Punching Toward Healing: Danish Inforatio Trial Reports Better Ulcer Closure

Figure 1 from the Danish inforatio trial: a gloved hand holds a biopsy punch beside a photograph of a foot ulcer after the procedure.

In 2022, we asked whether our Danish colleagues could “punch” their way toward better wound healing. Their protocol explored a familiar clinical puzzle: why can a small biopsy site heal while the chronic wound around it persists? Now we have randomized trial results.

Congratulations to Sahar Moeini and colleagues on their new JAMA Network Open study. Across four Danish clinics, 100 patients with noninfected Wagner grade 1 diabetic foot ulcers were analyzed. At 20 weeks, closure occurred in 24 of 49 patients receiving inforatio plus standard care (49.0%), compared with 14 of 51 receiving standard care alone (27.5%). That is a 21.5-percentage-point difference; the adjusted odds ratio was 3.01 (95% CI, 1.20–7.58).

A biopsy punch tool and a foot ulcer after the inforatio procedure, shown in Figure 1 of the Danish trial. — Supplied screenshot of Figure 1, Moeini and colleagues, JAMA Network Open (2026).

A simple adjunct, with important boundaries

Inforatio uses a 2-mm biopsy punch to make small wound-bed incisions without removing tissue, alongside standard care. The result is encouraging, but it applies to a selected population. It does not establish benefit for infected, deeply involved, or critically ischemic ulcers. Ulcer-related adverse events were fewer, an exploratory finding; serious adverse events and quality-of-life changes did not differ significantly. This is promising evidence for an adjunct, not a replacement for comprehensive diabetic foot care.

Watch the technique

Watch the official JAMA technique video (1 minute 20 seconds). The demonstration emphasizes assessing granulation-tissue thickness and protecting underlying bone, joint, and tendon. Clinical procedure footage is included; this is educational material for clinicians, not a self-treatment guide.

From earlier work to this trial

Our September 2022 DF Blog post covered the planned trial. For the research trail, see the 2021 feasibility study and the 2022 trial protocol. The new results give us a useful opportunity to revisit that original question with clinical evidence.

The appeal of a practical, accessible intervention deserves attention. So does the next question: how reproducible are these results across teams and patient populations?

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