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Introduction
The prevalence of diabetes continues to rise each year. In 2011, it was estimated that approximately 366 million people—7% of the world’s population—had diabetes, with approximately 80% of these people living in developing countries [1]. The expectation is that these numbers will increase to 552 million adults (8.3% of the world’s population) by 2030 [1]. Complications due to diabetes are also a growing public health problem. One of the most common complications of diabetes is diabetic foot ulcers (DFUs). DFUs are complex chronic wounds that have a major long-term impact on the morbidity, mortality and quality of patients’ lives [2, 3]. Individuals who develop DFUs are at greater risk of premature death, myocardial infarction and fatal stroke than those without a history of this complication [4]. Approximately 25% of people with diabetes will develop a lower extremity ulcer over time [5, 6]. The treatment of these wounds remains challenging as they are often slow to heal and frequently reoccur. The poor prognosis of DFUs is attributed to those conditions often associated with diabetes, such as peripheral vascular diseases, neuropathy and poor blood glucose control. The delayed healing of ulcers increases the risk for severe wound infection and amputation [7, 8]; approximately half of all people undergoing non-traumatic amputations are diagnosed with diabetes [9], with studies showing that up to 88% of all diabetes-related amputations are preceded by a foot ulcer [10, 11]. Amputation can in turn increase morbidity and healthcare costs while at the same time reduce an individual’s productivity and quality of life. Moreover, the mortality following amputation increases with level of amputation [12]. A 5-year mortality rate is very high among patients with any amputation (major and minor combined), ranging from 53 to 100%, and in patients with major amputation, it ranges from 52 to 80% [13]. Mortality following amputation is comparable to many types of cancer [10]. Therefore, any treatment that can reduce amputation rates is more than welcome. The main goal of treating DFUs is to promote a rapid and complete healing in order to reduce the risk of infection, amputation and other form of related complications.
Moist dressings, debridement, wound offloading and infection control are standard therapy or standard of care (SOC) in the management of DFUs. Standard therapy...