Growth factors and comprehensive surgical care of diabetic wounds.

In diabetic patients, nonhealing cutaneous ulcers are a significant clinical, social, and healthcare problem. Based on more than 10 million diabetic patients in the United States and an estimated prevalence of 15% for chronic cutaneous ulcers, there are approximately 1.5 million patients with this problem. These nonhealing cutaneous ulcers result in a high rate of lower extremity amputations in the diabetic population. Patients with diabetes have many complications that cause chronic cutaneous ulcers. These include peripheral vascular disease, autonomic and sensory neuropathy, impaired host defense against infection, and delayed wound repair. To treat diabetic patients with chronic cutaneous ulcers effectively all the complicating factors must be addressed. In this review we discuss the surgical care of these patients and the use of growth factors in combination with a comprehensive treatment algorithm.