Management of diabetic foot ulcers using advanced biomaterials and tissue engineering: A systematic overview

Diabetes mellitus is a significant health issue with diabetic foot ulcers (DFUs) being a major complication affecting between 15-25 per cent of patients, leading to considerable morbidity, such as amputation and increased expenditure in health care. This systematic review assesses the role of advanced biomaterials and tissue engineering in managing DFUs, considering the limitations of conventional treatment methods. Peer-reviewed literature (20152025) was clearly and comprehensively reviewed in the PubMed, Scopus, and Web of Science databases, including clinical trials and preclinical studies of biomaterials (e.g. hydrogels, electrospun nanofibers, 3D-printed scaffolds), and use of tissue engineering strategies (e.g. stem cell therapies, bioengineered skin substitutes). The interventions are designed to reduce chronic inflammation, deranged angiogenesis, and tissue regeneration deficiency, which are characteristic of DFUs. Evidence has shown that biomaterials, such as hyaluronic acid hydrogels and collagen dressings, increase the percentage of wound closure by 20% to 30% in comparison to standard care, whereas tissue-engineered products, such as Apligraf and Grafix, increase epithelialization by reducing the number of days it takes to heal. New technologies, including innovative biomaterials, 3D bioprinting, and nanotechnology, offer custom-made and adjustable solutions to treatment. Nevertheless, the problems of expensive prices, regulatory obstacles, and the absence of long-term data persist. The review indicates that these advanced therapies have the potential to revolutionize the way the problem of amputations is addressed and patient outcomes enhanced by prompting more research on how this is received in a more cost-effective and potentially scalable manner, as well as how to introduce such characteristics into digital health tools. There is a need to bridge the gap between these innovations and clinical practice, and a multidisciplinary approach can help address the challenge of the global burden of DFUs.