An exercise program for people with severe peripheral neuropathy and diabetic foot ulcers – a case series on feasibility and safety

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

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Vitamin D Status in a Bulgarian Population With Type 2 Diabetes and Diabetic Foot Ulcers

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620965820 ◽

2020 ◽

pp. 153473462096582

Author(s):

Ani S. Todorova ◽

Edward B. Jude ◽

Rumyana B. Dimova ◽

Nevena Y. Chakarova ◽

Mina S. Serdarova ◽

...

Keyword(s):

Type 2 Diabetes ◽

Vitamin D ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Diabetic Peripheral Neuropathy ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Vitamin D Status ◽

Active Infection

The aim of this study was to assess vitamin D status in patients with type 2 diabetes and diabetic foot ulcers (DFU). A total of 242 participants with type 2 diabetes, mean age 59.1 ± 10 years, mean body mass index 31.4 ± 6.3 kg/m2, and estimated glomerular filtration rate ≥45 mL/min/1.73m2, were divided into 2 groups: 73 with DFU (35 with and 38 without active infection) and 169 without DFU (106 with diabetic peripheral neuropathy, 63 without complications). Neuropathy was assessed by 10 g monofilament, Rydel-Seiffer 128 Hz tuning fork, and temperature discrimination. Serum 25(OH)D (25-hydroxy vitamin D) was assessed by ECLIA (electro-chemiluminescence immunoassay) method. Median 25(OH)D level was 12.6 ng/mL (IQR [interquartile range] 9.3-17.6 ng/mL) in the studied cohort. The DFU group presented with lower 25(OH)D level as compared with diabetic patients without foot ulcers (non-DFU group): 11.6 ng/mL (IQR 8.5-15.8 ng/mL) versus 13.5 ng/mL (IQR 9.6-18.6 ng/mL), P = .001; the diabetic peripheral neuropathy subgroup demonstrated lower 25(OH)D level in comparison with participants without complications: 12.5 ng/mL (IQR 9-17.2 ng/mL) versus 15.9 ng/mL (IQR 10.4-20.8 ng/mL), P = .031. This remained significantly different even after correction for age and duration of diabetes. There was no difference in 25(OH)D level between the subgroups according to the presence of active infection. In conclusion, vitamin D deficiency may play a role in the development of diabetes complications.

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The Use of a Mixture of Hypericum Perforatum and Azadirachta indica for the Management of Diabetic Foot Ulcers: A Case Series

Journal of Diabetes & Metabolism ◽

10.4172/2155-6156.1000499 ◽

2015 ◽

Vol 06 (02) ◽

Author(s):

Maria Letizia Iabichella

Keyword(s):

Azadirachta Indica ◽

Diabetic Foot ◽

Hypericum Perforatum ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers

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Maggot debridement therapy to treat hard-to-heal diabetic foot ulcers: a single-centre study

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup12.s30 ◽

2021 ◽

Vol 30 (Sup12) ◽

pp. S30-S36

Author(s):

Harikrishna KR Nair ◽

Nazni Wasi Ahmad ◽

AA Ismail ◽

Ali A Alabed ◽

Benjamin Oh Zheming ◽

...

Keyword(s):

Diabetic Foot ◽

Case Series ◽

Cost Effective ◽

Lucilia Cuprina ◽

Study Endpoint ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Necrotic Tissue ◽

Maggot Debridement Therapy ◽

Diabetic Wounds

Objective: Maggot debridement therapy (MDT) has seen a resurgence in recent years in the treatment of hard-to-heal wounds, as a result of rising antibiotic resistance. The sterilised larvae of Lucilia cuprina have been used in MDT in Malaysia since 2003, with encouraging results for the treatment of hard-to-heal diabetic wounds. We report a case series of 30 patients selected from our clinic by convenient sampling with diabetic lower limb ulcers treated with MDT. The average age of patients receiving MDT was >50 years. Of the 30 patients in the study, nine were female and 21 were male. All patients had underlying diabetes, two patients had leg ulcers and 28 patients had diabetic foot ulcers. Sterilised Lucilia cuprina larvae were applied via a standard method of 10 maggots per square centimetre and dressed with sterile gauze. The study endpoint was defined as ≤5% coverage with slough or necrotic tissue following three successive applications of MDT. In this study, maximum debridement of wounds was achieved in 96.6% (29 patients) of our patients, with ≤5% coverage with slough or necrotic tissue, in addition to a reduction in wound-related pain, as assessed by a visual analogue scale. No adverse events were reported. The findings of this study support the use of MDT as a safe, efficacious, and cost-effective method of managing diabetic wounds.

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