Brem H, Sheehan P, Boulton AJ, et al.
American journal of surgery. Date of publication 2004 May 1;volume 187(5A):1S-10S.
1. Am J Surg. 2004 May;187(5A):1S-10S.
Protocol for treatment of diabetic foot ulcers.
Brem H(1), Sheehan P, Boulton AJ.
Author information:
(1)Department of Surgery, Columbia University College of Physicians & Surgeons,
5141 Broadway, New York, New York 10034, USA. harold.brem@earthlink.net
Each year, 82,000 limb amputations are performed in patients with diabetes
mellitus. The majority of these amputations could be avoided by following strict
protocols. The collective experience treating patients with neuropathic diabetic
foot ulcers of 4 major diabetic foot programs in the United States and Europe
were analyzed. The following protocol has been developed for patients with
diabetic foot ulcers: (1) measurement of the wound by planimetry; (2) optimal
glucose control; (3) surgical debridement of all hyperkeratotic, infected, and
nonviable tissue; (4) systemic antibiotics for deep infection, drainage, and
cellulitis; (5) offloading; (6) moist-wound environment; and (7) treatment with
growth factors and/or cellular therapy if the wound is not healing after 2 weeks
with this protocol and a new epithelial layer is not forming. In addition, the
pathogenesis of diabetic foot ulcers is discussed, as well as the associated
costs and complications, including amputation. Debridement, wound-bed
preparation, antibiotics, various types of dressings, biological therapies,
growth factors, and offloading are described as treatment modalities for patients
with diabetic foot ulcers. In diabetic foot ulcers, availability of the above
modalities, in combination with early recognition and comprehensive treatment,
ensure rapid healing and minimize morbidity, mortality, and costs, as well as
eliminate amputation in the absence of ischemia and osteomyelitis.
DOI: 10.1016/S0002-9610(03)00299-X
PMID: 15147985 [Indexed for MEDLINE]
