111/wrr.12220
  9. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci 2018;1411:153-65. https://doi.org/10.1111/nyas.13569
  10. Tan JS, File TM Jr. Diagnosis and treatment of diabetic foot infections. Baillieres Best Pract Res Clin Rheumatol 1999;13: 149-61. https://doi.org/10.1053/berh.1999.0011
  11. Vas PR, Edmonds M, Kavarthapu V, Rashid H, Ahluwalia R, Pankhurst C, et al. The diabetic foot attack: "tis too late to retreat!". Int J Low Extrem Wounds 2018;17:7-13. https://doi.org/10.1177/1534734618755582
  12. Kim J, Chun DI, Kim S, Yang HJ, Kim JH, Cho JH, et al. Trends in lower limb amputation in patients with diabetic foot based on vascular intervention of peripheral arterial disease in Korea: a population-based nationwide study. J Korean Med Sci 2019; 34:e178.
  13. Kolossvary E, Farkas K, Colgan MP, Edmonds M, Fitzgerald HP, Fox M, et al. "No more amputations": a complex scientific problem and a challenge for effective preventive strategy implementation on vascular field. Int Angiol 2017;36:107-15. https://doi.org/10.23736/S0392-9590.16.03673-7
  14. Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014;59:220-34. https://doi.org/10.1016/j.jvs.2013.08.003
  15. Yavuz M. Plantar shear stress: is it the H pylori of diabetic foot ulcers? Clin Biomech (Bristol, Avon) 2022;92:105581.
  16. Yavuz M, Ersen A, Hartos J, Schwarz B, Garrett AG, Lavery LA, et al. Plantar shear stress in individuals with a history of diabetic foot ulcer: an emerging predictive marker for foot ulceration. Diabetes Care 2017;40:e14-5. https://doi.org/10.2337/dc16-2204
  17. van Deursen R. Mechanical loading and off-loading of the plantar surface of the diabetic foot. Clin Infect Dis 2004;39(Suppl 2):S87-91. https://doi.org/10.1086/383268
  18. de Oliveira AL, Moore Z. Treatment of the diabetic foot by offloading: a systematic review. J Wound Care 2015;24:560, 562-70. https://doi.org/10.12968/jowc.2015.24.12.560
  19. Bus SA, Armstrong DG, Crews RT, Gooday C, Jarl G, Kirketerp-Moller K, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2023;e3647.
  20. Bus SA. The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence. Plast Reconstr Surg 2016;138(3 Suppl):179S-187S. https://doi.org/10.1097/PRS.0000000000002686
  21. Chun DI, Kim S, Kim J, Yang HJ, Kim JH, Cho JH, et al. Epidemiology and burden of diabetic foot ulcer and peripheral arterial disease in Korea. J Clin Med 2019;8:748.
  22. Chun DI, Kim J, Kang EM, An CY, Min TH, Kim S, et al. Does amputation negatively influence the incidence of depression in diabetic foot patients?: a population-based nationwide study. Appl Sci 2022;12:1653.
  23. Smith DG, Ehde DM, Legro MW, Reiber GE, del Aguila M, Boone DA. Phantom limb, residual limb, and back pain after lower extremity amputations. Clin Orthop Relat Res 1999; (361):29-38.
  24. Koob TJ, Rennert R, Zabek N, Massee M, Lim JJ, Temenoff JS, et al. Biological properties of dehydrated human amnion/chorion composite graft: implications for chronic wound healing. Int Wound J 2013;10:493-500. https://doi.org/10.1111/iwj.12140
  25. Zelen CM. An evaluation of dehydrated human amniotic membrane allografts in patients with DFUs. J Wound Care 2013;22: 347-8, 350-1 https://doi.org/10.12968/jowc.2013.22.7.347
  26. Tettelbach W, Cazzell S, Sigal F, Caporusso JM, Agnew PS, Hanft J, et al. A multicentre prospective randomised controlled comparative parallel study of dehydrated human umbilical cord (EpiCord) allograft for the treatment of diabetic foot ulcers. Int Wound J 2019;16:122-30. https://doi.org/10.1111/iwj.13001
  27. Sledge I, Maislin D, Bernarducci D, Snyder R, Serena TE. Use of a dual-layer amniotic membrane in the treatment of diabetic foot ulcers: an observational study. J Wound Care 2020;29 (Suppl 9):S8-12. https://doi.org/10.12968/jowc.2020.29.Sup9.S8
  28. Liu Y, Min D, Bolton T, Nube V, Twigg SM, Yue DK, et al. Increased matrix metalloproteinase-9 predicts poor wound healing in diabetic foot ulcers. Diabetes Care 2009;32:117-9. https://doi.org/10.2337/dc08-0763
  29. Ren Y, Gu G, Yao M, Driver VR. Role of matrix metalloproteinases in chronic wound healing: diagnostic and therapeutic implications. Chin Med J (Engl) 2014;127:1572-81. https://doi.org/10.3760/cma.j.issn.0366-6999.20131179
  30. Kulahin N, Kiselyov V, Kochoyan A, Kristensen O, Kastrup JS, Berezin V, et al. Dimerization effect of sucrose octasulfate on rat FGF1. Acta Crystallogr Sect F Struct Biol Cryst Commun 2008;64(Pt 6):448-52. https://doi.org/10.1107/S174430910801066X
  31. Edmonds M, Lazaro-Martinez JL, Alfayate-Garcia JM, Martini J, Petit JM, Rayman G, et al. Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol 2018; 6:186-96. https://doi.org/10.1016/S2213-8587(17)30438-2
  32. Londahl M, Tarnow L, Karlsmark T, Lundquist R, Nielsen AM, Michelsen M, et al. Use of an autologous leucocyte and platelet-rich fibrin patch on hard-to-heal DFUs: a pilot study. J Wound Care 2015;24:172-4, 176-8. https://doi.org/10.12968/jowc.2015.24.4.172
  33. Game F, Jeffcoate W, Tarnow L, Jacobsen JL, Whitham DJ, Harrison EF, et al. LeucoPatch system for the management of hardto-heal diabetic foot ulcers in the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial. Lancet Diabetes Endocrinol 2018;6:870-8. https://doi.org/10.1016/S2213-8587(18)30240-7
  34. Londahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 2010;33:998-1003. https://doi.org/10.2337/dc09-1754
  35. Wenhui L, Changgeng F, Lei X, Baozhong Y, Guobin L, Weijing F. Hyperbaric oxygen therapy for chronic diabetic foot ulcers: an overview of systematic reviews. Diabetes Res Clin Pract 2021;176:108862.
  36. Kurze C, Farn CJ, Siow J. The interdisciplinary approach: preventive and therapeutic strategies for diabetic foot ulcers. Foot Ankle Clin 2022;27:529-43.
  37. Korzon-Burakowska A, Dziemidok P. Diabetic foot: the need for comprehensive multidisciplinary approach. Ann Agric Environ Med 2011;18:314-7.
  38. Rubio JA, Aragon-Sanchez J, Jimenez S, Guadalix G, Albarracin A, Salido C, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot. Int J Low Extrem Wounds 2014;13:22-6. https://doi.org/10.1177/1534734614521234
  39. Wang C, Mai L, Yang C, Liu D, Sun K, Song W, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer. BMC Endocr Disord 2016;16:38.
  40. Buggy A, Moore Z. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care 2017;26:324-39. https://doi.org/10.12968/jowc.2017.26.6.324