Three-Dimensional Human Tissue Models That Incorporate Diabetic Foot Ulcer-Derived Fibroblasts Mimic In Vivo Features of Chronic Wounds

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

Download Full-text

Valsartan solid lipid nanoparticles integrated hydrogel: A challenging repurposed use in the treatment of diabetic foot ulcer, in-vitro/in-vivo experimental study

International Journal of Pharmaceutics ◽

10.1016/j.ijpharm.2020.120091 ◽

2021 ◽

Vol 592 ◽

pp. 120091

Author(s):

Noha S. El-Salamouni ◽

Mennatallah A. Gowayed ◽

Nevine L. Seiffein ◽

Rehab A. Abdel- Moneim ◽

Maher A. Kamel ◽

...

Keyword(s):

Experimental Study ◽

Diabetic Foot ◽

Solid Lipid Nanoparticles ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Lipid Nanoparticles ◽

Solid Lipid

Download Full-text

Bioactive and superabsorbent cellulosic dressing grafted alginate and Carthamus tinctorius polysaccharide extract for the treatment of chronic wounds

Textile Research Journal ◽

10.1177/0040517520935213 ◽

2020 ◽

pp. 004051752093521

Author(s):

Yassine El-Ghoul ◽

Fahad M Alminderej

Keyword(s):

Diabetic Foot ◽

Chronic Wounds ◽

Negative Impact ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Carthamus Tinctorius ◽

Biological Properties ◽

Attenuated Total Reflection ◽

Curing Conditions ◽

Textile Functionalization

Diabetic foot ulcers have a negative impact on the lives of patients and are highly vulnerable to infection, leading to amputation too often. It is essential that the patient with a diabetic foot ulcer receives the best possible care. Herein, we developed a new functionalized cellulosic wound dressing with high-improved healing properties, able to be a serious alternative for diabetic acute wounds. First, a bioactive polysaccharide was extracted from the Carthamus tinctorius plant. Then a new crosslinked polymer-based alginate/ C. tinctorius polymer extract was prepared and checked for combined antimicrobial and tissue regeneration properties. Afterward, the efficiency of the textile functionalization process was optimized through studying the influence of different grafting parameters: curing conditions and the concentration of the impregnating solution. The drop method wettability technique exhibited significant improvement in the hydrophilicity behavior of treated textile samples, which increased with the grafting rate. Attenuated total reflection Fourier-transform infrared spectroscopy and thermogravimetric analysis or differential thermal analysis were investigated to test whether the chemical permanent grafting resisted the severe standard washing conditions. The tensile strength characteristics showed that the grafting does not affect the original mechanical properties of treated textile dressings. A morphological study via scanning electron microscopy images confirmed the permanent textile finishing performance and permitted us to assess its chemical grafting approach onto the treated surfaces. The biological and the bacteriological investigations of functionalized dressings proved that the functional biomaterial could be used as a medical bioactive device with improved biological properties.

Download Full-text

Management of Over-Granulation in a Diabetic Foot Ulcer: A Clinical Experience

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-24-1-19 ◽

2013 ◽

Vol 24 (1) ◽

pp. 19-22

Author(s):

I.N Krishnaprasad ◽

V Soumya ◽

S Abdulgafoor

Keyword(s):

Granulation Tissue ◽

Diabetic Foot ◽

Chronic Wounds ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Surgical Excision ◽

Long Term Effects ◽

Short Term ◽

Inflammatory Phase ◽

Cost Effective Treatment

Abstract Over-granulation or exuberant granulation tissue is a common problem encountered in the care of chronic wounds, especially that of diabetic foot ulcers. There are several potential options for the treatment of this challenging problem. Some have an immediate short term effect but may have a longer term unfavourable effect, for example, silver nitrate application and surgical excision, which may delay wound healing by reverting the wound back to the inflammatory phase of healing. Other products, such as foams and silver dressings may offer some effect in short term, but their long term effects are questionable. The more recent research supports Haelan cream and tape as an efficacious and cost effective treatment for over-granulation in a variety of wound types. The future of treating over-granulation may lie with surgical lasers, since lasers can not only remove over-granulation tissue but will also cauterise small blood vessels and are very selective, leaving healing cells alone while removing excess and unhealthy tissue. Recently Drs Lain and Carrington have demonstrated the utility of imiquimod, an immune-modulator with anti-angiogenic properties, in the treatment exuberant granulation tissue, in a patient with long standing diabetic foot ulcer, resistant to other forms of therapy. We adapted a modified version of their protocol in the management of a similar patient in our hospital and achieved a good result in lesser time than the former.

Download Full-text

Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients

PLoS ONE ◽

10.1371/journal.pone.0150900 ◽

2016 ◽

Vol 11 (3) ◽

pp. e0150900 ◽

Cited By ~ 21

Author(s):

Fatima Ochoa-Gonzalez ◽

Alberto R. Cervantes-Villagrana ◽

Julio C. Fernandez-Ruiz ◽

Hilda S. Nava-Ramirez ◽

Adriana C. Hernandez-Correa ◽

...

Keyword(s):

Cell Cycle ◽

Wound Healing ◽

Cell Cycle Arrest ◽

Clinical Outcomes ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cycle Arrest ◽

Healing Impairment

Download Full-text

Electrospun cellulose acetate/gelatin nanofibrous wound dressing containing berberine for diabetic foot ulcer healing: in vitro and in vivo studies

10.1101/787093 ◽

2019 ◽

Author(s):

Hadi Samadian ◽

Arian Ehterami ◽

Saeed Farzamfar ◽

Ahmad Vaez ◽

Hossein Khastar ◽

...

Keyword(s):

Cellulose Acetate ◽

Diabetic Foot ◽

Wound Dressing ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Biological Properties ◽

In Vivo Studies ◽

Vapor Permeability

AbstractFunctional dressing with tailored physicochemical and biological properties is vital for diabetic foot ulcer (DFU) treatment. Our main objective in the current study was to fabricate Cellulose Acetate/Gelatin (CA/Gel) electrospun nanofibrous mat loaded with berberine (Beri) as the DFU dressing. The results demonstrated that the diameter of the nanofibers was around 502 nm, the tensile strength, contact angle, porosity, water vapor permeability, and water uptake ratio of CA/Gel nanofibers were around 2.83 MPa, 58.07, 78.17 %, 11.23 mg/cm2 hr, and 12.78 respectively, while these values for CA/Gel/Beri nanofibers were 2.69 ± 0.05 MPa, 56.93 ± 1, 76.17 ± 0.76 %, 10.17 ± 0.21 mg/cm2 hr, 14.37 ± 0.42 respectively. The bacterial evaluations demonstrated that the dressings are an excellent barrier against bacterial penetration with potent antibacterial activity. The animal studies depicted that the collagen density and angiogenesis score in the CA/Gel/Beri treated group were 88.8±6.7 % and 19.8±3.8, respectively. These findings implied that the incorporation of berberine did not compromise the physical properties of dressing, while improving the biological activates. In conclusion, our findings implied that the prepared mat is a proper wound dressing for DFU management and treatment.

Download Full-text

Treatment of Non-Healing Diabetic Foot Wounds with Vaporous Hyperoxia Therapy in Conjunction with Standard Wound Care

Journal of the American Podiatric Medical Association ◽

10.7547/20-259 ◽

2021 ◽

Author(s):

Dustin Kruse ◽

Kenneth Morgan ◽

Jeremy Christensen ◽

Brian Derner ◽

Brett Sachs

Keyword(s):

Diabetic Foot ◽

Oxygen Therapy ◽

Chronic Wounds ◽

Wound Care ◽

Historical Analysis ◽

Low Frequency ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Closure Rate ◽

Wound Debridement

Vaporous Hyperoxia Therapy (VHTTM), a patented FDA-510 (k) cleared technology, is an adjunct therapy used in conjunction with standard wound care (SWC). VHT is said to improve the health of wounded tissue by administering a low-frequency, non-contact, non-thermal ionic anti-microbial hydrating mist alternating with concentrated topical oxygen therapy (TOT). VHT was used to treat 36 subjects with chronic diabetic foot ulcers (DFUs) that were previously treated unsuccessfully with SWC. The average age of DFU in the study was 11 months old and the average size was over 3 cm2. Wounds were either Wagner Grade 2 or 3 and most commonly on the plantar surface around the midfoot. Treatment consisted of twice weekly applications of VHT and wound debridement. Subjects were followed to wound closure, 20 weeks, or 40 treatments, whichever came first. The combination of SWC and VHT in the group that met and maintained compliance throughout the study period achieved an 83% DFU closure rate within a 20-week time period. The average time for DFU closure in this study was 9.4 weeks. Historical analysis of SWC shows a 30.9% healing rate of all wounds, not differentiating chronic wounds. Accordingly, SWC/VHT increases chronic diabetic foot ulcer healing rates by 2.85 times compared with SWC alone. The purpose of this study was two-fold: first, to observe the effect of VHT on healing rates and time to healing in previously nonhealing DFUs and second, to compare VHT with SWC, TOT and hyperbaric oxygen therapy (HBOT) and ultrasound therapies.

Download Full-text

The Application of 0.75% Metronidazole Gel for the Treatment of Chronic Wounds: Two Case Reports and Literature Review

10.21203/rs.3.rs-35421/v1 ◽

2020 ◽

Author(s):

Ruijuan Si ◽

Jing Han ◽

Xue Zhang ◽

Fang Ji ◽

Xu Yang ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Chronic Wounds ◽

Case Reports ◽

Anaerobic Bacteria ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Deep Wound ◽

Infected Wounds ◽

Large Wound

Abstract Objective: To explore the application of metronidazole gel in the healing of chronic foot wounds.Methods: On the basis of reviewing the previous literature, routine debridement care and local application of metronidazole gel were applied to two patients with foot wounds and observations of wound healing were made. The wound of patient A was a deep wound, and the wound of patient B was a diabetic foot ulcer complicated by gangrene.Results: The bleeding and exudate of the patient with a deep wound gradually disappeared, and the wound healed. In the patient with the diabetic foot ulcer, the bleeding and exudate decreased. This was followed by the gradual size reduction of the wound and the formation of a scab over the large wound size.Conclusion: Metronidazole gel was effective in wound resolution of anaerobic bacteria infected wounds. It can serve as a way to relieve patients' pain with a promising therapeutic effect. The effectiveness of metronidazole in the treatment of deep wounds and diabetic foot patients requires further and larger-scale research studies to confirm the findings shown here.

Download Full-text

Honey clinically stimulates granulation and epithelialization in chronic wounds: a report of two cases

Medical Journal of Indonesia ◽

10.13181/mji.v27i1.1457 ◽

2018 ◽

Vol 27 (1) ◽

pp. 62-8 ◽

Cited By ~ 2

Author(s):

Putu E.P. Kefani ◽

Ida B.A.D. Putra ◽

Ratna R.N. Roosseno

Keyword(s):

Side Effects ◽

Sodium Bicarbonate ◽

Diabetic Foot ◽

Wound Dressing ◽

Chronic Wounds ◽

Chronic Wound ◽

Ulcer Patient ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Treatment

Various studies have been widely reintroduced honey as a wound dressing in chronic wound treatment. However, its utilization in Indonesia is still very limited. This study reported the effect of honey in stimulating the epithelialization and granulation on chronic wound treatment in our center. Two chronic wound cases, diabetic foot ulcer patient and gangrenous extravasation due to sodium bicarbonate, were daily treated with honey applications. After six-week evaluation, clinically the tissue granulation and epithelization were seen at the edge of the observed wounds and decreased the wound size significantly with no reported side effects. Honey clinically stimulates the epithelialization and granulation on chronic wound treatment.

Download Full-text