Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents

Article ID: e120623217906 Pages: 13

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Abstract

Background: One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common.

Objective: The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly.

Method: The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system.

Results: Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments.

Conclusion: The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.

[1]
Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of international working group on diabetic foot (IWGDF). Pak J Med Sci 2013; 29(3): 730-4.
[http://dx.doi.org/10.12669/pjms.293.3473] [PMID: 24353617]
[2]
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes 2012; 3(6): 110-7.
[http://dx.doi.org/10.4239/wjd.v3.i6.110]
[3]
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87(1): 4-14.
[http://dx.doi.org/10.1016/j.diabres.2009.10.007] [PMID: 19896746]
[4]
Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94(3): 311-21.
[http://dx.doi.org/10.1016/j.diabres.2011.10.029] [PMID: 22079683]
[5]
Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani MR. Nurses’ role in diabetic foot prevention and care; a review. J Diabetes Metab Disord 2012; 11(1): 24.
[http://dx.doi.org/10.1186/2251-6581-11-24] [PMID: 23497582]
[6]
Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers. J Am Acad Dermatol 2014; 70(1): 21.e1-21.e24.
[http://dx.doi.org/10.1016/j.jaad.2013.07.048] [PMID: 24355276]
[7]
Raghav SS, Kumar B, Sethiya NK, Kaul A. A mechanistic insight on phytoconstituents delivering hypoglycemic activity: A comprehensive overview. Future Pharmacology 2022; 2(4): 511-46.
[http://dx.doi.org/10.3390/futurepharmacol2040032]
[8]
Coffey L, Mahon C, Gallagher P. Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta‐synthesis. Int Wound J 2019; 16(1): 183-210.
[http://dx.doi.org/10.1111/iwj.13010] [PMID: 30393976]
[9]
Brem H, Sheehan P, Boulton AJM. Protocol for treatment of diabetic foot ulcers. Am J Surg 2004; 187(5): S1-S10.
[http://dx.doi.org/10.1016/S0002-9610(03)00299-X] [PMID: 15147985]
[10]
Berlanga-Acosta J, Fernández-Montequín J, Valdés-Pérez C, et al. Diabetic foot ulcers and epidermal growth factor: Revisiting the local delivery route for a successful outcome. BioMed Res Int 2017; 2017: 1-10.
[http://dx.doi.org/10.1155/2017/2923759]
[11]
Amin N, Doupis J. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities. World J Diabetes 2016; 7(7): 153-64.
[http://dx.doi.org/10.4239/wjd.v7.i7.153] [PMID: 27076876]
[12]
Ahmad J. The diabetic foot. Diabetes Metab Syndr 2016; 10(1): 48-60.
[http://dx.doi.org/10.1016/j.dsx.2015.04.002] [PMID: 26072202]
[13]
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann Med 2017; 49(2): 106-16.
[http://dx.doi.org/10.1080/07853890.2016.1231932] [PMID: 27585063]
[14]
Tabanjeh SF, Hyassat D, Jaddou H, Younes NA, Robert AA, Ajlouni K. The frequency and risk factors of diabetic foot ulcer recurrence among Jordanian patients with diabetes. Curr Diabetes Rev 2020; 16(8): 910-5.
[http://dx.doi.org/10.2174/1573399816666200109094329] [PMID: 31916518]
[15]
Sela Y, Grinberg K, Cukierman-Yaffe T, Natovich R. Relationship between cognitive function in individuals with diabetic foot ulcer and mortality. Diabetol Metab Syndr 2022; 14(1): 133.
[http://dx.doi.org/10.1186/s13098-022-00901-1]
[16]
Microvascular complications and foot care: Standards of Medical Care in Diabetes—2021. Diabetes Care 2021; 44 (Suppl. 1): S151-67.
[http://dx.doi.org/10.2337/dc21-S011] [PMID: 33298422]
[17]
Aumiller WD, Dollahite HA. Pathogenesis and management of diabetic foot ulcers. JAAPA 2015; 28(5): 28-34.
[http://dx.doi.org/10.1097/01.JAA.0000464276.44117.b1] [PMID: 25853673]
[18]
Margolis SA. Editorial: Diabetic foot - A global health challenge. Aust J Gen Pract 2020; 49(5): 237.
[http://dx.doi.org/10.31128/AJGP-05-20-1234e] [PMID: 32416648]
[19]
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293(2): 217-28.
[http://dx.doi.org/10.1001/jama.293.2.217] [PMID: 15644549]
[20]
Aldana PC, Khachemoune A. Diabetic foot ulcers: Appraising Standard of Care and Reviewing New Trends in Management. Am J Clin Dermatol 2020; 21(2): 255-64.
[http://dx.doi.org/10.1007/s40257-019-00495-x] [PMID: 31848923]
[21]
AlAyed M, Younes N, Al-Smady M, Khader Y, Robert A, Ajlouni K. Prevalence of foot ulcers, foot at risk and associated risk factors among Jordanian diabetics. Curr Diabetes Rev 2017; 13(2): 182-91.
[http://dx.doi.org/10.2174/1573399812666151210143140] [PMID: 26652612]
[22]
Hinchliffe RJ, Forsythe RO, Apelqvist J, et al. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36(S1) (Suppl. 1): e3276.
[http://dx.doi.org/10.1002/dmrr.3276] [PMID: 31958217]
[23]
Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg 2011; 41(1): 110-6.
[http://dx.doi.org/10.1016/j.ejvs.2010.09.020] [PMID: 21095144]
[24]
Cychosz CC, Phisitkul P, Belatti DA, Wukich DK. Preventive and therapeutic strategies for diabetic foot ulcers. Foot Ankle Int 2016; 37(3): 334-43.
[http://dx.doi.org/10.1177/1071100715611951] [PMID: 26475457]
[25]
Jan YK, Shen S, Foreman RD, Ennis WJ. Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot. Microvasc Res 2013; 89: 40-6.
[http://dx.doi.org/10.1016/j.mvr.2013.05.004] [PMID: 23727385]
[26]
Reardon R, Simring D, Kim B, Mortensen J, Williams D, Leslie A. The diabetic foot ulcer. Aust J Gen Pract 2020; 49(5): 250-5.
[http://dx.doi.org/10.31128/AJGP-11-19-5161] [PMID: 32416652]
[27]
Santoro M, Gaudino G. Cellular and molecular facets of keratinocyte reepithelization during wound healing. Exp Cell Res 2005; 304(1): 274-86.
[http://dx.doi.org/10.1016/j.yexcr.2004.10.033] [PMID: 15707592]
[28]
Erem C. Hacıhasanoğlu A, Çelik Ş, et al. Coagulation and fibrinolysis parameters in type 2 diabetic patients with and without diabetic vascular complications. Med Princ Pract 2005; 14(1): 22-30.
[http://dx.doi.org/10.1159/000081919] [PMID: 15608477]
[29]
Chhabra S, Chhabra N, Kaur A, Gupta N. Wound healing concepts in clinical practice of OMFS. J Maxillofac Oral Surg 2017; 16(4): 403-23.
[http://dx.doi.org/10.1007/s12663-016-0880-z] [PMID: 29038623]
[30]
Werner S, Grose R. Regulation of wound healing by growth factors and cytokines. Physiol Rev 2003; 83(3): 835-70.
[http://dx.doi.org/10.1152/physrev.2003.83.3.835] [PMID: 12843410]
[31]
Xiao J, Li J, Cai L, Chakrabarti S, Li X. Cytokines and diabetes research. J Diabetes Res 2014; 2014: 1-2.
[http://dx.doi.org/10.1155/2014/920613] [PMID: 24551859]
[32]
Pradhan L, Nabzdyk C, Andersen ND, LoGerfo FW, Veves A. Inflammation and neuropeptides: The connection in diabetic wound healing. Expert Rev Mol Med 2009; 11: e2.
[http://dx.doi.org/10.1017/S1462399409000945] [PMID: 19138453]
[33]
Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005; 366(9498): 1736-43.
[http://dx.doi.org/10.1016/S0140-6736(05)67700-8] [PMID: 16291068]
[34]
Lan C-CE, Liu IH, Fang AH, Wen CH, Wu CS. Hyperglycaemic conditions decrease cultured keratinocyte mobility: Implications for impaired wound healing in patients with diabetes. Br J Dermatol 2008; 159(5): 1103-15.
[http://dx.doi.org/10.1111/j.1365-2133.2008.08789.x] [PMID: 18717678]
[35]
Galiano RD, Tepper OM, Pelo CR, et al. Topical vascular endothelial growth factor accelerates diabetic wound healing through increased angiogenesis and by mobilizing and recruiting bone marrow-derived cells. Am J Pathol 2004; 164(6): 1935-47.
[http://dx.doi.org/10.1016/S0002-9440(10)63754-6] [PMID: 15161630]
[36]
Lobmann R, Schultz G, Lehnert H. Proteases and the diabetic foot syndrome: Mechanisms and therapeutic implications. Diabetes Care 2005; 28(2): 461-71.
[http://dx.doi.org/10.2337/diacare.28.2.461] [PMID: 15677818]
[37]
Maione AG, Smith A, Kashpur O, et al. Altered ECM deposition by diabetic foot ulcer-derived fibroblasts implicates fibronectin in chronic wound repair. Wound Repair Regen 2016; 24(4): 630-43.
[http://dx.doi.org/10.1111/wrr.12437] [PMID: 27102877]
[38]
Hoogeveen RC, Dorresteijn JAN, Kriegsman DMW, Valk GD. Complex interventions for preventing diabetic foot ulceration. Cochrane Libr 2015; 2015(8): CD007610.
[http://dx.doi.org/10.1002/14651858.CD007610.pub3] [PMID: 26299991]
[39]
Jeffcoate WJ, Vileikyte L, Boyko EJ, Armstrong DG, Boulton AJM. Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care 2018; 41(4): 645-52.
[http://dx.doi.org/10.2337/dc17-1836] [PMID: 29559450]
[40]
Game FL, Apelqvist J, Attinger C, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: A systematic review. Diabetes Metab Res Rev 2016; 32(S1) (Suppl. 1): 154-68.
[http://dx.doi.org/10.1002/dmrr.2707] [PMID: 26344936]
[41]
Lung CW, Wu FL, Liao F, Pu F, Fan Y, Jan YK. Emerging technologies for the prevention and management of diabetic foot ulcers. J Tissue Viability 2020; 29(2): 61-8.
[http://dx.doi.org/10.1016/j.jtv.2020.03.003] [PMID: 32197948]
[42]
Bus SA, Armstrong DG, van Deursen RW, Lewis JEA, Caravaggi CF, Cavanagh PR. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev 2016; 32(S1) (Suppl. 1): 25-36.
[http://dx.doi.org/10.1002/dmrr.2697] [PMID: 26813614]
[43]
Crasto W, Patel V, Davies MJ, Khunti K. Prevention of microvascular complications of diabetes. Endocrinol Metab Clin North Am 2021; 50(3): 431-55.
[http://dx.doi.org/10.1016/j.ecl.2021.05.005] [PMID: 34399955]
[44]
Hemmingsen B, Lund SS, Gluud C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev 2013; 11(11): CD008143.
[http://dx.doi.org/10.1002/14651858.CD008143.pub3] [PMID: 24214280]
[45]
Internal Clinical Guidelines team. Diabetic foot problems: Prevention and management. 2015. Available From: https://www.nice.org.uk/guidance/ng19/resources/diabetic-foot-problems-prevention-andmanagement-1837279828933
[46]
Buggy A, Moore Z. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: A systematic review. J Wound Care 2017; 26(6): 324-39.
[http://dx.doi.org/10.12968/jowc.2017.26.6.324] [PMID: 28598756]
[47]
Prompers L, Schaper N, Apelqvist J, et al. Prediction of outcome in individuals with diabetic foot ulcers: Focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51(5): 747-55.
[http://dx.doi.org/10.1007/s00125-008-0940-0] [PMID: 18297261]
[48]
Wang C, Mai L, Yang C, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer. BMC Endocr Disord 2016; 16(1): 38.
[http://dx.doi.org/10.1186/s12902-016-0111-0] [PMID: 27388440]
[49]
Blakely M. The use of best practice in the treatment of a complex diabetic foot ulcer: A case report. Health Care 2016; 4(1): 18.
[http://dx.doi.org/10.3390/healthcare4010018] [PMID: 27417606]
[50]
Jull AB, Cullum N, Dumville JC, Westby MJ, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Libr 2015; 2015(6): CD005083.
[http://dx.doi.org/10.1002/14651858.CD005083.pub4] [PMID: 25742878]
[51]
Kateel R, Adhikari P, Augustine AJ, Ullal S. Topical honey for the treatment of diabetic foot ulcer: A systematic review. Complement Ther Clin Pract 2016; 24: 130-3.
[http://dx.doi.org/10.1016/j.ctcp.2016.06.003] [PMID: 27502813]
[52]
Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54(12): e132-73.
[http://dx.doi.org/10.1093/cid/cis346] [PMID: 22619242]
[53]
Abbas M, Uçkay I, Lipsky BA. In diabetic foot infections antibiotics are to treat infection, not to heal wounds. Expert Opin Pharmacother 2015; 16(6): 821-32.
[http://dx.doi.org/10.1517/14656566.2015.1021780] [PMID: 25736920]
[54]
Barwell ND, Devers MC, Kennon B, et al. Diabetic foot infection: Antibiotic therapy and good practice recommendations. Int J Clin Pract 2017; 71(10): e13006.
[http://dx.doi.org/10.1111/ijcp.13006] [PMID: 28892282]
[55]
Rubio JA, Aragón-Sánchez J, Jiménez S, et al. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot. Int J Low Extrem Wounds 2014; 13(1): 22-6.
[http://dx.doi.org/10.1177/1534734614521234] [PMID: 24659624]
[56]
Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined U.K. population: Benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care 2008; 31(1): 99-101.
[http://dx.doi.org/10.2337/dc07-1178] [PMID: 17934144]
[57]
Dumville JC, O’Meara S, Deshpande S, Speak K. Hydrogel dressings for healing diabetic foot ulcers. Cochrane Libr 2013; 2013(7): CD009101.
[http://dx.doi.org/10.1002/14651858.CD009101.pub3] [PMID: 23846869]
[58]
Motley TA, Gilligan AM, Lange DL, et al. Cost-effectiveness of clostridial collagenase ointment on wound closure in patients with diabetic foot ulcers: Economic analysis of results from a multicenter, randomized, open-label trial. J Foot Ankle Res 2015; 8: 7.
[http://dx.doi.org/10.1186/s13047-015-0065-x]
[59]
Tallis A, Motley TA, Wunderlich RP, Dickerson JE Jr, Waycaster C, Slade HB. Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: Results of a randomized controlled study. Clin Ther 2013; 35(11): 1805-20.
[http://dx.doi.org/10.1016/j.clinthera.2013.09.013] [PMID: 24145042]
[60]
Abela G. Benefits of maggot debridement therapy on leg ulcers: A literature review. Br J Community Nurs 2017; 22(Sup6): S14-9.
[http://dx.doi.org/10.12968/bjcn.2017.22.Sup6.S14]
[61]
Armstrong DG, Salas P, Short B, et al. Maggot therapy in “lower-extremity hospice” wound care: Fewer amputations and more antibiotic-free days. J Am Podiatr Med Assoc 2005; 95(3): 254-7.
[http://dx.doi.org/10.7547/0950254] [PMID: 15901812]
[62]
Saco M, Howe N, Nathoo R, et al. Comparing the efficacies of alginate, foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of diabetic foot ulcers and venous leg ulcers: A systematic review and meta-analysis examining how to dress for success. Dermatol Online J 2016; 22(8)
[http://dx.doi.org/10.5070/D3228032089]
[63]
de Smet GHJ, Kroese LF, Menon AG, et al. Oxygen therapies and their effects on wound healing. Wound Repair Regen 2017; 25(4): 591-608.
[http://dx.doi.org/10.1111/wrr.12561] [PMID: 28783878]
[64]
Dumville JC, Hinchliffe RJ, Cullum N, et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev 2013; 10(10): CD010318.
[http://dx.doi.org/10.1002/14651858.CD010318] [PMID: 24132761]
[65]
Liu S, He C, Cai Y, et al. Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: Systematic review and meta-analysis. Ther Clin Risk Manag 2017; 13: 533-44.
[http://dx.doi.org/10.2147/TCRM.S131193] [PMID: 28458556]
[66]
Guo X, Mu D, Gao F. Efficacy and safety of acellular dermal matrix in diabetic foot ulcer treatment: A systematic review and meta-analysis. Int J Surg 2017; 40: 1-7.
[http://dx.doi.org/10.1016/j.ijsu.2017.02.008] [PMID: 28232031]
[67]
Uchi H, Igarashi A, Urabe K, et al. Clinical efficacy of basic fibroblast growth factor (bFGF) for diabetic ulcer. Eur J Dermatol 2009; 19(5): 461-8.
[http://dx.doi.org/10.1684/ejd.2009.0750] [PMID: 19638336]
[68]
Garg R, Kumar A, Gill C, Singla S. Efficacy of topical application of beta urogastrone (recombinant human epidermal growth factor) in Wagner′s Grade 1 and 2 diabetic foot ulcers: Comparative analysis of 50 patients. J Nat Sci Biol Med 2014; 5(2): 273-7.
[http://dx.doi.org/10.4103/0976-9668.136160] [PMID: 25097397]
[69]
Gomez-Villa R, Aguilar-Rebolledo F, Lozano-Platonoff A, et al. Efficacy of intralesional recombinant human epidermal growth factor in diabetic foot ulcers in Mexican patients: A randomized double-blinded controlled trial. Wound Repair Regen 2014; 22(4): 497-503.
[http://dx.doi.org/10.1111/wrr.12187] [PMID: 25041620]
[70]
Aktaş S, Baktıroğlu S, Demir L, et al. Intralesional application of epidermal growth factor in limb-threatening ischemic diabetic foot ulcers. Acta Orthop Traumatol Turc 2015; 50(3): 277-83.
[http://dx.doi.org/10.3944/AOTT.2015.14.0434] [PMID: 27130382]
[71]
Martí-Carvajal AJ, Gluud C, Nicola S, et al. Growth factors for treating diabetic foot ulcers. Cochrane Libr 2015; 2015(10): CD008548.
[http://dx.doi.org/10.1002/14651858.CD008548.pub2] [PMID: 26509249]
[72]
Ahmed M, Reffat SA, Hassan A, Eskander F. Platelet-rich plasma for the treatment of clean diabetic foot ulcers. Ann Vasc Surg 2017; 38: 206-11.
[http://dx.doi.org/10.1016/j.avsg.2016.04.023] [PMID: 27522981]
[73]
Li L, Chen D, Wang C, et al. Autologous platelet-rich gel for treatment of diabetic chronic refractory cutaneous ulcers: A prospective, randomized clinical trial. Wound Repair Regen 2015; 23(4): 495-505.
[http://dx.doi.org/10.1111/wrr.12294] [PMID: 25847503]
[74]
Santema TB, Poyck PPC, Ubbink DT. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes. Cochrane Libr 2016; 2017(3): CD011255.
[http://dx.doi.org/10.1002/14651858.CD011255.pub2] [PMID: 26866804]
[75]
Wirsing PG, Habrom AD, Zehnder TM, Friedli S, Blatti M. Wireless micro current stimulation - an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers. Int Wound J 2015; 12(6): 693-8.
[http://dx.doi.org/10.1111/iwj.12204] [PMID: 24373098]
[76]
Asadi MR, Torkaman G, Hedayati M, Mohajeri-Tehrani MR, Ahmadi M, Gohardani RF. Angiogenic effects of low-intensity cathodal direct current on ischemic diabetic foot ulcers: A randomized controlled trial. Diabetes Res Clin Pract 2017; 127: 147-55.
[http://dx.doi.org/10.1016/j.diabres.2017.03.012] [PMID: 28371685]
[77]
Jeppesen SM, Yderstraede KB, Rasmussen BSB, et al. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: A prospective randomised trial. J Wound Care 2016; 25(11): 641-9.
[http://dx.doi.org/10.12968/jowc.2016.25.11.641]
[78]
Piaggesi A, Sambataro M, Nicoletti C, Goretti C, Lacopi E, Coppelli A. Safety and effectiveness of therapeutic magnetic resonance in diabetic foot ulcers: A prospective randomised controlled trial. J Wound Care 2016; 25(12): 704-11.
[http://dx.doi.org/10.12968/jowc.2016.25.12.704] [PMID: 27974006]
[79]
de Sousa RG, Batista K. Laser therapy in wound healing associated with diabetes mellitus - Review. An Bras Dermatol 2016; 91(4): 489-93.
[80]
Monami M, Scatena A, Zannoni S, et al. A randomized, open-label, controlled trial to evaluate the antimicrobial and surgical effect of CO2 laser treatment in diabetic infected foot ulcers: DULCIS (diabetic ulcer, CO2 laser, and infections) study. J Endocrinol Invest 2017; 40(9): 985-9.
[http://dx.doi.org/10.1007/s40618-017-0666-2] [PMID: 28378156]
[81]
Wang HT, Yuan JQ, Zhang B, Dong ML, Mao C, Hu D. Phototherapy for treating foot ulcers in people with diabetes. Cochrane Libr 2017; 6(6): CD011979.
[http://dx.doi.org/10.1002/14651858.CD011979.pub2] [PMID: 28657134]
[82]
Wood R. Treatment of diabetic ulcers. U.S. Patent 20030176442A1, 2003.
[83]
Biesbrouck GM, et al. A device and method for checking a diabetic foot. W.O. Patent 2004002309A1, 2004.
[84]
Breen T, Bunting S, Semba C. Wound Healing. U.S. Patent 20070021342A1, 2007.
[85]
Acosta JB, Montequin JIF, Pérez CV, et al. Methods for enhancing healing of diabetic foot ulcers by injecting epidermal growth factor (EGF). U.S. Patent 7465704B2, 2008.
[86]
Farzamfar B, Madani H, Gharibdoust F, et al. Herbal extracts for treatment of chronic wounds. U.S. Patent 20100233305a1, 2010.
[87]
Brem H. Method for treating diabetic ulcers with vectors encoding VEGF. U.S. Patent 7919478B2, 2011.
[88]
Wade M, Jeffs RA, Strootman D. Use of treprostinil to treat neuropathic diabetic foot ulcers. U.S. Patent 8563614B2, 2011.
[89]
Huimin H. Chinese medicinal detoxifying myo-regeneration paste for treating diabetic foot ulcer and preparation method thereof. C.N. Patent 101926872A, 2013.
[90]
Qin BSH. Medicine for treating diabetes skin ulcer. C.N. Patent 103417625A, 2013.
[91]
Bhaskaran S, Vishwaraman M. A method of managing diabetic foot ulcers, pressure ulcers, venous leg ulcers and associated complication. W.O. Patent 2014024136A1, 2014.
[92]
Deshpande SK, Kulkarni SA, Gollapudy R. Topical formulation for diabetic foot ulcers. U.S. Patent 8741953B2, 2014.
[93]
Betante Rodriguez VM, Seth Martinez R, Pesmerelles JA, et al. Pharmaceutical composition of microspheres for preventing diabetic foot amputation. C.N. Patent 103933552A, 2014.
[94]
Chunyan Z, et al. Moist antibacterial hydrogel dressing for curing diabetic foot ulcer. C.N. Patent 103041438B, 2014.
[95]
Bloom JD, Linders DR, Engler JM, et al. Method and apparatus for indicating the risk of an emerging ulcer. US9259178B2, 2016.
[96]
Tseng S, Tan EK, Tseng A. Umbilical cord products. U.S. Patent 20160106785A1, 2016.
[97]
Yuyu Q, Qufu W, Jing C, et al. Cowherb seed flavonoid glycoside/bacterial cellulose dressing for treating diabetic foot ulcers and preparation method thereof. C.N. Patent 104436291A, 2016.
[98]
Fuhua YHD. Medicine for treating diabetic foot disease and preparing method thereof. C.N. Patent 103784748A, 2017.
[99]
Rodgers KE, Dizeriga GS. The method for treating diabetic foot ulcer. C.N. Patent 102858360B, 2017.
[100]
Xu R. Use of pharmaceutical compositions in preparing pharmaceuticals for treating diabetic ulcer. U.S. Patent 9814750B2, 2017.
[101]
Huijun Y, Yichao Z, Zhiyi L, Dongliang Z. Application of Pien Tze Huang and preparation thereof to preparation of medicine for preventing diabetic foot ulcers. C.N. Patent 105687275A, 2020.
[102]
Becker-Pelster EM. Substituted piperidinyl-tetrahydroquinolines and their use as alpha-2c adrenoreceptor antagonists. A.U. Patent 2019202709B2, 2020.
[103]
Purvis DR, Thomas JA, Bennett B, Keeling C. Pharmaceutical composition, method of manufacturing the Pharmaceutical composition and method of treating a chronic wound which includes, but not limited to, a leg ulcer, diabetic foot ulcer or ulcer arising from a individual pressure ulcer. B.R. Patent 112020020500A2, 2021.
[104]
Mohamed M, Mostafa K. Ointment for diabetic foot ulcer treatment. W.O. Patent 2021013315A1, 2021.
[105]
Freeman JE, Panasyuk S, Hopmeier M. Hyperspectral technology for assessing and treating diabetic foot and tissue disease. U.S. Patent 20190059787A1, 2021.
[106]
Burns MF, Barrington S, Rose GO. Determination of susceptibility to diabetic foot ulcers. K.R. Patent 102283395B1, 2021.
[107]
Linders DR, Bloom JD, Engler JM. Method and apparatus for detecting and monitoring a foot pre-ulcer. U.S. Patent 11103138B2, 2021.