The Japanese Dermatological Association's wound, pressure ulcer and burn committee has published a fully revised third edition of its guideline on diabetic foot ulcers and gangrene, developed with the GRADE approach. Three clinical questions were backed by meta-analyses: imaging procedures for osteomyelitis, topical negative-pressure wound therapy and platelet-rich plasma. Each received a weak recommendation. The guideline also covers diagnosis, prevention, assessment and unconventional treatments in general terms.
A weak recommendation means the benefits probably outweigh the harms but the evidence is limited, so the choice should reflect the patient's circumstances and local availability. The abstract does not give effect sizes or detail on which imaging method or when.
This is a national dermatology society guideline; it does not replace your local or international diabetic foot guidance, and the evidence behind it should be read in the full text before changing practice.
- Imaging for suspected osteomyelitis, negative-pressure therapy and platelet-rich plasma each got a weak recommendation.
- Weak recommendations call for shared decisions, not routine use.
- Check your multidisciplinary foot team's protocol before adopting any of them.
- Cost and access matter, particularly for negative-pressure devices and platelet-rich plasma.
- Read the full guideline for specific indications.
Why it matters
It gives dermatologists involved in wound care a structured, graded view of three adjuncts they are often asked about.
Don't overread it
This is a single national society guideline with weak recommendations, so it does not change international guidance.
The statistics, in plain English
A weak GRADE recommendation reflects low or moderate certainty in the evidence, or a close balance between benefit and harm. It indicates that reasonable clinicians and patients may choose differently.
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