Hard-to-heal diabetic foot ulcers treated using negatively charged polystyrene microspheres: a 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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Healing hard-to-heal diabetic foot ulcers: the role of dehydrated amniotic allograft with cross-linked bovine-tendon collagen and glycosaminoglycan matrix

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup7.s47 ◽

2021 ◽

Vol 30 (Sup7) ◽

pp. S47-S53

Author(s):

Grace L Tsai ◽

Daniel Zilberbrand ◽

Wei Jei Liao ◽

Lawrence P Horl

Keyword(s):

Amniotic Membrane ◽

Diabetic Foot ◽

Wound Closure ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Dermal Matrix ◽

Increased Risk ◽

The Mean ◽

Prospective Case Series

The treatment of diabetic foot ulcers is complex and costly with an increased risk for infection, which may even lead to amputation. This prospective case series aims to assess the effectiveness of a dehydrated amniotic membrane allograft combined with a bilayer dermal matrix for healing complicated foot ulcers in patients with comorbidities. A total of six patients with complicated full-thickness ulcers and comorbidities, such as diabetes and peripheral vascular disease were treated with this technique. Each wound was measured intraoperatively just before graft application, at 14 days after application, and then at weeks 4, 8, and 12. Changes in wound volume and area were compared over time. One patient had complete wound closure by week eight, a second patient by week 12. The other four patients had wounds that decreased in size during the course of 12 weeks. The mean decrease in wound volume was 73.5% post-removal of the bilayer dermal matrix after two weeks of application. At week 12, the mean decrease in wound area and volume were 93.2% and 97.1%, respectively. This case series provides initial evidence that the combination of dehydrated amniotic membrane allograft with bilayer dermal matrix promotes complete wound closure in patients with comorbidities that may impede wound healing. Further clinical trials are needed to confirm these results.

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Treatment of diabetic foot ulcers with dehydrated amniotic membrane allograft: a prospective case series

Journal of Wound Care ◽

10.12968/jowc.2016.25.sup7.s4 ◽

2016 ◽

Vol 25 (Sup7) ◽

pp. S4-S9 ◽

Cited By ~ 6

Author(s):

R.J. Abdo

Keyword(s):

Amniotic Membrane ◽

Diabetic Foot ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Prospective Case Series

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Treatment of diabetic foot ulcers with dehydrated amniotic membrane allograft: a prospective case series

Journal of Wound Care ◽

10.12968/jowc.2016.25.7.s4 ◽

2016 ◽

Vol 25 (Sup7) ◽

pp. S4-S9 ◽

Cited By ~ 1

Author(s):

R.J. Abdo

Keyword(s):

Amniotic Membrane ◽

Diabetic Foot ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Prospective Case Series

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The Use of a Mixture of Hypericum Perforatum and Azadirachta indica for the Management of Diabetic Foot Ulcers: A Case Series

Journal of Diabetes & Metabolism ◽

10.4172/2155-6156.1000499 ◽

2015 ◽

Vol 06 (02) ◽

Author(s):

Maria Letizia Iabichella

Keyword(s):

Azadirachta Indica ◽

Diabetic Foot ◽

Hypericum Perforatum ◽

Case Series ◽

Foot Ulcers ◽

Diabetic Foot Ulcers

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Maggot debridement therapy to treat hard-to-heal diabetic foot ulcers: a single-centre study

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup12.s30 ◽

2021 ◽

Vol 30 (Sup12) ◽

pp. S30-S36

Author(s):

Harikrishna KR Nair ◽

Nazni Wasi Ahmad ◽

AA Ismail ◽

Ali A Alabed ◽

Benjamin Oh Zheming ◽

...

Keyword(s):

Diabetic Foot ◽

Case Series ◽

Cost Effective ◽

Lucilia Cuprina ◽

Study Endpoint ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Necrotic Tissue ◽

Maggot Debridement Therapy ◽

Diabetic Wounds

Objective: Maggot debridement therapy (MDT) has seen a resurgence in recent years in the treatment of hard-to-heal wounds, as a result of rising antibiotic resistance. The sterilised larvae of Lucilia cuprina have been used in MDT in Malaysia since 2003, with encouraging results for the treatment of hard-to-heal diabetic wounds. We report a case series of 30 patients selected from our clinic by convenient sampling with diabetic lower limb ulcers treated with MDT. The average age of patients receiving MDT was >50 years. Of the 30 patients in the study, nine were female and 21 were male. All patients had underlying diabetes, two patients had leg ulcers and 28 patients had diabetic foot ulcers. Sterilised Lucilia cuprina larvae were applied via a standard method of 10 maggots per square centimetre and dressed with sterile gauze. The study endpoint was defined as ≤5% coverage with slough or necrotic tissue following three successive applications of MDT. In this study, maximum debridement of wounds was achieved in 96.6% (29 patients) of our patients, with ≤5% coverage with slough or necrotic tissue, in addition to a reduction in wound-related pain, as assessed by a visual analogue scale. No adverse events were reported. The findings of this study support the use of MDT as a safe, efficacious, and cost-effective method of managing diabetic wounds.

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