*2.1.7 Dressing*

A dressing is a substance that is applied topically to the area to help the wound heal and protect it. Plaster serves as a barrier between the dressing and the wound, preventing direct dressing contact. Film, hydrogel, composite, alginate, hydrocolloid, foam, and other absorptive dressings including negative pressure wound therapy are some of the several types of dressings (NPWT) [18].

The primary function of a closed-clean wound or granulated wound is to create a moist healing environment that promotes cell migration and protects against dry sores. The type and quantity of exudate present in the wound determine the appropriate dressing. Cuts with a little amount of exudate are ideally suited for hydrogel dressing, film, and composite use. Hydrocolloids are utilized for wounds with exudate amounts, and alginate, foam, and NPWT are frequently used for wounds with exudate amounts. Before applying a dressing, injuries with significant necrotic tissue should be debrided [18].

A sponge which is put on the wound, covering it with a dressing which is airtight, and then installing a vacuum is known as negative pressure wound therapy or closure of wound with vacuum. Large lymphatic leaks and fistulas can be treated using negative pressure wound therapy. The primary goal of NPWT is to reduce edema; by removing lymphatic or interstitial fluid, it increases the passage of interstitial oxygen into cells. The MMP enzymes and collagenase, in which of levels rise in chronic wounds, are also eliminated by negative pressure wound therapy [18].

## **2.2 Prevention of diabetic foot**

#### *2.2.1 Primary prevention*

Reduced cardiovascular risks make the foot less susceptible to ischemia caused by macrovascular disease, while improved blood-glucose control reduces microvascular consequences. Patients' feet that are at risk will be identified by routine surveillance, and they should undergo specialized care.

#### *2.2.1.1 Metabolic control*

Hyperglycemia enhances the macrovascular and microvascular problems in diabetes. Foot ulcerations that can result in limb amputations are linked to this higher risk.

A systematic review comparing intense control (HbA1c (HbA1c) 6–7.5%) with less intensive glycemic control found a lower risk of amputees (RR = 0.65, 95% CI 0.45 to 0.94) and a delayed decline in sensory vibration cutoff point (MD = -8.27, 95% CI -9.75 to −6.79). Other neuropathic shifts (RR = 0.89, 95% CI 0.75 to 1.05) and ischemic changes (RR = 0.92, 95% CI 0.67 to1.26), on the other hand, were unaffected [30].

In a Cochrane literature review on the prevention of diabetes-related neuropathy, focused blood glucose control (HbA1c 7.0%) significantly reduced the risk of continuing to develop neuropathy in T1DM however not in T2DM at 12 months follow-up. However, including both T1DM and T2DM, this was associated with a higher risk of severe hypoglycemia, excess weight, hospital admissions, and deaths [32] (**Figure 2**).

#### *2.2.1.2 Preventive footcare*

Walking or having to stand while structurally trying to load the feet exemplifies stress on the plantar surface, exacerbating compression and shear stress. Foot abnormalities, such as hammer and claw toes, which are frequent in diabetic individuals, add to the pressure and tension. A systematic review of apparel and off-loading techniques throughout diabetics of neuropathy found that bespoke insoles reduced recurring metatarsal head ulcers at 15 months (p = 0.007) [33].

*Current Perspective of Prevention and Management of Diabetic Foot DOI: http://dx.doi.org/10.5772/intechopen.108197*

#### **Figure 2.**

*Management of diabetic foot disease. Note: From Ref. [31].*

