The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient’s general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The “TIME” framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant. 1. Introduction The principles involved in wound bed treatment have influenced the management of diabetic wounds, particularly diabetic foot ulcers. Since its introduction by Falanga and Sibbald in 2000, this concept has evolved from focusing on local wound problems and management to the development of an algorithmic approach commonly summarized as the “TIME” acronym [1, 2]. In 2006, Sibbald et al. expanded the concept to look at the patient as a whole in finding the cause of the wound and optimizing general factors that impair wound healing, diabetes mellitus being one of them [3]. The portion of the world population with diabetes mellitus in 2003 was approximately 194 million people, and this number increased steeply to reach approximately 366 million people in 2011. The International Diabetes Federation has estimated that the world diabetes incidence will be approximately 522 million people by year 2030. This incidence has indirectly increased the prevalence of diabetic foot ulcers, which occur in 1 to 4% of patients with diabetes mellitus [4, 5], and will further contribute to minor and major amputations of the lower limbs, for which foot ulcer
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