IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes

Abstract

1. Clean ulcers regularly with clean water or saline, debride them when possible in order to remove debris from the wound surface and dress them with a sterile, inert dressing in order to control excessive exudate and maintain a warm, moist environment in order to promote healing. (GRADE strength of recommendation: strong; quality of evidence: low) 2. In general, remove slough, necrotic tissue and surrounding callus with sharp debridement in preference to other methods, taking relative contraindications such as severe ischemia into account. (strong; low) 3. Select dressings principally on the basis of exudate control, comfort and cost. (strong; low) 4. Do not use antimicrobial dressings with the goal of improving wound healing or preventing secondary infection. (strong; moderate) 5. Consider the use of systemic hyperbaric oxygen therapy, even though further blinded and randomized trials are required to confirm its cost-effectiveness, as well as to identify the population most likely to benefit from its use. (weak; moderate) 6. Topical negative pressure wound therapy may be considered in post-operative wounds even though the effectiveness and cost-effectiveness of the approach remain to be established. (weak; moderate) 7. Do not select agents reported to improve wound healing by altering the biology of the wound, including growth factors, bioengineered skin products and gases, in preference to accepted standards of good quality care. (strong; low) 8. Do not select agents reported to have an impact on wound healing through alteration of the physical environment, including through the use of electricity, magnetism, ultrasound and shockwaves, in preference to accepted standards of good quality care. (strong; low) 9. Do not select systemic treatments reported to improve wound healing, including drugs and herbal therapies, in preference to accepted standards of good quality care. (strong; low).