Limb Salvage: A review of stem cell and growth factor therapies for diabetic foot ulcers.

Diabetic foot ulcers (DFUs) remain a major cause of morbidity, hospitalization, and lower-limb amputation among individuals with diabetes, despite advancements in conventional wound care. Increasing evidence highlights the therapeutic potential of stem cell-based and growth factor-based interventions in correcting impaired angiogenesis, chronic inflammation, and defective extracellular matrix remodeling characteristic of diabetic wounds. This review synthesizes current mechanistic and clinical insights into mesenchymal stem cells, mononuclear cells, pluripotent stem cells, and key growth factors-including EGF, PDGF, VEGF, and PRP-and evaluates their comparative efficacy based on recent randomized trials and network meta-analyses. Findings demonstrate significant improvements in ulcer healing, perfusion indices, and amputation reduction in selected modalities; however, clinical translation remains limited by small sample sizes, methodological heterogeneity, variable delivery techniques, and short-term follow-up. Emerging approaches such as exosome therapy, bioengineered matrices, and combined biologic platforms represent promising future directions. This review underscores the need for standardized protocols and robust multicenter trials to integrate regenerative therapies effectively into DFU management.