IWGDF Guideline on interventions to enhance healing of foot ulcers in persons with diabetes

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. Since the last guideline published in 2015 there has been a marked increase in the number of published controlled trials in this area with a number of important developments. This updated guidance is based on a systematic review of the literature centred on the Population (P), Intervention (I), comparator (C) and outcomes (O) framework developed by the wound healing committee, use of the SIGN guideline/Cochrane review system and the recent 21 point scoring system advocated by IWGDF/EWMA , in conjunction with advice from internal and external reviewers and expert consultants in the field, resulting in 13 recommendations. The recommendations that sharp debridement and that the selection of dressings should be based on the need for exudate control, comfort and cost remain unchanged. The recommendation to consider negative pressure wound therapy in post-surgical wounds and the judicious use of hyperbaric oxygen therapy in certain non-healing ischaemic ulcers also remains unchanged. We continue to recommend against the use of growth factors, autologous platelet gels, bioengineered skin products, ozone, topical carbon dioxide and nitric oxide or interventions reporting improvement of ulcer healing through an alteration of the physical environment or through other systemic medical or nutritional means. New recommendations, albeit subject to further supportive trials, are the consideration of the use of sucrose-octasulfate impregnated dressings in difficult to heal neuroischaemic ulcers and the consideration of the use of autologous combined leucocyte, platelet and fibrin patch in ulcers that are difficult to heal when used in addition to best standard of care. A further new recommendation is consideration of topical placental derived products when used in addition to best standard of care. © 2019 The International Working Group on the Diabetic Foot IWGDF Wound Healing Interventions Guideline