Diabetic foot ulcers and associated wound care methodologies have been the subject of rigorous research during the last decade. It is important for clinicians to educate themselves on the latest therapies and incorporate them into wound care protocols appropriately. This report reviews innovations in diabetic foot care from a US perspective and provides a guide to the effective use of advanced therapies, including debridement, promotion of granulation tissue and wound closure, to help clinicians achieve optimum wound healing.

INNOVATIONS IN DIABETIC FOOT CARE

Key innovations in the US include:

1. Development of a wound healing timeline to guide clinicians on the optimum use of advanced wound care therapies.
2. The use of biguanides as an alternative hydrotherapy whirlpool additive or in streaming NPWT techniques to reduce infection/contamination in wounds.
3. Instillation of a chemotherapeutic agent (eg Dakin's solution) in conjunction with NPWT to help reduce bacterial colonisation.
4. New treatment strategies for healing chronic diabetic foot ulcers could be directed towards reducing the concentration of MMPs and increasing levels of TIMPs.
5. An electrically active wound dressing approved for use in light to moderately exudating, partial- and full-thickness wounds.
6. A novel micrografting procedure that is currently being clinically tested in patients with diabetic foot ulcers.
7. The use of bioengineered alternative tissues (BATs) to increase the clinician's ability to provide soft tissue closure of lower extremity ulcers.
8. The development of a re-ulceration prevention programme in which patients are educated about self-monitoring and provided with a hand-held digital thermometer.

INTRODUCTION

Diabetic foot disease is a progressive condition that is associated with a number of major risk factors. These include neuropathy, peripheral vascular disease and infection, which can lead to poor healing and subsequent amputation. Each risk factor along the disease pathway represents a target for intervention. This approach, coupled with a well-equipped limb salvage team, to identify, treat and manage these targets for intervention, is essential for good quality patient care.

The University of Arizona's Southern Arizona Limb Salvage Alliance (SALSA) has set up a model of interdisciplinary care. This includes a clinical team involving podiatric surgeons and vascular surgeons. However, the comprehensive care model also includes expertise from various hospital departments including: Internal Medicine, Diabetology, Infectious Disease, Physical Therapy, Plastic Surgery, Nursing, Emergency Medicine and Prosthetics.

SALSA has significantly contributed to clinical and translational research efforts in wound healing, infectious diseases, biomechanics (offloading), bioengineering, and surgery [1,2]. This has led to the development of several innovative modalities/tools that have been clinically targeted to address the disease pathology.