Management of the Diabetic Foot: Preventing Amputation

Marvin E. Levin, MD


South Med J. 2002;95(1) 

In This Article

Adjunctive Therapies

A variety of adjunctive treatments have been proposed for accelerating wound healing ( Table 5 ). To be successful, all of the basic wound-healing techniques listed in Table 3 should be used. The adjunctive therapies of electrical stimulation[46] and ultrasonography[47] require additional studies in controlled trials to establish their efficacies.

The use of hyperbaric oxygen (HBO)[48] is encouraging; however, a criticism regarding HBO is that, with one exception,[49] there have been no randomized controlled trials.[50] Certainly more trials are needed.[51] Using HBO for treatment of diabetic foot ulcers should not be considered the primary treatment; HBO should be used only after all of the standard treatments described herein have been done. In addition, patients with severe vascular insufficiency are not candidates for HBO.

Diabetic Foot Conditions Limiting Exercise
  • Insensate foot

  • Deformed foot

    • Cocked-up toes

    • Charcot's foot

  • Foot ulcer

  • Previous ulcer

The use of growth factors to stimulate wound healing is gaining greater acceptance. Procuren[52] (Curative Health Services Inc, Hauppauge, NY), autologous growth factors made from the patient's own platelets, came into use in the early 1990s but has not been approved by the Food and Drug Administration (FDA). A recombinant platelet-derived growth factor, Regranex, (Ortho-McNeil Pharmaceuticals Inc, Raritan, NJ) is FDA-approved and is now widely used.[53] Living tissue equivalents have been shown to accelerate wound healing.[54,55] Apligraf (Organogenesis Inc, Canton, Mass), a bilayered living skin equivalent, is FDA-approved. Dermagraft (Advanced Tissue Sciences Inc, LaJolla, Calif), another living skin equivalent, is awaiting FDA approval.[55] The administration of a granulocyte-stimulating factor appears to be potentially helpful by stimulating white blood cell production to fight infection, and it has been reported to accelerate wound healing.[56]


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