This update summarizes the key messages of the IWGDF 2023 wound healing and offloading guidelines and the ADA 2026 foot care standard in patient-friendly language.
Advanced technologies are considered for selected wounds that fail to make expected progress despite standard care, after infection control, adequate blood supply, offloading, metabolic management and appropriate wound care have been established. They do not guarantee outcomes on their own.
- Modern treatment does not replace basic assessment and care addressing the causes.
- Negative pressure may be considered conditionally for postoperative wounds; it is not routinely recommended for nonsurgical ulcers.
- Offloading is as important a treatment component as technology.
- Treatment selection should follow multidisciplinary assessment.
Negative pressure wound therapy
IWGDF 2023 considers negative pressure wound therapy a conditional option alongside standard care for postsurgical diabetic foot wounds; it does not recommend routine use to heal nonsurgical diabetic foot ulcers. Active bleeding, unremoved dead tissue and other contraindications are assessed separately.
Advanced wound dressings
Basic dressings are selected by discharge control, ease of use and cost. Cellular or acellular skin substitutes are not routinely recommended; options such as placental-derived products or topical oxygen may be considered conditionally when standard care produces an inadequate response, after discussing evidence, cost and patient preferences.
Infection and surgical debridement
For clinical infection, appropriate sampling, antibiotics and surgical debridement when needed are planned. Antibiotics should be used only when infection is present and as directed by the physician.
Offloading and circulation
Advanced wound products may have limited effects without reducing load on the wound and correcting blood flow when needed. Suitable devices, footwear and vascular treatment are planned individually.
Multidisciplinary follow-up
Orthopedics, the diabetes team, infection and vascular specialists, and wound care professionals coordinate different problems toward a shared goal. Treatment response is measured regularly, and the approach is changed if necessary.
Technology is useful for the right patient
A method's suitability should be determined by assessment of wound depth, infection, circulation and pressure rather than advertising promises.
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Scientific sources
This information is for general education. The assessment and treatment appropriate for you are determined by a medical examination.
