Diabetic Foot Ulcer Management Guidelines

Guideline Recommendations

The International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines provide a conditional recommendation against using cellular skin substitutes as routine adjunct therapy for diabetic foot ulcers (Conditional; Low quality evidence) 1, 2, 3
The IWGDF guidelines note that cost-effectiveness does not favor cellular skin substitutes over standard of care due to moderate resource requirements and lack of formal cost-effectiveness data 2, 3
Feasibility is rated as low due to expertise and costs required, raising equity concerns 2, 3
The IWGDF guidelines strongly recommend against using antibacterial ointment for wound healing purposes (Strong; Moderate certainty) 1, 6

Implement sharp debridement to remove hyperkeratotic rim and address undermining—frequency determined by clinical need 1, 6
Discontinue antibacterial ointment unless there is documented infection, as topical antimicrobials are contraindicated for wound healing 1, 6
Use basic wound dressings that absorb exudate and maintain moist wound environment 7, 5

Sucrose-octasulfate impregnated dressing may be considered for non-infected, neuro-ischemic ulcers after at least 2 weeks of optimized standard care (Conditional; Moderate certainty) 1, 6, 8
Autologous leucocyte, platelet, and fibrin patch is the only cellular therapy with conditional support where standard care has been ineffective and resources exist (Conditional; Moderate certainty) 1, 6, 8
Placental-derived products may be considered where standard care has failed (Conditional; Low certainty) 1, 6, 8