Abstract:

Diabetic foot ulcer (DFU) is a severe complication of diabetes that can lead to disability and death. Infection and biofilm-mediated persistent microbial burden are key factors driving wound stalling, deep tissue involvement, and a sharply increased risk of amputation. In comprehensive DFU management, topical antimicrobial dressings serve as stage-specific, indication-driven adjuncts to rapidly suppress microbial load and promote improvements in the wound microenvironment. Iodine-containing dressings, including molecular iodine and polymeric iodine-containing systems, exert broad-spectrum bactericidal effects via multi-target oxidation and halogenation, with an extremely low risk of acquired resistance and potent antibiofilm potential. Current evidence indicates that, provided that standard treatments, including metabolic and nutritional support, adequate debridement, and effective offloading, are fully implemented, iodine-containing dressings are generally non-inferior in terms of healing outcomes. Their core clinical benefits are specifically focused on certain wound subtypes characterized by high infection risk, moderate-to-heavy exudate, or suspected biofilm-associated wound stalling, and are mainly reflected in effective and sustained bioburden control, accelerated wound bed preparation, and reduced nursing burden.Meanwhile, the integration of advanced materials science and drug delivery technologies is driving iodine-containing systems toward multifunctional platforms featuring controlled iodine release and microenvironment responsiveness. However, their clinical application should adhere to the principle of "short-term trial use and dynamic reassessment," with close attention to potential safety risks, including iodine hypersensitivity and thyroid dysfunction. This article reviews the mechanisms of action, clinical evidence, and advances in materials science relating to iodine-containing dressings in DFU management. It systematically summarizes their clinical positioning and practical strategies to provide a theoretical reference for the standardized and high-quality implementation of topical antimicrobial interventions for DFU in China and promoting the continued development of evidence-based and precision-oriented diabetic foot wound management.

Key words: diabetic foot ulcer (DFU), iodine-containing dressing, povidone-iodine, cadexomer iodine, biofilm, topical antimicrobial therapy