Paper Authors and Title

Ruvimbo Chiweshe (Atlantic Technological University), Elizabeth Carroll, “Diabetic Foot Ulcers : Prevalence, Current Tissue Debridement Therapies, Their Existing Challenges and Future Perspectives”


Diabetic foot ulcers (DFUs) are debilitating chronic wounds affecting approximately 25% of diabetics. Apart from a prolonged wound healing and high mortality rate, DFUs reduce the quality of life (QoL) through extremities like hospitalization, amputation and sepsis. Moreover, DFUs are expensive with an estimated annual cost of thirteen billion United States dollars. Current DFU therapies follow the TIME principle (tissue debridement, infection control, moisture control and excision of wound edges). Presently, surgical debridement (SD) is considered the gold standard. However, it is not suitable for all DFUs. Through an electronic literature search, case studies published between 2018 and 2023 were evaluated to assess the efficacy of alternative therapies to SD. These therapies were maggot debridement therapy (MDT), ultrasound assisted wound therapy (UAWT) and negative pressure wound therapy (NPWT).

Key outcomes assessed: complete wound healing time, wound surface area reduction (cm2 ), granulation tissue formation surface area (cm2 ) and polymicrobial load changes (%) demonstrated the efficacy of these alternative therapies. However, similar to SD, these therapies have limitations. These include amputation, pain, recurrence within a year, cellulitis, and death for NPWT treated DFU patients. Considering the impact of DFUs on patients’ QoL these limitations (adverse effects) indicate a great need for more effective and advanced therapies. Recommendations formulated in this thesis currently in clinical trials are advanced therapy medicinal products namely mesenchymal stem cell therapy, tissue engineering and exosome-based therapies. Understanding DFU current therapies, their limitations and formulating future therapy recommendations is an avenue to restoring the QoL of affected DFU patients.