Compounding Pearls -- Wound Care: Diabetic Foot Ulcers, Part 1.

The often-debilitating ulcers that develop on the feet of patients with diabetes (i.e., "diabetic foot ulcers") are among the most common types of chronic wounds. Their persistent failure to heal despite treatment is a significant cause of morbidity in a patient population often challenged by concomitant health conditions and quality-of-life issues. When a commercially manufactured therapy does not adequately heal such lesions, a compounded formulation may offer an effective alternative. In those customized medications, several drugs with different mechanisms of action can be combined in strengths or titrations compatible with each patient's pharmacogenomics profile, and the formulation of a compound can be easily altered as healing progresses and/or the patient's medical needs change. In this first in a series of 2 articles on compounding for the treatment of diabetic foot ulcers, the types, pathophysiologic causes, risk factors, and treatment of those lesions are discussed and formulations that promote their healing are provided. In part 2 of the series, differences in the healing of acute and chronic wounds are examined, the results of pharmacotherapy in treating diabetic foot ulcers are reviewed, the effectiveness of several drugs that promote chronic-wound healing is assessed, and additional formulations effective in treating nonhealing wounds are presented.