Effect of Vibration on Alleviating Foot Pressure-Induced Ischemia under Occlusive Compression

Objectives. Foot ulcers often occur in people with diabetes because of pressure-induced tissue ischemia. Vibration has been reported to be helpful in alleviating mechanical damage and promoting wound healing. The objective of this study is to explore whether vibration can relieve reactive hyperemia in foot tissue under occlusive compression. Methods. Thirteen healthy adults participated in the study. Each foot was placed under occlusive compression without or with vibration intervention, which was randomly assigned every other day. The dorsal foot skin blood flow (SBF) was measured pre- and postintervention for each subject in each test. Temporal variations and spectral features of SBF were recorded for comparison. Results. The results showed that subjects displayed an obvious reactive hyperemia in the foot tissue after pressure occlusion, whereas they displayed a more regular SBF when vibration was applied along with occlusive compression. Moreover, the amplitude of metabolic, neurogenic, and myogenic pathways for SBF was significantly reduced during the hyperemia process when vibration was applied. Conclusions. This study demonstrated that vibration can effectively reduce the level of hyperemia in foot tissue under occlusive compression and also induce less protective physiological regulatory activities. This is helpful for protecting foot tissue from pressure-induced ischemic injury and foot ulcers.

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Effects of Preconditioning Local Vibrations on Subsequent Plantar Skin Blood Flow Response to Walking

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620905744 ◽

2020 ◽

pp. 153473462090574 ◽

Cited By ~ 1

Author(s):

Xiaotong Zhu ◽

Fu-Lien Wu ◽

Ting Zhu ◽

Fuyuan Liao ◽

Yuanchun Ren ◽

...

Keyword(s):

Blood Flow ◽

Skin Blood Flow ◽

Repeated Measures ◽

Recovery Time ◽

Reactive Hyperemia ◽

Weight Bearing ◽

Metatarsal Head ◽

Foot Ulcers ◽

Sham Control ◽

First Metatarsal

Weight-bearing exercise such as walking may increase risk of foot ulcers in people with diabetes mellitus (DM) because of plantar ischemia due to repetitive, high plantar pressure. Applications of local vibrations on plantar tissues as a preconditioning intervention before walking may reduce plantar tissue ischemia during walking. The objective of this study was to explore whether preconditioning local vibrations reduce reactive hyperemia after walking. A double-blind, repeated-measures, and crossover design was tested in 10 healthy participants without DM. The protocol included 10-minute baseline, 10-minute local vibrations (100 Hz or sham), 10-minute walking, and 10-minute recovery periods. The order of local vibrations was randomly assigned. Skin blood flow (SBF) was measured over the first metatarsal head during baseline and recovery periods. SBF responses were characterized as peak SBF, total SBF, and recovery time of reactive hyperemia. SBF was expressed as a ratio of recovery to baseline SBF to quantify the changes. Peak SBF in the vibration protocol (6.98 ± 0.87) was significantly lower than the sham control (9.26 ± 1.34, P < .01). Total SBF in the vibration protocol ([33.32 ± 7.98] × 103) was significantly lower than the sham control ([48.09 ± 8.9] × 103, P < .05). The recovery time in the vibration protocol (166.08 ± 32.71 seconds) was not significantly different from the sham control (223.53 ± 38.85 seconds, P = .1). Local vibrations at 100 Hz could reduce walking-induced hyperemic response on the first metatarsal head. Our finding indicates that preconditioning local vibrations could be a potential preventive intervention for people at risk for foot ulcers.

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Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

VASA ◽

10.1024/0301-1526/a000203 ◽

2012 ◽

Vol 41 (4) ◽

pp. 275-281 ◽

Cited By ~ 3

Author(s):

da Rocha Chehuen ◽

G. Cucato ◽

P. dos Anjos Souza Barbosa ◽

A. R. Costa ◽

M. Ritti-Dias ◽

...

Keyword(s):

Blood Flow ◽

Oxygen Uptake ◽

Intermittent Claudication ◽

Lower Limb ◽

Ventilatory Threshold ◽

Reactive Hyperemia ◽

Ankle Brachial Index ◽

Metabolic Parameters ◽

Walking Distance ◽

The Relationship

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

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A study of effectiveness of topical recombinant human platelet derived growth factor for wound healing in patients with chronic diabetic foot ulcers at tertiary health care center

Medpusle International Journal of Surgery ◽

10.26611/1061028 ◽

2019 ◽

Vol 10 (2) ◽

pp. 62-64

Author(s):

Shirish Maskepatil ◽

◽

Sanjay Prabu Warad ◽

Keyword(s):

Health Care ◽

Wound Healing ◽

Growth Factor ◽

Diabetic Foot ◽

Human Platelet ◽

Care Center ◽

Platelet Derived Growth Factor ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Health Care Center

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The Mesenchymal Stem Cell-Derived Exosomal Long Noncoding RNA H19 Promotes Wound Healing in Diabetic Foot Ulcers by Up-Regulating PTEN via MicroRNA-152-3p

SSRN Electronic Journal ◽

10.2139/ssrn.3408040 ◽

2019 ◽

Author(s):

Bo Li ◽

Song Luan ◽

Jing Chen ◽

Yue Zhou ◽

Tingting Wang ◽

...

Keyword(s):

Wound Healing ◽

Stem Cell ◽

Mesenchymal Stem Cell ◽

Diabetic Foot ◽

Long Noncoding Rna ◽

Noncoding Rna ◽

Foot Ulcers ◽

Diabetic Foot Ulcers

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Wound With Diabetes: Present Scenario And Future

Current Diabetes Reviews ◽

10.2174/1573399816666200703180137 ◽

2020 ◽

Vol 16 ◽

Author(s):

Kuldeep B. Pawar ◽

Shivani Desai ◽

Ramesh R. Bhonde ◽

Ritesh P. Bhole ◽

Atul A. Deshmukh

Keyword(s):

Wound Healing ◽

Blood Flow ◽

Healing Process ◽

Endocrine System ◽

Healing Time ◽

Special Focus ◽

Diabetic Wound ◽

Management Options ◽

And Migration ◽

Proliferation And Migration

: Diabetes is a chronic metabolic disorder of endocrine system characterized by increase in blood glucose level. Several factors such as pancreatic damage, oxidative stress, infection, genetic factor, obesity, liver dysfunction play a vital role in pathogenesis of diabetes which further lead to serious diabetic complications. Diabetic wound is one such complication where the wound formation occurs, especially due to pressure and its healing process is disrupted due to factors such as hyperglycemia, neuropathy, nephropathy, peripheral vascular disease, reduction of blood flow, atherosclerosis, impaired fibroblast. Process of wound healing is delayed due to different abnormalities like alteration in nitric oxide level, increase in aldose reductase, sorbitol and fructose. Therefore, diabetic wound requires more time to heal as compare to normal wound. Healing time is delayed in diabetic wound due to many factors such as stress, decreased oxygenation supply, infection, decreased blood flow, impaired proliferation and migration rate, impaired growth factor production, impaired keratinocytes proliferation and migration, and altered vascular endothelial mediators. The current treatment for diabetic wound includes wound patches, oxygenation therapy, hydrogel patches, gene therapy, laser therapy, and stem cell therapy. Medications with phytoconstituents is also one way to manage diabetic wound, but it is not more effective for quick healing. The objective of this review is to understand the potential of various management options which are available for diabetic wound, with a special focus on biological cells.

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

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211031085 ◽

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.

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Therapeutic Properties of Honey for the Management of Wounds; Is There a Role in the Armamentarium of Diabetic Foot Ulcer Treatment? Results From In vitro and In vivo Studies

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211026819 ◽

2021 ◽

pp. 153473462110268

Author(s):

Ioanna A. Anastasiou ◽

Ioanna Eleftheriadou ◽

Anastasios Tentolouris ◽

Georgia Samakidou ◽

Nikolaos Papanas ◽

...

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Diabetic Animal ◽

Cochrane Library ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Diabetic Wound ◽

Diabetic Wound Healing ◽

Therapeutic Properties

Diabetic foot ulcers are one of the most dreadful complications of diabetes mellitus and efforts to accelerate diabetic wound healing are of paramount importance to prevent ulcer infections and subsequent lower-limb amputations. There are several treatment approaches for the management of diabetic foot ulcers and honey seems to be a safe and cost-effective therapeutic approach on top of standard of care. The aim of this review was to summarize the therapeutic properties of honey and the data regarding its possible favorable effects on diabetic wound healing. A literature search of articles from 1986 until April 2021 was performed using MEDLINE, EMBASE, and the Cochrane Library to assess for studies examining the therapeutic wound healing properties of honey, it's in vitro effect, and the efficacy and/or mechanism of action of several types of honey used for the treatment of diabetic animal wounds. Honey has antioxidant, anti-inflammatory, and antibacterial properties and in vitro studies of keratinocytes and fibroblasts, as well as studies in diabetic animal models show that treatment with honey is associated with increased re-epithelialization and collagen production, higher wound contraction, and faster wound healing. The use of honey could be a promising approach for the management of diabetic foot ulcers.

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Using reactive hyperemia to investigate the effect of cupping sizes of cupping therapy on skin blood flow responses

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200120 ◽

2021 ◽

pp. 1-7

Author(s):

Xiangfeng He ◽

Xueyan Zhang ◽

Fuyuan Liao ◽

Li He ◽

Xin Xu ◽

...

Keyword(s):

Blood Flow ◽

Laser Doppler Flowmetry ◽

Skin Blood Flow ◽

Repeated Measures ◽

Recovery Time ◽

Reactive Hyperemia ◽

Cupping Therapy ◽

Doppler Flowmetry ◽

Healthy Participants ◽

Hyperemic Response

BACKGROUND: Various cupping sizes of cupping therapy have been used in managing musculoskeletal conditions; however, the effect of cupping sizes on skin blood flow (SBF) responses is largely unknown. OBJECTIVE: The objective of this study was to compare the effect of three cupping sizes of cupping therapy on SBF responses. METHODS: Laser Doppler flowmetry (LDF) was used to measure SBF on the triceps in 12 healthy participants in this repeated measures study. Three cup sizes (35, 40 and 45 mm in diameter) were blinded to the participants and were tested at -300 mmHg for 5 minutes. Reactive hyperemic response to cupping therapy was expressed as a ratio of baseline SBF. RESULTS: All three sizes of cupping cups resulted in a significant increase in peak SBF (p< 0.001). Peak SBF of the 45 mm cup (9.41 ± 1.32 times) was significantly higher than the 35 mm cup (5.62 ± 1.42 times, p< 0.05). Total SBF of the 45 mm cup ((24.33 ± 8.72) × 103 times) was significantly higher than the 35 mm cup ((8.05 ± 1.63) × 103 times, p< 0.05). Recovery time of the 45 mm cup (287.46 ± 39.54 seconds) was significantly longer than the 35 mm cup (180.12 ± 1.42 seconds, p< 0.05). CONCLUSIONS: Our results show that all three cup sizes can significantly increase SBF. The 45 mm cup is more effective in increasing SBF compared to the 35 mm cup.

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Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite

Journal of Clinical Medicine ◽

10.3390/jcm10020371 ◽

2021 ◽

Vol 10 (2) ◽

pp. 371

Author(s):

Kor H. Hutting ◽

Wouter B. aan de Stegge ◽

Jaap J. van Netten ◽

Wouter A. ten Cate ◽

Luuk Smeets ◽

...

Keyword(s):

Wound Healing ◽

Surgical Treatment ◽

Treatment Regimen ◽

Diabetic Foot ◽

Prospective Trial ◽

Calcium Sulphate ◽

Foot Ulcers ◽

Ulcer Recurrence ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis

Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.

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