Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities

Table 5 Additional adjuvant care of diabetic foot ulcer

Item	Description
Negative pressure wound therapy (VAC)	Widely used, removal of the excess third space fluid from the area, reduction of bacterial load, increased granulation tissue, but RCTs have high risk of bias
Synthetic skin grafts (Bio-engineered skin substitutes)	Contribute to the new dermal tissue but limited data to prove benefit of these products
Non-surgical debridement agents (enzymatic debridement, autolytic debridement, hydroterapy, Maggot therapy)	Promoting fibroblast migration and improving skin perfusion but due to small RCTs, it has clinical bias for beneficial effect
Topical growth factors (EGF, VEGF, PDGF, FGF)	Promote healing non-infected foot ulcer and stimulating angiogenesis but limited trials confirming positive outcomes
Electrical stimulation	Bacteriostatic and bactericidal effect on foot ulcer but lack of evidence due to limited clinical trials
HBOC	HBOC therapy increases blood and oxygen content in hypoxic tissues and has antimicrobial activity, but it is unclear whether it has benefit in long term wound healing

RCT: Randomised controlled studies; HBOC: Hyperbaric oxygen chambers; VAC: Vacuum assisted closure; EGF: Epidermal growth factor; VEGF: Vascular endotelial growth factor; PDGF: Platelet derived growth factor; FGF: Fibroblast growth factor.