Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care

I read with interest the article “Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care” published in your esteemed journal.¹ The study compares surgical debridement with standardized wound care for diabetic foot ulcers (DFUs). However, certain limitations and methodological issues warrant discussion.

First, the study does not thoroughly explore the impact of other diabetes-related complications on treatment outcomes. Diabetic patients often have numerous comorbidities that should be addressed, as these would likely affect the outcomes. Second, the influence of factors such as glycaemic control, diabetes duration and concurrent medications on outcomes is not clearly addressed, yet these may significantly affect the results.² Exact procedures for debridement and wound care are not extensively described, which may hinder reproducibility. Moreover, the study only included patients with adequate vascular status (Ankle-Brachial Index > 0.9), potentially excluding a significant portion of DFU patients. Importantly, the study population was limited to a single tertiary care hospital in Iran, lacking diversity in the sample, which may affect the generalizability of the results to broader, more varied populations.³ The study's short duration and lack of long-term follow-up data are crucial limitations, as understanding DFU recurrence rates and long-term treatment effectiveness is essential. Some limitations mentioned by the authors, such as the cross-sectional study design, retrospective data collection and small sample size of 75 patients, call the study's results into question. Additionally, there was no control group to evaluate the effectiveness of the treatment against other methods or standard care. Furthermore, the study does not address the cost-effectiveness of the treatment methods, which is essential for evaluating the feasibility and sustainability of the interventions in different healthcare settings.⁴

In conclusion, while the study provides valuable insights for comparing surgical debridement with standardized wound care for DFUs and highlights the need for comprehensive prevention and control strategies, addressing these methodological limitations would strengthen the article and provide a more robust foundation for future research and clinical practice. I hope the authors and the journal will consider these points in their ongoing efforts to address this important public health issue.

The authors declare no conflicts of interest.