What are the most effective wound care measures for diabetic foot ulcers?

Diabetic foot ulcers as one of the most common complications of diabetes mellitus are defined as nonhealing or long-lasting chronic skin ulcers in diabetic patients. Multidisciplinary care for the diabetic foot is common, but treatment results are often unsatisfactory. Low level laser therapy (LLLT) on wound areas as well as on acupuncture points, as a noninvasive, pain-free method with minor side effects, has been considered as a possible treatment option for the diabetic foot syndrome. A systematic literature review identified 1764 articles on this topic. Finally, we adopted 22 eligible references; 8 of them were cell studies, 6 were animal studies, and 8 were clinical trials. Cell studies and animal studies gave evidence of cellular migration, viability, and proliferation of fibroblast cells, quicker reepithelization and reformed connective tissue, enhancement of microcirculation, and anti-inflammatory effects by inhibition of prostaglandine, interleukin, and cytokine as well as direct antibacterial effects by induction of reactive oxygen species (ROS). The transferral of these data into clinical medicine is under debate. The majority of clinical studies show a potential benefit of LLLT in wound healing of diabetic ulcers. But there are a lot of aspects in these studies limiting final evidence about the actual output of this kind of treatment method. In summary, all studies give enough evidence to continue research on laser therapy for diabetic ulcers, but clinical trials using human models do not provide sufficient evidence to establish the usefulness of LLLT as an effective tool in wound care regimes at present. Further well designed research trials are required to determine the true value of LLLT in routine wound care.

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Outcomes Following Advanced Wound Care for Diabetic Foot Ulcers: A Canadian Study

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2016.06.007 ◽

2017 ◽

Vol 41 (1) ◽

pp. 26-32 ◽

Cited By ~ 15

Author(s):

Ivana Roth-Albin ◽

Safiah H.C. Mai ◽

Zeeshan Ahmed ◽

Ji Cheng ◽

Karen Choong ◽

...

Keyword(s):

Diabetic Foot ◽

Wound Care ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Canadian Study

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Combination Therapy Revives Hope for Patients with Diabetic Foot Ulcer: A Case Report

10.21203/rs.3.rs-199325/v1 ◽

2021 ◽

Author(s):

Naser Parizad ◽

Kazem Hajimohammadi ◽

Rasoul Goli

Keyword(s):

Case Report ◽

Combination Therapy ◽

Diabetic Foot ◽

Wound Care ◽

Stable Condition ◽

Foot Ulcer ◽

Wound Management ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Present Case Report

Abstract BackgroundDiabetic foot ulcers, as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of diabetic foot ulcers are among the most critical challenges for the patients and their families. Case presentationThe present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had diabetic foot ulcers for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6×4 cm and 6×8 cm, the sole as a superficial ulcer with a size of 6×3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. Despite antibiotic therapy and routine dressing changes, the patient showed no improvement during the hospital stay. Accordingly, the patient was transferred to our service after consulting with the wound management team. Diabetic foot ulcers were treated and managed using a combination of maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition. ConclusionsBased on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this study to treat refractory diabetic foot ulcers.

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MANAJEMEN ULKUS KAKI DIABETIKUM : EFEKTIFITAS FOOT EXERCISE TERHADAP RISIKO DFU (DIABETIC FOOT ULCERS) PASIEN DIABETES MELLITUS DI AL HIJRAH WOUND CARE CENTER

Jurnal Ilmiah PANNMED (Pharmacist, Analyst, Nurse, Nutrition, Midwivery, Environment, Dentist) ◽

10.36911/pannmed.v14i2.593 ◽

2019 ◽

Vol 14 (2) ◽

pp. 95-101

Author(s):

Fahruddin Kurdi ◽

Ratna Puji Priyanti

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Wound Care ◽

Care Center ◽

Foot Ulcers ◽

P Value ◽

Diabetic Foot Ulcers ◽

Post Test ◽

Diabetic Foot Screening ◽

Diabetes Melitus

ABSTRAK Jumlah penderita DM (diabetes melitus) saat ini semakin meningkat. Salah satu komplikasi yang terjadi yaitu DFU (diabetic foot ulcers). Banyak cara yang dapat dilakukan untuk mencegah DFU, salah satunya dengan diabetic foot exercise. Penelitian ini bertujuan untuk mengetahui efektifitas diabetic foot exercise terhadap risiko dfu (diabetic foot ulcers) pasien diabetes mellitus. Penelitian menggunakan design pre-eksperimen dengan pendekatan one-group pra-post test design. Populasi penderita diabetes yang berjumlah 60 orang, besar sampel 40 orang yang diambil menggunakan teknik purposive sampling. Resiko DFU dinilai menggunakan inlow’s 60-second diabetic foot screening tool dengan metode observasi. Analisa data menggunakan uji statistik Wilcoxon. Hasil penelitian ini didapatkan bahwa sebelum dilakukan diabetic foot exercise sebagian besar reponden mempunyai risiko sedang sebanyak 30 orang (75%), sesudah dilakukan diabetic foot exercise diperoleh bahwa sebagian besar responden risiko rendah sebanyak 32 orang (80%). Uji statistik Wilcoxon diperoleh nilai p value = 0,001 dimana nilai p value<α (0,05) yang berarti ada pengaruh diabetic foot exercise terhadap risiko diabetic foot ulcers. Diabetes foot exercise sangat efektif untuk penderita diabetes dalam mencegah risiko DFU. Penderita diabetes dapat melakukan diabetic foot exercise 2 kali dalam seminggu secara teratur. Kata Kunci : Diabetes mellitus, Diabetic foot ulcers, diabetic foot exercise

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Allogeneic Skin Substitutes Versus Human Placental Membrane Products in the Management of Diabetic Foot Ulcers: A Narrative Comparative Evaluation of the Literature

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734618818301 ◽

2019 ◽

Vol 18 (1) ◽

pp. 10-22 ◽

Cited By ~ 5

Author(s):

Joshua Luck ◽

Timo Rodi ◽

Alexander Geierlehner ◽

Afshin Mosahebi

Keyword(s):

Diabetic Foot ◽

Wound Care ◽

Controlled Trial ◽

Intervention Group ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Foot Ulcers ◽

Skin Substitute ◽

Diabetic Foot Ulcers ◽

Skin Substitutes

Outcomes following standard wound care (SWC) for diabetic foot ulcers (DFUs) remain suboptimal. Supplementing SWC with tissue engineered allogeneic cellular wound therapies represents an emerging treatment strategy. This review aimed to evaluate the efficacy and safety of allogeneic skin substitutes and human placental membrane allografts in the management of DFUs. Ovid MEDLINE and Embase databases were searched from inception to October 2017. Any randomized controlled trial (RCT) with an allogeneic skin substitute or placental membrane allograft intervention group was included. Our primary outcome measure was the proportion of completely healed ulcers. Secondary outcome measures included time to complete wound healing and local adverse event rates. Each study was assessed for risk of bias and the quality of evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Moderate quality evidence from 11 included RCTs demonstrated that both allogeneic cellular approaches improve the proportion of completely healed ulcers at 6 and 12 weeks. One RCT showed that a placental membrane allograft was superior to an allogeneic skin substitute, although this has yet to be repeated in other studies. The addition of allogeneic cellular wound products to SWC improves DFU outcomes. Further studies are required to conclusively establish if placental membrane allografts are superior to allogeneic skin substitutes.

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Efektivitas Kompres Iodine Terhadap Zona Hambat Staphylococcus Aureus Pada Ulkus Diabetikum

Jurnal Keperawatan Indonesia ◽

10.7454/jki.v16i3.323 ◽

2013 ◽

Vol 16 (3) ◽

pp. 139-144

Author(s):

Asep Kuswandi ◽

Kusmiyati Kusmiyati ◽

Holikin Holikin

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Wound Care ◽

Positive Culture ◽

Foot Ulcers ◽

Distilled Water ◽

Diabetic Foot Ulcers ◽

Average Size

AbstrakUlkus diabetikum merupakan salah satu komplikasi kronis diabetes melitus dan menjadi penyebab amputasi kaki. Infeksi pada ulkus tersebut umumnya disebabkan oleh Staphylococcus aureus. Salah satu teknik pencegahan amputasi kaki diabetes adalah perawatan ulkus. Berbagai jenis bahan kompres ulkus diabetikum yang telah dikenal selama ini adalah:kompres madu, gula, Iodine, dan NaCl 0,9%. Penelitian ini bertujuan mengetahui efektifitas bahan kompres ulkus terhadap daya hambat Staphylococcus aureus. Penelitian ini merupakan penelitian eksperimen in vitro menggunakan satu faktor perlakuan yaitu zona hambat bahan kompres terhadap Staphylococcus aureus pada ulkus diabetikum. Enam jenis bahan yang diuji adalah aquadest, gula, Iodine 10%, campuran gula dan Iodine 10 %, madu, dan NaCl 0,9 %. Eksperimen dilakukan sebanyak 10 kali untuk mengetahui rerata luas daya hambatnya selama 24 jam. Sampel diambil dari ulkus diabetikum. Staphylococcus aureus diisolasi dari ulkus tersebut untuk eksperimen dengan berbagai bahan kompres ulkus. Hasil penelitian menunjukkan bahwa zona hambat madu rata-rata sebesar 0,4 mm, gula 3,0 mm, aquadest 0,0 mm, NaCl 0,9% 0,0 mm, Iodine 10% 8,3 mm dan campuran gula-Iodine 6,0 mm. Zona hambat terluas dihasilkan dari uji menggunakkan Iodine 10% (8,3 mm). Sementara campuran gula Iodine 10% menghasilkan zona hambat seluas 6 mm dan gula menghasilkan 3 mm. Penelitian ini merekomendasikan jika ditemukan Staphylococcus aureus maka dilakukan kompres Iodine 10% dengan kasa steril. Penelitian selanjutnya dengan metode in vivo perlu dilakukan untuk mengetahui efektifitas cairan Iodine pada ulkus diabetikum.Kata Kunci: kompres ulkus, staphylococcus aureus, ulkus diabetikum, zona hambatAbstractEffectivity of Iodine Compress to Blocking Zone of Staphylococcus aureus in Diabetes Ulcers. Diabetic foot ulcers is one of diabetes chronic complications that might lead to leg amputations. Staphylococcus aureus is known as the cause of infection in diabetic foot ulcers. One of techniques to prevent diabetic foot amputations is wound care. Various materials are known to be used to compress diabetic foot ulcers. These include of using honey, sugar, 10% of Iodine and 0.9% of NaCl. This study aimed ttify to identify the effectiveness of various wound care materials to block Staphylococcus aureus. This is an in vitro experiment study to investigate the effetiveness of six wound care materials used to wounds compress: distilled water, sugar, 10% of Iodine, a mixture of sugar and Iodine, honey and 0.9% of NaCl. Experiments were carried out in 10 times to determine the average size of block area in 24 hours. Staphylococcus aureus were isolated and soiled with various wound compressss materialls. The results showed that honey produced 0.4 mm of a blocking zone, 3.0 mm for glucose, 0.0 mm for distilled water, 0.0 mm for 0.9% of NaCl, 8.3 mm for 10% of Iodine, and 6.0 mm for mixed-Iodine Sugar. Ten percents of Iodine produced the widest zone to block Staphylicoccus aureus. This study recommends of apllying a 10% of Iodine compress if there is a positive culture of Staphylococcus aureus. A further in vivo study is a necessity to investigate the effectiveness of Iodine to diabetes foot ulcers.Keywords: blocking zone, diabetic foot ulcers, Staphylococcus aureus, wound compress

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Assessment of diabetic foot ulcers based on pictorial material: an interobserver study

Journal of Wound Care ◽

10.12968/jowc.2020.29.11.658 ◽

2020 ◽

Vol 29 (11) ◽

pp. 658-663

Author(s):

Tue Smith Jørgensen ◽

Ylva Hellsten ◽

Hans Gottlieb ◽

Stig Brorson

Keyword(s):

Diabetic Foot ◽

Interobserver Agreement ◽

Wound Care ◽

Wound Management ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Pictorial Material ◽

Frequent Change ◽

Level Of Education ◽

Care Training

Objective: The frequent change in clinicians, and the emerging use of photographic documentation in wound management, could require a more diverse treatment of patients due to poor interobserver agreement. The aim of this study was to assess the interobserver agreement of a commonly used classification system for diabetic foot ulcers (DFUs), the Meggitt–Wagner classification, and to compare the agreement on classification with the agreement in treatment recommendations. Method: An interobserver study was conducted based on a questionnaire linked to 30 photographs of DFUs. Different groups of observers were tested to investigate whether there was a difference between professions or level of education: experienced orthopaedic wound care doctors (n=7); nurses specialised in wound care (n=8) and untrained nurses assigned to a diabetic wound care training course (n=23). Krippendorff's alpha was used to calculate interobserver agreement, and an agreement of >0.67 was defined as substantial. Results: The Krippendorff's alpha value for interobserver agreement on the Meggitt–Wagner classification was 0.52 for the doctors group, 0.67 for the specialised nurses and 0.61 for the untrained nurses. The corresponding values regarding agreement on recommendation of surgical revision of the wound were 0.35, 0.22 and 0.15, respectively. The choice of dressing type or antibiotic treatment had even lower interobserver agreement. Conclusions: The interobserver agreement on the Meggitt–Wagner classification was substantial in the specialised nurse group, but the evaluation and treatment of DFUs should not be exclusively based on pictorial materials.

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