title: Diabetic foot ulcer: an evidence-based treatment update.
abstract: BACKGROUND
  Diabetic foot ulcers (DFUs) are extremely debilitating and difficult to treat. Multidisciplinary management, patient education, glucose control, debridement, offloading, infection control, and adequate perfusion are the mainstays of standard care endorsed by most practice guidelines. Adjunctive therapies represent new treatment modalities endorsed in recent years, though many lack significant high-powered studies to support their use as standard of care.
  
  
  OBJECTIVE
  This update intends to identify recent, exclusively high level, evidence-based evaluations of DFU therapies. Furthermore, it suggests a direction for future research.
  
  
  METHODS
  PubMed, Embase, Ovid Technologies, CINAHL, Cochrane, and Web of Science databases were systematically searched for recent systematic reviews published after 2004, and randomized controlled trials published in 2012-2013 that evaluated treatment modalities for DFUs. These papers are reviewed and the quality of available evidence is discussed.
  
  
  RESULTS
  A total of 34 studies met inclusion criteria. Studied therapies include debridement, off-loading, negative pressure therapy, dressings, topical therapies, hyperbaric oxygen therapy, growth factors, bioengineered skin substitutes, electrophysical therapy, and alternative therapy. Good-quality evidence is lacking to justify the use of many of these therapies, with the exception of standard care (offloading, debridement) and possibly negative pressure wound therapy.
  
  
  CONCLUSIONS
  There is an overall lack of high-level evidence in new adjunctive management of DFU. Comparison of different treatment modalities is difficult, since existing studies are not standardized.
  
  
  CONCLUSIONS
  Many therapeutic modalities are available to treat DFU. Quality high-level evidence exists for standard care such as off-loading. Evidence for adjunctive therapies such as negative pressure wound therapy, skin substitutes, and platelet-derived growth factor can help guide adjunctive care but limitations exist in terms of evidence quality.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
authors.forename: Liza R
authors.initials: LR
authors.lastname: Braun
authors.forename: Whitney A
authors.initials: WA
authors.lastname: Fisk
authors.forename: Hadar
authors.initials: H
authors.lastname: Lev-Tov
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
authors.forename: Roslyn R
authors.initials: RR
authors.lastname: Isseroff
mesh_terms: D001458:Bandages; D001786:Blood Glucose / Q000378:metabolism; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D017410:Practice Guidelines as Topic; D014945:Wound Healing
chemical_list: D001786:Blood Glucose