Infections in Diabetic Foot Ulcers (DFUs) can cause severe complications, including tissue death and limb amputation, highlighting the need for accurate, timely diagnosis. Previous machine learning methods have focused on identifying infections by analyzing wound images alone, without utilizing additional metadata such as medical notes. In this study, we aim to improve infection detection by introducing Synthetic Caption Augmented Retrieval for Wound Infection Detection (SCARWID), a novel deep learning framework that leverages synthetic textual descriptions to augment DFU images. SCARWID consists of two components: (1) Wound-BLIP, a Vision-Language Model (VLM) fine-tuned on GPT-4o-generated descriptions to synthesize consistent captions from images; and (2) an Image-Text Fusion module that uses cross-attention to extract cross-modal embeddings from an image and its corresponding Wound-BLIP caption. Infection status is determined by retrieving the top-k similar items from a labeled support set. To enhance the diversity of training data, we utilized a latent diffusion model to generate additional wound images. As a result, SCARWID outperformed state-of-the-art models, achieving average sensitivity, specificity, and accuracy of 0.85, 0.78, and 0.81, respectively, for wound infection classification. Displaying the generated captions alongside the wound images and infection detection results enhances interpretability and trust, enabling nurses to align SCARWID outputs with their medical knowledge. This is particularly valuable when wound notes are unavailable or when assisting novice nurses who may find it difficult to identify visual attributes of wound infection.

Diabetic foot ulcers (DFUs) are a leading cause of hospitalizations and lower limb amputations, placing a substantial burden on patients and healthcare systems. Early detection and accurate classification of DFUs are critical for preventing serious complications, yet many patients experience delays in receiving care due to limited access to specialized services. Telehealth has emerged as a promising solution, improving access to care and reducing the need for in-person visits. The integration of artificial intelligence and pattern recognition into telemedicine has further enhanced DFU management by enabling automatic detection, classification, and monitoring from images. Despite advancements in artificial intelligence-driven approaches for DFU image analysis, the application of large language models for DFU image transcription has not yet been explored. To address this gap, we introduce UlcerGPT, a novel multimodal approach leveraging large language and vision models for DFU image transcription. This framework combines advanced vision and language models, such as Large Language and Vision Assistant and Chat Generative Pre-trained Transformer, to transcribe DFU images by jointly detecting, classifying, and localizing regions of interest. Through detailed experiments on a public dataset, evaluated by expert clinicians, UlcerGPT demonstrates promising results in the accuracy and efficiency of DFU transcription, offering potential support for clinicians in delivering timely care via telemedicine.