*2.1.1 Debridement*

Diabetic feet develop calluses as a result of frequent sheer force [15]. Debridement is known as a wound treatment that removes slough or scar tissue. This necrotic tissue works as a barrier, preventing wound edges from coming together; eliminating it allows wound healing [16]. To accomplish this function, the base of abnormal injuries, wound edge tissue such as epidermal hyperkeratosis (callus) and necrotic dermal tissue, debris, and bacterial elements which can hinder wound healing are removed. According to multiple clinical trial studies, debridement promotes the growth of granulation tissue, which aids in the healing of wounds [17, 18].

According to Frank et al. theory, because there is fresh wound bleeding at the time of debridement in diabetic foot ulcers, debridement can raise VEGF levels [19]. Debridement of diabetic foot ulcers on a regular basis may speed up wound healing, however, there is little evidence to back up this claim [20].

Clinical trials have shown that only surgical debridement is effective out of the 5 methods of debridement: enzymatic, autolytic, mechanical, and biologic. Sharp debridement is used during surgery to remove all bone and dead tissue. Debridement's goal is to change the environment for chronic wound healing to one that is more conducive to acute wound healing. Enzymatic debridement uses enzymes that have been carefully formulated to break down proteins, including collagenase, trypsin, papain/urea from papaya, streptokinase as well as fibrinolysis/DNAse, and streptodornase combinations. Natural autolytic debridement occurs in ulcers that are healthy, moist, and perfused. Lavage, pressure irrigation, dry-wet dressing, and hydrotherapy are used for mechanical debridement. Utilizing the sterile Lucilia sericata fly larvae as the debridement method, in which the necrotic tissue is found to be able to be thinned out due to the proteolytic enzyme emitted by the larvae [21].
