Evaluation of the safety and healing potential of a fibroin-aloe gel film for the treatment of diabetic foot ulcers

2021 ◽  
Vol 30 (12) ◽  
pp. 1020-1028
Author(s):  
Saran Worasakwutiphong ◽  
Tanapron Termwattanaphakdee ◽  
Thanpawee Kamolhan ◽  
Preeyawass Phimnuan ◽  
Anuphan Sittichokechaiwut ◽  
...  
Keyword(s):  
Porous Structure ◽  
Diabetic Foot ◽  
Wound Dressing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Swelling Ratio ◽  
Wound Area ◽  
Area Reduction ◽  
Gel Film ◽  
Aloe Gel

Objective: This study aimed to develop a wound dressing prepared from the blending of silkworm fibroin and aloe gel extract for use in the treatment of diabetic foot ulcers (DFUs). Methods: Fibroin extracted from silkworm cocoons and aloe gel extract were dissolved in deionised water. pH levels were then adjusted with lactic acid solution. A simple casting technique was used to obtain the fibroin–aloe gel film. The surface morphology, hardness, flexibility and infrared spectrum of the sterilised film were tested. Swelling ratio was measured from changes in weight. The cytocompatibility of the film to human dermal fibroblast was determined using XTT assay. Hard-to-heal DFUs (grade I Wagner score) were treated with the film for four weeks. The application site was assessed for allergic reactions and/or sensitisation. Wound size was measured using standardised digital photography. Results: A total of five hard-to-heal DFUs were treated. The obtained film sterilised with ozonation showed a non-porous structure. The elongation at break and tensile strength of the wet film were 9.00±0.95% and 6.89±1.21N, respectively. Fourier-transform infrared spectroscopy data indicated the presence of amides I, II and III, of peptide linkage, which are the chemical characteristics of the fibroin. Functional groups relating to healing activity of the aloe gel extract were also found. The swelling ratio of the film immersed in water for 24 hours was 0.8±0.01. In three DFUs (40–50mm2 in size), a wound area reduction of 0.4–0.8mm2/day was observed and were healed in 2–3 weeks. The remaining two SFUs (500mm2 in size) showed a wound area reduction of 4mm2/day and were almost closed at four weeks. No allergic reaction or infection was observed in any of the wounds. Conclusion: The obtained film showed a non-porous structure, and its strength and flexibility were adequate for storage and handling. The film tended to increase the proliferation of fibroblasts. The wound dressing showed potential for accelerating the healing rate of DFUs.

Blind Comparative study between Silver nanoparticles dressings and Standard Moist Wound Dressings (SMWD) in management of diabetic foot ulcers

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Abdelaal ◽  
Mostafa Soliman ◽  
Hany Rafik ◽  
Mohamed Emam ◽  
Mohamed Mahmoud Mohamed Elsadek
Keyword(s):  
Silver Nanoparticles ◽  
Diabetic Foot ◽  
Wound Dressing ◽  
Treatment Modalities ◽  
Controlled Study ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Group A ◽  
Group B

Abstract Background Diabetic foot ulcers (DFUs) are the main cause of hospitalization in diabetic patients and they are considered a major worldwide health problem. Thus, there is a need to evaluate various treatment modalities. In this study we will assess the clinical efficacy of Silver nanoparticles dressing vs Standard Moist Wound Dressing (SMWD) in management of diabetic foot ulcers. Objective To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers and cost effectiveness in terms of duration of hospital stay between Silver nanotechnology dressings and Standard moist wound therapy (SMWT) in management of diabetic foot ulcers. Patients and Methods This is a prospective randomized controlled study involving 34 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Silver nanoparticles wound dressing. Results Our study correlates with the study conducted by K.Suhas et al. which had observed that Silver nanoparticles wound dressing was safe and effective treatment for complex diabetic foot wounds and could lead to higher proportion of healed wounds and faster healing rates. At the end of the study, group B promised a better outcome as compared to group A. Conclusion The role of Silver nanoparticles wound dressing in healing of diabetic foot ulcers has been proposed as a novel method of manipulating the chronic wound environment in a way that it reduces bacterial burden and chronic interstitial wound fluid, increases vascularity and cytokine expression and to an extent mechanically exploiting the viscoelasticity of peri wound tissues.

Evaluation of three different techniques for measuring wound area in diabetic foot ulcers: a reproducibility study

2020 ◽  
Vol 29 (9) ◽  
pp. 518-524
Author(s):  
Ismail Toygar ◽  
Ilgin Yildirim Simsir ◽  
Sevki Cetinkalp
Keyword(s):  
Diabetic Foot ◽  
Three Dimensional ◽  
Measurement Methods ◽  
Assessment Tools ◽  
Area Measurement ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Area ◽  
Reproducibility Study ◽  
Significant Difference

Objective: Wound surface area can be measured with several assessment tools, including a manual planimetric method, ImageJ software and three-dimensional wound measurement (3DWM) methods. This study aimed to determine the advantages of each method as well as the concordance between them. Method: This reproducibility study included adult patient volunteers with diabetic foot ulcers (DFUs). Wounds with ambiguous borders were excluded. All included wounds were sequentially assessed with each of the three measurement methods, and the time for each measurement was recorded with a chronometer. SPSS and MedCalc package software were used for all statistical analyses. Results: A total of 20 patients with 20 DFUs took part in the study. According to the measurement method, the average wound area was 6.41cm2 by the manual planimetric method, 6.53cm2 by ImageJ and 6.32cm2 by 3DWM. Correlation analyses revealed correlation coefficients of 0.997 between the manual planimetric method and ImageJ, 0.929 between the manual planimetric method and 3DWM, and 0.929 between ImageJ and 3DWM. Bland–Altman analysis was used to determine whether these three measurement methods could be used interchangeably. There was no significant difference between the three measurement methods and, therefore, it was concluded that they could be used interchangeably. Wound area measurement times were 173.35±19.38 seconds by the manual planimetric method, 61.60±9.21 seconds by ImageJ and 36.90±6.91 seconds by the 3DWM method. Conclusion: The three measurement methods studied can be used interchangeably, as each method is highly concordant with the other two. The fastest method was 3DWM and the manual planimetric method was the slowest.

scholarly journals Evaluation of Polyvinyl Alcohol/Cobalt Substituted Hydroxyapatite Nanocomposite as a Potential Wound Dressing for Diabetic Foot Ulcers

2020 ◽  
Vol 21 (22) ◽  
pp. 8831
Author(s):  
Wei-Chun Lin ◽  
Cheng-Ming Tang
Keyword(s):  
Polyvinyl Alcohol ◽  
Diabetic Foot ◽  
Wound Dressing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
E Coli ◽  
Accelerate Wound Healing ◽  
Persistent Infections ◽  
Electrochemically Deposited ◽  
Potential Applications

Diabetic foot ulcers (DFUs) caused by diabetes are prone to serious and persistent infections. If not treated properly, it will cause tissue necrosis or septicemia due to peripheral blood vessel embolism. Therefore, it is an urgent challenge to accelerate wound healing and reduce the risk of bacterial infection in patients. In clinical practice, DFUs mostly use hydrogel dressing to cover the surface of the affected area as an auxiliary treatment. Polyvinyl alcohol (PVA) is a hydrophilic hydrogel polymer widely used in dressings, drug delivery, and medical applications. However, due to its weak bioactivity and antibacterial ability, leads to limited application. Filler adding is a useful way to enhance the biocompatibility of PVA. In our study, cobalt-substituted hydroxyapatite (CoHA) powder was prepared by the electrochemically-deposited method. PVA and PVA-CoHA nanocomposite were prepared by the solvent casting method. The bioactivity of the PVA and composite was evaluated by immersed in simulated body fluid for 7 days. In addition, L929 cells and E. coli were used to evaluate the cytotoxicity and antibacterial tests of PVA and PVA-CoHA nanocomposite. The results show that the addition of CoHA increases the mechanical properties and biological activity of PVA. Biocompatibility evaluation showed no significant cytotoxicity of PVA-CoHA composite. In addition, a small amount of cobalt ion was released to the culture medium from the nanocomposite in the cell culture period and enhanced cell growth. The addition of CoHA also confirmed that it could inhibit the growth of E. coli. PVA-CoHA composite may have potential applications in diabetic trauma healing and wound dressing.

scholarly journals Estimation of percent wound area reduction over a period of four weeks among diabetic foot ulcers

2020 ◽  
Vol 11 (3) ◽  
pp. 4503-4510
Author(s):  
Jayalakshmi M
Keyword(s):  
Normal Saline ◽  
Diabetic Foot ◽  
Saline Group ◽  
Foot Ulcers ◽  
Saline Control ◽  
Control Group ◽  
Saline Irrigation ◽  
Wound Area ◽  
Area Reduction ◽  
Reduction In Area

Foot ulcers are the most commonly experienced,fearful complications of diabetes which can frequently be life or limb-threatening.Several factors can lead to the occurrence of foot ulcers in diabetics.Prevention and proper management of DFUs are the prime most important in the care of patients with diabetes. It is essential to predictthe wound healingtime in managing the diabetic foot ulcers.The main objective of the study is to examine the reduction in wound area over four weeks in achieving more than 50 % Percentage Area Reduction (PAR) as a clinical outcome.Twowound irrigation methods were used for irrigating the wounds. Assessment of the wound area was done and comparedon achieving more than 50 % reduction in ulcer area at the end of four weeks. The studyused a descriptive comparative design with a control group. DiabeticFoot ulcerpatients (N = 160) from a private hospital were randomly allocated into 80 in each group (Neem solutionirrigation and Normal saline irrigation groups). In both groupsSurface area of the wound was measured using a disposable wound ruler with standard calibrations at baseline and then at the end of each week till four weeks are completed. Data were analyzed in SPSS20 software while considering p< .05 as statistically significant.The mean Wound surface area of the Normal saline group was 18.41 at the end of the first week and 14.04 after four weeks verses 19.84. The above-quoted scores in the Neem solution irrigation group were 14.68 and 6.92, respectively, against 17.13(p < .05).At the end of 4 weeks, the mean per cent reduction in area from baseline of DFUs irrigated with Neem solution was 72.4 % and with Normal saline was 48.7 %. Ulcers irrigated with neem solution had a 28.7 % greater mean reduction in area from baseline when compared with the normal saline control group at the end four weeks (p<.05).

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