Preparation of the Wound Bed of the Diabetic Foot Ulcer

Abstract

Over the last few years, substantial advances have been made in our understanding of diabetic foot ulcers, the importance of thorough surgical debridement, and how this standard therapeutic modality impacts on wound bed preparation. Importantly, wound bed preparation is revolutionizing the way we approach nonhealing or difficult to heal wounds. Much of what we do clinically, from elimination of bacterial burden, to debridement, and to the use of new technologies to heal diabetic foot ulcers, can now be seen as helping wound bed preparation and facilitating the process of healing. From a therapeutic standpoint, at least in the United States, large multicenter clinical trials have led to the regulatory approval of topically applied platelet-derived growth factor (PDGF)-BB (Regranex, Ortho McNeill, NJ) and bioengineered skin (Apligraf, Organogenesis, Canton, MA; Dermagraft, Smith & Nephew, Largo, FL), and have dramatically increased the number of available therapeutic options. However, not to be forgotten are advances that these and other clinical trials have brought to the standard of care for treating neuropathic diabetic foot ulcers. Indeed, these improvements in standards of care for diabetic foot ulcers have raised the bar for proving the effectiveness of new treatments. Stated differently, it has become harder to prove the effectiveness of new therapeutic agents. Thus, from now on we may be looking for “quantum”; jumps in therapeutic efficacy in the treatment of diabetic foot ulcers.