CONTEMPORARY STRATEGIES FOR AMPUTATION PREVENTION IN DIABETIC FOOT: ADVANCES IN WOUND MANAGEMENT, EARLY DIAGNOSIS, AND MULTIDISCIPLINARY CARE

Abstract

Diabetic foot is one of the major chronic complications of diabetes mellitus and is characterized by the interaction of peripheral neuropathy, peripheral arterial disease, biomechanical abnormalities, and infectious processes, which contribute to the development of ulcerations, impair wound healing, and may ultimately lead to lower-limb amputations. Given the complexity of this condition and recent advances in the identification of the at-risk foot, wound management, and limb-preservation strategies, this study aimed to conduct a narrative review of the literature on contemporary strategies for preventing amputations in patients with diabetic foot, with emphasis on early diagnosis, risk stratification, ulcer management, and multidisciplinary care. This descriptive and qualitative narrative review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, Embase, and SciELO databases and included clinical trials, observational studies, systematic reviews, meta-analyses, and clinical guidelines published between 2020 and 2026 in Portuguese and English. The findings demonstrated that preventing diabetic foot progression is closely associated with periodic screening, identification of loss of protective sensation, assessment of peripheral arterial disease, and individualized risk stratification, enabling interventions before advanced complications develop. In patients with ulcerations, assessment of perfusion and wound severity, early recognition of infection and osteomyelitis, and the integrated use of strategies such as debridement, offloading, infection control, and appropriate wound dressings were particularly relevant. Vascular assessment and revascularization, when indicated, were essential components in the management of ischemic limbs, whereas advanced wound-healing therapies may serve as adjunctive approaches in selected cases. Furthermore, the integration of endocrinology, vascular surgery, infectious diseases, orthopedics, nursing, podiatry, and other relevant disciplines enables the simultaneous management of metabolic, vascular, infectious, and biomechanical factors. In conclusion, amputation prevention depends on the combination of early diagnosis, risk stratification, individualized ulcer management, and coordinated multidisciplinary care. Structured protocols and continuous follow-up are essential to promote wound healing, preserve limb function, and prevent progression to irreversible complications.