Poloxamer 188: Hydrogel-Surfactant's Use in Diabetic Foot Ulcers

Purpose: Poloxamer 188* (P188) is a concentrated water-soluble hydrogel and surfactant used in the treatment of diabetic foot ulcerations. Hydrogels maintain moist environments while promoting debridement of necrotic tissue. P188* stabilizes cell membranes in the setting of abnormal physiologic conditions i.e temperature, oxidative stress, and electrical fields. However, there is limited understanding of P188’s* role as a hydrogel in treatment of ulcerations in the setting of poorly controlled diabetes (A1c >6.5%) The goal of this retrospective case series is to investigate P188’s* usage in the treatment of diabetic foot ulcerations. Case Study: 11 patients were identified with poorly controlled diabetes, foot ulceration, and P188* use for >4 weeks.  Indications for P188* use included ulcerations with dry stable eschars, uninfected ulcerations i.e: absence of rubor, calor, dolor, tumor, probe to bone), and without evidence of osteomyelitis as confirmed by radiographic images and/or MRI.  Results: The average duration of P188* usage was 79.1 days for healed wounds vs 72.4 days for unhealed wounds prior to any surgical intervention. _ patients with unhealed wounds developed necrotizing fasciitis confirmed by intraoperative biopsy pathology; 5/5 patients required proximal amputation for definitive surgical source control. Analysis & Discussions: Clinical implications for P188* range from dry eschars, ulcers with minimal to moderate exudate, pressure ulcers, surgical wounds, and burns. This study found that P188* can play a nuanced adjunct treatment role for management of biofilm through cell salvage, debridement of necrotic tissue, and maintenance of wound bed hydration despite increased inflammation and oxidative stresses present in uncontrolled diabetes.