scholarly journals Wound Fluid Matrix Metalloproteinase-9 as a Potential Predictive Marker for the Poor Healing Outcome in Diabetic Foot Ulcers

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Punyanuch Jindatanmanusan ◽  
Sivat Luanraksa ◽  
Tanit Boonsiri ◽  
Thirayost Nimmanon ◽  
Pasra Arnutti
Keyword(s):  
Wound Healing ◽  
G Protein ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Fluid ◽  
The Poor ◽  
Wound Size

Background and Objective. Evidence for the roles of matrix metalloproteinases-9 (MMP-9) in the healing process of diabetic foot ulcers has remained unclear. We therefore aimed to demonstrate the relationship of MMP-9 with the wound healing process and determine its potential usefulness in predicting the wound healing outcome. Methods. Twenty-two patients with diabetic foot ulcer were recruited. The wound size was determined, and the wound fluid was collected for the measurement of MMP-9 levels using an ELISA during the 12-week follow-up period regularly. The patients were categorized as good healers and poor healers when the wound area reduction was ≥ 50% and < 50% at week 4 when compared to the initial wound size at week 0. Results. Median wound fluid MMP-9 levels in the poor healer group were shown to be significantly higher than those in the good healer group (1.03 pg/µg protein vs. 0.06 pg/µg protein, p = 0.001), and the levels fluctuated throughout the 12-week follow-up period. In contrast to the poor healer group, the MMP-9 levels were demonstrated to be constantly low throughout the follow-up period in the good healer group. ROC analysis showed that the MMP-9 level of 0.38 pg/µg protein was able to predict the wound healing outcome with the sensitivity of 81.8%, the specificity of 64.6%, and the area under the curve of 0.901 (CI 0.78-1.03, p = 0.001). Conclusion. These findings suggested that determination of wound fluid MMP-9 levels might become a promising biomarker predicting wound healing outcomes and a novel potential therapeutic target for diabetic foot ulcers.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

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.

Effect of Family Empowerment on HbA1c Levels and Healing of Diabetic Foot Ulcers

2020 ◽  
pp. 153473462093012
Author(s):  
Rasnah Appil ◽  
Elly Lilianty Sjattar ◽  
Saldy Yusuf ◽  
Kasmawati Kadir
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Intervention Group ◽  
Foot Ulcers ◽  
Control Group ◽  
Wound Healing Process ◽  
Diabetic Foot Ulcers ◽  
Family Empowerment ◽  
Hba1c Levels

Objective. To evaluate the effectiveness of family empowerment through educational interventions against HbA1c level and healing progress of diabetic foot ulcers. Method. A quasi-experimental design was employed involving 33 participants from 4 wound care clinics in Makassar, eastern Indonesia. The intervention group consisted of 17 participants and their families; the control group was composed of 16 participants who received nonstructural education. Family empowerment was measured by the Indonesian version of the Family Empowerment Scale instrument. Glycemic control was evaluated with HbA1c levels, and the wound healing process was evaluated on the Diabetic Foot Ulcers Assessment Scale. Result. After 3 months, Family Empowerment Scale scores improved, particularly in the subdomain of family knowledge (16.59 ± 3.92 vs 13.38 ± 1.26; P = .005) and attitude (3.65 ± 0.93 vs 2.75 ± 0.45; P = .002). After 3 months of intervention, HbA1c decreased (from 10.47 ± 2.44% to 8.81 ± 1.83%), compared with the control group ( P = .048). Meanwhile, an independent t test further revealed that the wound healing process tended to be better with the intervention group (4.71 ± 7.74) compared with the control group (17.25 ± 17.06), with P = .010 at the third month. Conclusion. Family-based education intervention creates family empowerment to control HbA1c levels and accelerate wound healing of diabetic foot ulcer.

scholarly journals Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
F. R. Henshaw ◽  
P. Boughton ◽  
L. Lo ◽  
S. V. McLennan ◽  
S. M. Twigg
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Fluid ◽  
Diabetic Wounds

Aims/Hypothesis. Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken.Methods. Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1 μg rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulation tissue. In the human study across 32 subjects, serial CTGF regulation was analyzed longitudinally in postdebridement diabetic wound fluid.Results. CTGF treated diabetic wounds had an accelerated closure rate compared with vehicle treated diabetic wounds. Healed skin withstood more strain before breaking in CTGF treated rat wounds. Granulation tissue from CTGF treatment in diabetic wounds showed collagen IV accumulation compared with nondiabetic animals. Woundα-smooth muscle actin was increased in CTGF treated diabetic wounds compared with untreated diabetic wounds, as was macrophage infiltration. Endogenous wound fluid CTGF protein rate of increase in human diabetic foot ulcers correlated positively with foot ulcer healing rate (r=0.406;P<0.001).Conclusions/Interpretation. These data collectively increasingly substantiate a functional role for CTGF in human diabetic foot ulcers.

Nanobiocatalysts: Cu/TiO2-SiO2 Nanoparticles as Tissue-Regeneration Treatment for Diabetic Foot Ulcers: In Vivo Studies

2020 ◽  
Vol 9 (3) ◽  
pp. 230-239
Author(s):  
Tessy López-Goerne ◽  
Francisco J. Padilla-Godínez ◽  
Luis Pérez-Dávalos ◽  
Paola Ramírez-Olivares ◽  
Daniela Arellano
Keyword(s):  
Wound Healing ◽  
Tissue Regeneration ◽  
Diabetic Foot ◽  
Conservative Therapy ◽  
Healing Process ◽  
In Vivo Studies ◽  
Successful Outcome ◽  
Foot Ulcers ◽  
Wound Healing Process ◽  
Diabetic Foot Ulcers

Background: Diabetic foot ulcers (DFUs) exhibit 80% of prevalence in Mexico. Efficient tissue regeneration therapies are the key factors to avoid amputations. Objective: In this study, the healing properties of a Cu/TiO2-SiO2 nanobiocatalyst applied in DFUs were analyzed. Furthermore, the morphology and crystalline structures were characterized. Methods: The nanobiocatalyst was synthesized by a sol-gel patented method proposed by López et al. The compound was characterized by scanning and transmission electron microscopies and Xray diffraction. The nanoparticles were embedded in a polymeric gel matrix (nanogel), which was utilized as a conservative therapy for chronic non-healing DFU in 8 patients with several comorbidities and chronic complications of diabetes. Wound debridement was performed prior to the nanogel administration. The nanogel was applied over the ulcers on alternate days for different periods of time, depending on the case. Results: Significant improvement in terms of enhanced epithelialization was observed in the wound healing process after a few applications. Infection spread was limited, and tissue regeneration was enhanced, with significant healing of the ulcers observed in each case. Furthermore, the successful outcome allowed to avoid the amputations that were proposed to some of the patients. Conclusion: The study proved the efficiency of the nanobiocatalyst as a safe, conservative therapy for chronic non-healing DFUs. Further investigation must be carried out to fully elucidate the wound-healing mechanisms of the nanoparticles.

scholarly journals Matrix Metalloproteinases (MMPs) and Diabetic Foot: Pathophysiological Findings and Recent Developments in Their Inhibitors of Natural as well as Synthetic Origin

2020 ◽  
Author(s):  
Kirandeep Kaur ◽  
Atamjit Singh ◽  
Shivani Attri ◽  
Danish Malhotra ◽  
Aditi Verma ◽  
...  
Keyword(s):  
Wound Healing ◽  
Matrix Metalloproteinases ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Inflammatory Phase ◽  
Recent Developments ◽  
Multiple Biomarkers ◽  
Synthetic Origin

Management of diabetic foot remains a major challenge for healthcare system. Though wound healing is a multiphase process and involved multiple biomarkers that acts in stepwise manner, pathophysiology diabetic foot ulcers is still not much clear and need standardization. Matrix metalloproteinases (MMPs) are often linked with non-healing characteristic of diabetic foot ulcers. They play vital roles in various phases of healing process. Major functions are removal of damaged extracellular matrix in inflammatory phase, breakdown of capillary basement membrane prior to angiogenesis and facilitation in fibroblast migration during proliferation phase. For efficient healing, these enzymes are needed in certain amount only. Imbalance of these enzymes leads to excessive degradation which has been linked with the non-healing nature of diabetic ulcers. This chapter will shed light on the role of MMP’s in various phases of wound healing and the inhibitors of MMP’s from natural as well as synthetic origin. It would help researchers and physicians to the understand nature of diabetic foot more clearly and design of strategies for diabetic foot management.

scholarly journals Targeting MMP-9 in Diabetic Foot Ulcers

2019 ◽  
Vol 12 (2) ◽  
pp. 79 ◽  
Author(s):  
Jeffrey I. Jones ◽  
Trung T. Nguyen ◽  
Zhihong Peng ◽  
Mayland Chang
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Wound Healing Process ◽  
Diabetic Foot Ulcers ◽  
Novel Approach ◽  
Medical Need ◽  
Diabetic Wound Healing ◽  
Diabetic Wounds

Diabetic foot ulcers (DFUs) are significant complications of diabetes and an unmet medical need. Matrix metalloproteinases (MMPs) play important roles in the pathology of wounds and in the wound healing process. However, because of the challenge in distinguishing active MMPs from the two catalytically inactive forms of MMPs and the clinical failure of broad-spectrum MMP inhibitors in cancer, MMPs have not been a target for treatment of DFUs until recently. This review covers the discovery of active MMP-9 as the biochemical culprit in the recalcitrance of diabetic wounds to healing and targeting this proteinase as a novel approach for the treatment of DFUs. Active MMP-8 and MMP-9 were observed in mouse and human diabetic wounds using a batimastat affinity resin and proteomics. MMP-9 was shown to play a detrimental role in diabetic wound healing, whereas MMP-8 was beneficial. A new class of selective MMP-9 inhibitors shows clinical promise for the treatment of DFUs.

scholarly journals Treatment of diabetic foot ulcers

2021 ◽  
Vol 64 (8) ◽  
pp. 529-536
Author(s):  
Jiyong Ahn
Keyword(s):  
Wound Healing ◽  
Cost Effectiveness ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Wound Healing Process ◽  
Diabetic Foot Ulcers ◽  
High Quality ◽  
Dressing Materials

Background: Diabetic foot ulcers (DFUs), a risk factor for infection, remain a difficult clinical complication. Infected DFUs may be associated with lower extremity amputation. To achieve wound healing and avoid amputation, an assortment of dressing materials and negative pressure wound therapy (NPWT) have been used on soft tissue injuries resulting from infected DFUs. A great deal of interest about the use of dressing materials and NPWT in the treatment of DFUs has arisen. However, there have only been a few high-quality studies regarding this topic.Current Concepts: Ideal dressing materials should satisfy certain conditions to alleviate symptoms of DFU infection and enhance the wound healing process. A single dressing material cannot fulfill all of these requirements. Based on clinical trials, different dressing materials must be chosen according to the status of the individual wound environment, including the amount of exudate, degree of pain, severity of the infection, and cost-effectiveness. However, there has been no clear evidence that advanced wound dressing materials are superior to basic dressing materials in wound healing. Recently, NPWT has been used to cover the soft tissue defects of infected DFU with granulation tissue. NPWT may contribute to changing growth factor expression, micro- and macro-deformation, vascular flow, amount of exudate, and the bacterial environment in DFU, despite the unclear mechanism of its role in wound repair.Discussion and Conclusion: Further research to obtain high-quality evidence regarding the benefits of using dressing materials and NPWT is needed. The optimal protocol for DFU and cost-effectiveness should be included in these future studies.

scholarly journals Studi Kasus Uji Pra Klinik Perawatan Ulkus Kaki Diabetic Dengan Topikal Hidrokoloid Kunyit

2018 ◽  
Vol 13 (2) ◽  
pp. 111-119
Author(s):  
Doddy Yumam Prasetyo ◽  
Muhammad Mardiyono ◽  
Heni Kusuma
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Wound Care ◽  
Healing Process ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Ulcer ◽  
Warm Environment ◽  
The One

Diabetic foot ulcers is a chronic complications, which has many long term, can result amputation. Wound care is the one of nursinginterventions effective; principles in wound care are giving a moist and warm environment in order to improve wound healing process.Hydrocolloid turmeric is one of wound treatment moisture balance and can be used as an anti-inflammatory and anti-bacterial. This study aimed to analyze the effect of hydrocolloid turmeric against diabetic ulcer healing process. This research was conducted by case study on 7 respondents, wound care with hydrocolloid tumeric at 21 days. At 7 patient with diabetic foot ulcers were intervention wound care with hydrocolloid tumeric at 21 days, showed score decrease in degree of wound healing, based Betes Jensen Scale. 

Attack of the NETs! NETosis primes IL-1β-mediated inflammation in diabetic foot ulcers

2020 ◽  
Vol 134 (12) ◽  
pp. 1399-1401
Author(s):  
Man K.S. Lee ◽  
Gopalkrishna Sreejit ◽  
Prabhakara R. Nagareddy ◽  
Andrew J. Murphy
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcers ◽  
Wound Healing Process ◽  
Inflammasome Activation ◽  
Diabetic Foot Ulcers ◽  
Nlrp3 Inflammasome Activation ◽  
Improve Wound Healing ◽  
Insight Into

Abstract In volume 133 issue 4 of Clinical Science, Liu et al. showed that neutrophils release extracellular traps (NETs) in the setting of diabetes which acts as a stimulus for NLRP3 inflammasome activation in macrophages to promote IL1β-dependent exacerbation of inflammation. They also provide evidence to show that degrading NETs improves the wound healing process. These findings provide an insight into how NETs communicate with other cells in the vicinity (e.g. macrophages) to exacerbate the inflammatory response. Most importantly, they provide novel avenues to improve wound healing process such as diabetic foot ulcers (DFUs) by targeting NETs.

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