Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical
debridement, dressings to facilitate a moist
wound environment and exudate control,
wound off-loading, vascular assessment, and
infection and
glycemic control. These practices are best coordinated by a multidisciplinary
diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant
therapies have been studied to reduce DFU healing times and
amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant
therapies reviewed include the following categories: nonsurgical
debridement agents, dressings and topical agents,
oxygen therapies, negative pressure wound therapy, acellular bioproducts, human
growth factors, energy-based
therapies, and systemic
therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.