Buried Chip Skin Grafting in Neuropathic Diabetic Foot Ulcers Following Vacuum-Assisted Wound Bed Preparation: Enhancing a Classic Surgical Tool with Novel Technologies

Background: Negative pressure wound therapy (NPWT) is a non-invasive wound closure system that uses controlled, localized negative pressure to help heal chronic and acute wounds. The objective of the present study was to compare home based NPWT and moist wound dressing in home care setting with respect to wound healing and time taken for healing among diabetic ulcer patients and the comparison of cost involved for the treatment.Methods: A hospital based prospective observational study where all patients were presented to the Department of Surgery at MES Medical College with diabetic ulcer between 1st January 2016 and 30th March 2017 were included in the study; ulcer size and surface area were measured using vernier calipers and Wagner’s grade between the two groups were evaluated at the time of enrollment.Results: Complete ulcer healing by primary intention was achieved in 86.8% in home based NPWT group vs. 44.3% in conventional moist dressing group. Average duration taken for healing in home based NPWT patient was 3.03 months and in moist dressing group was 4.58 months. Split skin grafting was needed in 2 patients in HB-NPWT group vs. 7 in moist dressing group. 9.3 hospital visits in HB-NPWT group vs 136.8 sessions in moist dressing group.Conclusions: The present study states that NPWT is superior to conventional moist dressing for the management of chronic diabetic foot ulcers. Cost is approximately 1/10th of standard NPWT.

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Application of 3D Bioprinting Technologies to the Management and Treatment of Diabetic Foot Ulcers

Biomedicines ◽

10.3390/biomedicines8100441 ◽

2020 ◽

Vol 8 (10) ◽

pp. 441

Author(s):

Chew Teng Tan ◽

Kun Liang ◽

Zong Heng Ngo ◽

Christabel Thembela Dube ◽

Chin Yan Lim

Keyword(s):

Diabetic Foot ◽

Skin Grafting ◽

Current Treatment ◽

Wound Dressings ◽

Wound Management ◽

Healthcare Sector ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

3D Bioprinting ◽

Skin Substitutes

Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. Diabetic foot ulcers (DFUs) are a serious complication of DM. It is estimated that 15–25% of DM patients develop DFU at least once in their lifetime. The lack of effective wound dressings and targeted therapy for DFUs often results in prolonged hospitalization and amputations. As the incidence of DM is projected to rise, the demand for specialized DFU wound management will continue to increase. Hence, it is of great interest to improve and develop effective DFU-specific wound dressings and therapies. In the last decade, 3D bioprinting technology has made a great contribution to the healthcare sector, with the development of personalized prosthetics, implants, and bioengineered tissues. In this review, we discuss the challenges faced in DFU wound management and how 3D bioprinting technology can be applied to advance current treatment methods, such as biomanufacturing of composite 3D human skin substitutes for skin grafting and the development of DFU-appropriate wound dressings. Future co-development of 3D bioprinting technologies with novel treatment approaches to mitigate DFU-specific pathophysiological challenges will be key to limiting the healthcare burden associated with the increasing prevalence of DM.

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Novel technologies for detection and prevention of diabetic foot ulcers

The Science, Etiology and Mechanobiology of Diabetes and its Complications ◽

10.1016/b978-0-12-821070-3.00007-6 ◽

2021 ◽

pp. 107-122

Author(s):

Neil D. Reeves ◽

Bill Cassidy ◽

Caroline A. Abbott ◽

Moi Hoon Yap

Keyword(s):

Diabetic Foot ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Novel Technologies

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How does the use of skin grafting and/or tissue replacement compare with standard care for treating diabetic foot ulcers?

Cochrane Clinical Answers ◽

10.1002/cca.1436 ◽

2016 ◽

Keyword(s):

Diabetic Foot ◽

Standard Care ◽

Skin Grafting ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Tissue Replacement

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Changes in Bacterial Profiles and Antibiotic Sensitivity Before and After Wound Bed Preparation for Diabetic Foot Ulcers

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734615574940 ◽

2015 ◽

Vol 14 (2) ◽

pp. 160-167 ◽

Cited By ~ 1

Author(s):

Guangyu Wang ◽

Jinghua Tian ◽

Lv-yun Zhu ◽

Shaoling Yang ◽

Yi Ding ◽

...

Keyword(s):

Diabetic Foot ◽

Antibiotic Sensitivity ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Before And After ◽

Wound Bed Preparation

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Wound Bed Preparation for Chronic Diabetic Foot Ulcers

ISRN Endocrinology ◽

10.1155/2013/608313 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 17

Author(s):

Arman Zaharil Mat Saad ◽

Teng Lye Khoo ◽

Ahmad Sukari Halim

Keyword(s):

Diabetic Foot ◽

Management Strategies ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcers ◽

Holistic Approaches ◽

Practice Of Medicine ◽

Moisture Balance ◽

Infection And Inflammation ◽

Wound Bed Preparation

The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient’s general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The “TIME” framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant.

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A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

International Surgery Journal ◽

10.18203/2349-2902.isj20175142 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3858

Author(s):

Caren Dsouza ◽

. Rouchelle ◽

. Chirag ◽

Erel Diaz ◽

Shubha Rao

Keyword(s):

Randomized Controlled Trial ◽

Diabetic Foot ◽

Chronic Wounds ◽

Low Cost ◽

Controlled Trial ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Vac Therapy ◽

Randomized Controlled ◽

Wound Bed Preparation

Background: Diabetic foot ulcers are chronic wounds which are difficult to heal, due to ischemia and intrinsic defects in angiogenesis and impaired immunity against infection. VAC therapy influences positive mechanical forces on the growth of tissues, especially in stimulating cell migration and mitosis, optimizes blood flow, decreases local tissue edema from the wound bed and provides an occlusive environment for wound healing under moist, clean and sterile conditions. Aims and objective was to compare the effectiveness of low cost hospital made VAC dressing with conventional dressings in healing of diabetic foot ulcers.Methods: This study was a prospective, randomized controlled trial and included 60 patients with diabetic foot ulcers admitted over 3 months. Patients were randomly allocated to two groups: odd numbered patients to VAC therapy and the even numbered patients to conventional dressings. Wound swab was taken before the start of the study. The data was analyzed and presented in percentages or proportions using Chi-square test and Student-t-test wherever applicable. Results: In this study it was found that in the VAC dressing group 76.7% of the ulcers had red granulation tissue at the end of therapy compared to 46.7% in conventional group. The mean wound bed preparation time was found to be 15.60 days in the conventional dressing group and 8.50 days in the VAC therapy group. In the VAC group 72.73% ulcers had no bacteria at the end of therapy.Conclusion: In this study, it was found that Vacuum Assisted Closure therapy was more effective than conventional dressings in the wound bed preparation of diabetic foot ulcers.

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