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➤ For DFUs that fail to demonstrate improvement (>50% wound area
reduction) after a minimum of 4 weeks of standard wound therapy, we
recommend adjunctive wound therapy options (1B).
• These include negative pressure therapy, biologics (platelet-derived growth
factor [PDGF], living cellular therapy, extracellular matrix products, amnionic
membrane products), and hyperbaric oxygen therapy.
• Choice of adjuvant therapy is based on clinical findings, availability of therapy, and
cost-effectiveness. There is no recommendation on ordering of therapy choice.
• Re-evaluation of vascular status, infection control, and off-loading is
recommended to ensure optimization before initiation of adjunctive wound
therapy.
➤ We suggest the use of negative pressure wound therapy for chronic
diabetic foot wounds that do not demonstrate expected healing
progression with standard or advanced wound dressings after 4–8
weeks of therapy (2B).
➤ We suggest consideration of the use of PDGF (becaplermin) for the
treatment of DFUs that are recalcitrant to standard therapy (2B).
➤ We suggest consideration of living cellular therapy using a bilayered
keratinocyte/fibroblast construct or a fibroblast-seeded matrix for
treatment of DFUs when recalcitrant to standard therapy (2B).
➤ We suggest consideration of the use of extracellular matrix products
employing acellular human dermis or porcine small intestinal
submucosal tissue as an adjunctive therapy for DFUs when
recalcitrant to standard therapy (2C).
➤ In patients with DFU who have adequate perfusion that fails to
respond to 4–6 weeks of conservative management, we suggest
hyperbaric oxygen therapy (2B).
