Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec;11(12):666-686.
doi: 10.1089/wound.2021.0016. Epub 2021 Dec 21.

Debridement of Diabetic Foot Ulcers

David Dayya  1   2   3   4   5   6   7 , Owen J O'Neill  1   4   8 , Tania B Huedo-Medina  2   3 , Nusrat Habib  2   3 , Joanna Moore  7 , Kartik Iyer  7
Affiliations
Review

Debridement of Diabetic Foot Ulcers

David Dayya et al. Adv Wound Care (New Rochelle). 2022 Dec.

Abstract

Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly consuming health care resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both nonmechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). It is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms and rationale behind debridement? This article comprehensively reviews cutting-edge methods and the science behind debridement and diabetic foot ulcers.

Keywords: debridement; diabetes; dressings; foot ulcers; public health.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist. No ghostwriters or editorial service was used for any portion of this article.

Figures

None
David Dayya, DO, PhD, MPH
Figure 1.
Figure 1.
Diabetic patient before (A) and after (B) with a Wagner Grade 1 ulcer due to friction with poorly fitting shoes treated with offloading, and using a combination of sharp debridement, enzymatic debridement, and antifungal treatment to treat the onychomycosis/Tinea pedis.
Figure 2.
Figure 2.
Serial images depicting measurements of Wagner grade 2 wound with progressive healing clockwise in this diabetic (A–C) patient using a combination of offloading and sequential debridement's lasting 12 weeks, including a combination of sharp, enzymatic, and autolytic.
Figure 3.
Figure 3.
Diabetic patient with sensory impairment who stepped on a nail that penetrated his shoe and foot and did not perceive an injury until later. He developed a Wagner grade 4 wound with gangrenous involvement of the forefoot and osteomyelitis that could have resulted in amputation (A). He was successfully treated with a combination of intraoperative surgical debridement, and autolytic debridement. The healthy granulation tissue appears (B) and the wound was amenable to receiving a graft.
See this image and copyright information in PMC

References

    1. International Working Group on the Diabetic Foot. IWGDF Guidelines on the prevention and management of diabetic foot disease. Maastricht, The Netherlands: International Working Group on the Diabetic Foot, 2019.
    1. Sumpio BE. Foot ulcers. N Engl J Med 2000;343:787–793. - PubMed
    1. Sheffield PJ, Fife CE, Smith AP. Wound Care Practice. Flagstaff, AZ: Best Publising Company, 2004.
    1. Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: the association of wound size, wound duration, and wound grade on healing. Diabetes Care 2002;25:1835–1839. - PubMed
    1. Diabetes.org.uk. Diabetes Reports and Statistics 2019. Diabetes.org.uk, 2019.