Punch-incision technique boosts diabetic foot ulcer healing

Clinical takeaway: Consider the inforatio technique as a potential adjunct to standard care for selected patients with noninfected Wagner grade 1 diabetic foot ulcers. The procedure is inexpensive, takes only a few minutes to perform, and increased the likelihood of ulcer closure without an apparent increase in adverse events in this trial.

Diabetic foot ulcers affect roughly 1 in 4 people with diabetes during their lifetime and remain difficult to heal despite guideline-based wound care. Low-cost interventions that can be implemented in a wide range of clinical settings are particularly attractive as diabetes prevalence continues to rise globally.

Investigators found that 49.0% of patients treated with the inforatio technique plus standard care achieved complete ulcer closure within 20 weeks, compared with 27.5% of those receiving standard care alone. The absolute difference was 21.5 percentage points.

The technique involves creating small punch-tool incisions in the wound bed after debridement. Among 100 patients included in the primary analysis, ulcer-related adverse events occurred in 32.7% of the inforatio group versus 58.8% of the standard-care group. Serious adverse events occurred in 14.3% and 25.5% of patients, respectively, although the study was not powered to definitively assess those outcomes. Quality-of-life measures did not differ between groups.

Researchers randomized 100 adults with noninfected Wagner grade 1 diabetic foot ulcers at four Danish wound-care clinics to receive either the inforatio technique every 3 weeks for 12 weeks plus standard care or standard care alone. The primary outcome was complete ulcer closure, defined as full epithelialization without discharge, within 20 weeks.

The authors say larger studies are needed to evaluate the technique's effectiveness and cost-effectiveness in routine clinical practice. They also note that the procedure uses a sterile 2-mm biopsy punch costing about $2.50 and typically requires 1-5 minutes to perform.

"Our findings suggest that the inforatio technique may be a simple, low-cost adjunctive treatment for diabetic foot ulcers, with the potential to improve healing without requiring specialized equipment," wrote the authors.

Source: Moeini S, et al. (2026 Nov 9) JAMA Netw Open. Inforatio Technique and Foot Ulcer Closure Among Patients With Diabetes: A Randomized Clinical Trial