When acral malignant melanoma facades as diabetic foot!

2021 ◽  
Vol 14 (7) ◽  
pp. e242918
Author(s):  
Zainab Akram Yousif Yasear ◽  
Lynda Bloomer ◽  
Roshan Siddique ◽  
Haroon Siddique
Keyword(s):  
Diabetic Foot ◽  
Standard Treatment ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Initial Response ◽  
Final Diagnosis ◽  
Complete Healing ◽  
Acral Lentiginous Melanoma ◽  
Black Spots ◽  
Initial Intervention

An 85-year-old Indian man presented with non-healing foot ulcer over the left heel. There was initial response to wound size with standard treatment including offloading, debridement and antibiotic therapy. However, subsequently, there was no progress noted. Incidentally, two small black spots in the wound bed raised the suspicion of melanoma. Incisional biopsy confirmed acral lentiginous melanoma (ALM). The final diagnosis was ALM coexisting with diabetic foot ulcer (DFU). The wound was treated by surgical resection and flap reconstruction that resulted in complete healing. Fourteen months after the initial intervention, the patient developed a new lump and ulceration around the previous wound bed. This turned out to be recurrent disease with distant metastasis. The patient died eventually with palliative support. Through this case, we would like to highlight the importance of early biopsy and intervention in DFU especially for those wounds with atypical presentation or refractory to standard treatment.

scholarly journals A Rare Form of Melanoma Masquerading as a Diabetic Foot Ulcer: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Susan Thomas ◽  
Yuan-Xiang Meng ◽  
Vijaykumar G. Patel ◽  
Gregory Strayhorn
Keyword(s):  
Case Report ◽  
Diabetic Foot ◽  
Primary Care Clinic ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Care Clinic ◽  
Acral Lentiginous Melanoma ◽  
Diabetic Ulcer ◽  
Formidable Challenge

Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion’s location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer.Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark’s Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy.Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients.Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.

Cardiac Autonomic Neuropathy is Associated with Improved Diabetic Foot Ulcer Healing: A Single Centre Prospective Cohort Study

2020 ◽  
Author(s):  
Frederick Farrow ◽  
Nikolaos Fountoulakis ◽  
Kelly Cummins ◽  
Angelica Sharma ◽  
Rabiah Mahmood ◽  
...  
Keyword(s):  
Cohort Study ◽  
Autonomic Neuropathy ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Major Amputation ◽  
Complete Healing ◽  
University Hospital ◽  
Cardiac Autonomic Neuropathy ◽  
Single Centre

Abstract Aims People with diabetes and peripheral neuropathy (DPN) are at high risk of diabetic foot ulceration (DFU). The prevalence of cardiac autonomic neuropathy (CAN) in people with DFU is unknown and if CAN influences DFU healing is unclear. Methods We investigated, in a prospective observational single-centre cohort study, if CAN predicts DFU healing in 47 (77% male) people with a DFU and DPN attending a university hospital foot clinic. CAN was diagnosed by 2 or more abnormal Ewing’s tests. Baseline DFU severity was evaluated using the site, ischaemia, neuropathy, bacterial infection, area and depth (SINBAD) score. The primary outcome was defined as evidence of DFU healing on clinical examination. Median (interquartile) length of follow-up was 1150 (624–1331) days. Results The prevalence of CAN was 43%. Of the cohort, 70% had complete healing of their DFU. Participants with CAN had a shorter median (interquartile) duration time to heal compared to those without CAN [91 (44–164) days compared to 302 (135–413) (p=0.047)]. Minor/major amputation and mortality was similar in both groups. The presence of CAN increased DFU healing by two-fold [HR=2.05, 95% CI 1.01–4.16, p=0.046] in multivariable competing risk analyses. Conclusions We demonstrate a high prevalence of CAN in a DFU cohort and that CAN is associated with improved DFU healing. The results of this study establish the scientific rationale for further studies to better understand the mechanisms between CAN and DFU outcomes.

scholarly journals Silver colloid dressings score over conventional dressings in diabetic foot ulcer: a randomized clinical trial

2017 ◽  
Vol 4 (8) ◽  
pp. 2627 ◽  
Author(s):  
Rajkumar Sharma ◽  
Niraj Gupta ◽  
Vipan Kumar ◽  
Sanjay Pal ◽  
Vishal Kaundal ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Controlled Trial ◽  
Local Treatment ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Complete Healing ◽  
P Value ◽  
Silver Colloid ◽  
Wound Area ◽  
Ulcer Size

Background: Topical silver treatments and silver dressings are increasingly used for the local treatment of contaminated or infected wounds; however, there is a lack of clarity regarding the evidence for their effectiveness. To compare the outcome of silver colloidal based dressing in comparison to conventional dressing in management of diabetic foot ulcers.Methods: This was a single institution prospective randomized controlled trial. Patients with Wagner grade 1and 2 diabetic foot ulcer were enrolled in this study. Patients were assessed on day one and then at two weeks interval for twelve weeks for ulcer size by planimetry.Results: Out of 25 patients, 13 were randomized to silver colloid group and 12 in conventional dressing group. Age and sex distribution was comparable among two groups. Total 29 ulcers were present in silver colloidal and conventional dressing group. Mean wound area in silver colloidal dressing group and conventional dressing group on admission was 36.8 and 20.46 cm2 respectively. After 12 weeks of dressing mean wound area in silver colloidal dressing group and conventional dressing group decreased by 31.52 (85.65%) and 14.04 (68.62%) and after 12-week complete healing was seen in 11 (84.62%) patients in silver colloidal dressing group and 5 (41.67) patients in conventional dressing group.Conclusions: The results suggest that silver colloidal based dressing had significantly better outcome in form of complete healing and decrease in ulcer size in comparison to conventional dressing in diabetic foot ulcers (p value <0.05).

Use of GBT013, a Collagen-Based Dressing, for the Healing of Diabetic Foot Ulcers

2018 ◽  
Vol 108 (5) ◽  
pp. 419-429
Author(s):  
Isabelle J. Dumont ◽  
Marc Lepeut ◽  
Coralie Segalen ◽  
Yannis Guillemin ◽  
Jean Noel Gouze
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Complete Healing ◽  
Ease Of Use ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Foot Care ◽  
University Of Texas

The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (&gt;44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients.

scholarly journals Efficacy of lysine versus mupirocin in the treatment of non-diabetic foot ulcer: the sessing scale for assessment of pressure ulcer

2020 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Sridhar Prasad Y. P. ◽  
Sandeep B. ◽  
Shashi Kumara ◽  
Prathima C. ◽  
Vani J.
Keyword(s):  
Wound Healing ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Standard Treatment ◽  
Foot Ulcer ◽  
Test Group ◽  
Diabetic Foot Ulcer ◽  
Treated Group ◽  
Control Group ◽  
Open Label

Background: This present studies intended to evaluate the wound healing ability, efficacy and tolerability of lysine cream (15%) in non- diabetic foot ulcer assessed by way of sessing scale.Methods: A randomized, open-label, interventional study was directed on 20 subjects (participants) non-diabetic ulcers. Participants were grouped into two groups, control (n=10) and case (n=10). The control was treated with standard treatment with mupirocin and the test group was treated with standard treatment alongside lysine cream (15%) twice every day. Wound healing in the participants was assessed by the sessing scales.Results: A total of 20 participants were allotted into two groups. The results expressed as mean±standard deviation values imply the size and depth of the foot ulcer from the first week to the 8th week. Both the groups showed a significant increase the ulcer healing and decrease the pressure of foot ulcer of over a period of 8 weeks. Assessment of the first week showed no significant ulcer healing and its pressure. The overall outcome indicated that the lysine-treated group extensively reduced each of the parameters favouring wound healing than the standard therapy with mupirocin (control group).Conclusions: Results concluded that, lysine cream is better efficacious in the repair of wound and additionally well tolerated compared to mupirocin.

scholarly journals Saline dressing versus povidone iodine dressing in chronic diabetic foot ulcer healing: a prospective comparative study

2019 ◽  
Vol 6 (5) ◽  
pp. 1524
Author(s):  
Srinivas B. Kulkarni ◽  
Venkatesh S. ◽  
Kruthi S. R.
Keyword(s):  
Comparative Study ◽  
Surface Area ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Daily Basis ◽  
Complete Healing ◽  
Prospective Comparative Study ◽  
The Mean

Background: Numerous topical agents are used for chronic diabetic foot ulcer (DFU) care and healing. In most of the hospitals in India povidone iodine is used topically for DFU dressing, however few other agents are more efficacious; the present study was aimed to compare the effect of povidone iodine and normal saline dressing in healing of DFU.Methods: A total of 50 patients (25 patients in each arm of povidone Iodine and Saline dressing group) with complaints of chronic DFU attending surgery outpatient department of Rajarajeswari Medical College and Hospital were considered in this prospective comparative study from July 2017 to December 2018. Dressings were done on daily basis for a period of 6 weeks, and the results were compared on 2nd, 4th and 6th week, using reduction in surface area of chronic DFU as parameter of healing process.Results: The mean surface area of wound in povidone iodine group was: baseline- 12.2 sq.cm, 2nd week- 11.7 sq.cm, 4th week- 10.6 sq.cm, 6th week- 9.8 sq.cm; While in saline group was: baseline- 13.3 sq.cm, 2nd week- 11.6 sq.cm, 4th week- 10.8 sq.cm, 6th week- 9.6 sq.cm. After 6 weeks, the mean reduction in surface area of wound is more in the saline dressing group compared with the povidone iodine dressing group and the results are statistically significant at a p<0.05.Conclusions: Saline dressing is more effective than povidone iodine dressing in achieving complete healing, reducing wound surface area, and increasing comfort in subjects with chronic DFU.

scholarly journals Comparison Low-Level Laser Therapy (LLLT) of 10J/cm2 and 5 J/cm2 Energy Density for Healing Diabetes Foot Ulcer

2020 ◽  
Vol 70 (2) ◽  
pp. 16-22
Author(s):  
Purwitasari Darmaputri ◽  
Nury Nusdwinuringtya ◽  
Nyoman Murdana ◽  
Tri Juli Edi Tarigan ◽  
Dewi Friska
Keyword(s):  
Energy Density ◽  
Laser Therapy ◽  
Diabetic Foot ◽  
Standard Treatment ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Low Level Laser Therapy ◽  
Level Laser ◽  
Group A ◽  
Group B

Background: Diabetic foot ulcer is a problem in patients with diabetes mellitus (DM). One adjuvant therapy that can enhance wound healing is Low-Level Laser Therapy (LLLT), but there is no established guideline regarding the dosage. In Indonesia, there has been no study comparing the energy density of LLLT on diabetic ulcer healingMethods: This is an experimental study on 28 subjects with a randomized diabetic foot ulcer. Group A received standard treatment of ulcer and LLLT 5J/cm2. Group B received standard treatment of ulcer and LLLT 10J/cm2.Results: The difference in wound size between group A and group B were 4.15 mm2 and 7.5 mm2 (p=0.178). The healing rate of group A and group B were 4.15 (-10-34.5) mm2/4 weeks and 7.5 (-2.8-34) mm2/4weeks (p=0.168). Conclusions: There was no statistically significant difference between the group receiving LLLT 5J/cm2 or 10 J/cm2 in diabetic foot ulcer healing.

scholarly journals Angiosome based revascularization for diabetic foot ulcer

2019 ◽  
Vol 6 (10) ◽  
pp. 3474
Author(s):  
Ahmed M. Hossny ◽  
Mahmoud S. Eldesouky ◽  
Mohamed A. Abdellatif
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Complete Healing ◽  
Controlled Study ◽  
University Hospitals ◽  
Acceptable Result ◽  
Group A ◽  
Group B

Background: The purpose of this study was to analyze the clinical benefit in wound healing and limb preservation after infrapopliteal endovascular revascularization guided by an angiosome model of perfusion in the healing process of diabetic foot ulcers.Methods: This is a prospective controlled study was conducted on 60 patients with critical lower limb ischemia in the form of diabetic foot ulcer and/or gangrene. The study period started from August 2017 until February 2019. Patients included in the study were essentially attending the Vascular Outpatient Clinic at Menoufia University Hospitals and Nasser Institute for Search and Treatment at Cairo treated by infra-popliteal angioplasty.Results: The 60 patients of our study who underwent successful infra-popliteal angioplasty we found that after six months 18 patients in the direct group A (85.71%), 9 patients in indirect group B (42.85%) and 17 patients in combined group C (94.44%) showed complete healing of their wounds and that 18 patients in group A (85.71%), 15 patients in group B (71.42%) and 17 patients in group C (94.44%) have their limbs salvaged total 50 patients (83.33%).Conclusions: We concluded that dilation of angiosome target artery plus any other significant tibial artery lesions should be considered and indirect revascularization should not be denied with acceptable result over time.

scholarly journals Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rakesh Sharma ◽  
Suresh K. Sharma ◽  
Shiv Kumar Mudgal ◽  
Prasuna Jelly ◽  
Kalpana Thakur
Keyword(s):  
Clinical Trials ◽  
Mortality Rate ◽  
Hyperbaric Oxygen ◽  
Diabetic Foot ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Complete Healing ◽  
Controlled Clinical Trials

AbstractStudies have suggested that hyperbaric oxygen therapy (HBOT) is effective in the healing of diabetic foot ulcer (DFU); however, there is a lack of consensus. Therefore, to assess the efficacy of HBOT on diabetic foot ulcer among diabetic patients, controlled clinical trials were searched through PubMed, EMBASE, Clinical key, Ovid Discovery, ERMED, Clinical Trials.gov databases for randomized controlled trials (RCTs) and other sources until 15 September 2020. Studies that evaluated the effect of HBOT on diabetic foot ulcer, complete healing, amputation, adverse events, ulcer reduction area, and mortality rate were included. Of 1984 study records screened, 14 studies (768 participants) including twelve RCTs, and two CCTs were included as per inclusion criteria. The results with pooled analysis have shown that HBOT was significantly effective in complete healing of diabetic foot ulcer (OR = 0.29; 95% CI 0.14–0.61; I2 = 62%) and reduction of major amputation (RR = 0.60; 95% CI 0.39–0.92; I2 = 24%). Although, it was not effective for minor amputations (RR = 0.82; 95% CI 0.34–1.97; I2 = 79%); however, less adverse events were reported in standard treatment group (RR = 1.68; 95% CI 1.07–2.65; I2 = 0%). Nevertheless, reduction in mean percentage of ulcer area and mortality rate did not differ in HBOT and control groups. This review provides an evidence that hyperbaric oxygen therapy is effective as an adjunct treatment measure for the diabetes foot ulcers. These findings could be generalized cautiously by considering methodological flaws within all studies.

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