References
Management of diabetic foot ulcers: evaluation of case studies
Abstract
This article explores local barriers to diabetic foot ulcer healing, and describes the use of a dressing designed to manage exudate, infection and biofilm (AQUACEL Ag+ dressing (AQAg+)) on recalcitrant diabetic foot ulcers. The authors consider four case studies that demonstrate how managing local barriers to wound healing with antimicrobial and anti-biofilm dressings in protocols of care can improve outcomes for patients.
Diabetic foot ulcers (DFU) pose a difficult problem for clinicians to manage owing to chronicity and complexities of the underlying pathophysiology. It is widely recognised that three distinct pathologies have the greatest effect on the diabetic foot: ischaemia, infection and neuropathy.1 However, there is a growing body of evidence to suggest that wound biofilm represents a fourth major pillar of chronic wound pathogenesis,2 exists in at least 60% of chronic wounds,3 and can delay healing.4 Biofilm involves microorganisms embedded in a self-produced, slimy matrix of complex carbohydrates, protein and DNA, which protects them from threats such as host defences, antibiotics and antiseptics.5 The use of antimicrobial therapy alone may temporarily improve the signs of infection, but owing to the tolerance of biofilm-associated bacteria they are difficult to eradicate, leading to recurrent infections.6,7 In current clinical practice the most effective method to disrupt wound biofilm is mechanical debridement; however, clinical and in vivo observations indicate that biofilm re-forms quickly.4
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