Diabetic foot ulcers and their wound management

Abstract Diabetic foot ulcer (DFU) is a severe diabetic complication that reduces capability in activities of daily living (ADL) and significantly impairs quality of life. DFU is a complex diverse pathology associated with ischemia that consists of microangiopathy and peripheral arterial disease (PAD), infection in the deep tissues, and neuropathic foot deformity. However, the presence of PAD, also found in most patients with diabetic foot infection (DFI), is almost certainly associated with worse outcomes in patients with infection. In recent years, some guidelines recommended that chronic limb-threatening ischemia (CLTI) be evaluated using the WIfI (wound, ischemia, foot infection) classification. The DFU practice pathway starts from a wound assessment that evaluates ischemia and infection because ischemia and infection are the most important assessments in the management of DFU. Since the worsening of DFU occurs rapidly, it is necessary to perform these two evaluations quickly and put their results on the pathway as soon as possible. The speed of the diagnosis is also important. When the pathological assessment is delayed, it will be difficult to treat, and in addition to becoming impossible to salvage the limb, it often becomes difficult to save the patient’s life. After the assessment of the wound, treatment is performed according to the DFU practice pathway. Therapeutic approaches in DFU treatment are eight stages of treatment: 1. assessment of the wound, 2. wound bed preparation/debridement and amputation, 3. revascularization, 4. treatment to promote wound healing, 5. reconstruction of the soft tissue, 6. offloading/prosthetic device, 7. rehabilitation, and 8. prevention of recurrence/preventive foot care. In this chapter, from a clinical point of view, the diagnosis and treatment of DFU were outlined by demonstrating actual clinical cases.