The use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome

Aim. Clinical assessment of the use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome (DFS). Materials and methods. The study included 24 patients with DM1 and DM2 and neuropathic or neuroischemic forms of DFS in the absence of pronounced leg ischemia (ankle-brachial index >0.7). Duration of the observation period was 8 weeks, the patients were examined once in 2 weeks. The dressing materials used in the study were based on the Cellosorb NA, Cellosorb Ag, Urgotul S Ag. technology (Laboratories Urgo). Efficacy and safety of the dressing materials were estimated from the wound size, degree of exudation, characteristics of the wound bed and the surrounding tissues. The data obtained were treated using Statistica v. 7.0 software (StatSoft Inc.). Results. Efficacy of local therapy was assessed based on the Pressure Ulcer Scale of Healing (PUSH). Neither local nor systemic adverse events related to the use of the above dressing materials were registered during the follow-up. Cellosorb NA and Cellosrb Ag hydrocellular dressings showed high absorption activity and atraumatic properties. Most patients especially those using Cellosorb Ag were free from local infection. Conclusion. Dressing materials based on the lipid-colloid technology are safe and meet all requirements for the means of local treatment of chronic wounds.

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Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17116/vto201803-04147 ◽

2018 ◽

Vol 25 (3-4) ◽

pp. 47-57

Author(s):

M. V Parshikov ◽

P. S Bardyugov ◽

G. R Galstyan ◽

N. V Yarygin ◽

V. M Golovchak ◽

...

Keyword(s):

Diabetic Foot ◽

Mechanical Effect ◽

Diabetic Foot Syndrome ◽

Foot Deformities ◽

Surgical Interventions ◽

Ulcer Relapse ◽

Study Results ◽

Prevention And Treatment ◽

Grade 3

Purpose: to study the potentialities of orthopaedic surgery in foot deformities as a method for prevention and treatment of diabetic foot syndrome (DFS). Patients and methods. During the period from 2014 to 2017 thirty seven patients (13 men and 24 women aged 47 - 75 years) with DFS were operated on for feet deformity. According to Texas University classification 4 patients had grade 0, 7 - grade 3 and 26 patients - grade 4a pathology. Primary deformities were observed in 13 cases, secondary deformities resulting from DFS - in 24 cases. Forty seven different surgical interventions were performed. All interventions were grouped according to D.G. Armstrong classification for DFS surgical treatment. The surgical task was the correction of biomechanics, unloading of foot segments that were subjected to high mechanical effect caused by the deformity. Results. The follow up period was from 2 moths to 3 years. Primary healing of the ulcers was observed after 32 surgical interventions. In 2 cases revision (more radical) surgical intervention was performed. No deformity relapse was noted. Postoperative wound suppuration was recorded in 1 case. Ulcer relapse was observed in 1 case. Conclusion. The study results allow suggesting a significant role and wide-ranging potentialities of surgical orthopaedics for the effective and functional treatment of patients with DFS.

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Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

Medical Bulletin of the Main Military Clinical Hospital named after N.N. Burdenko ◽

10.53652/2782-1730-2021-2-3(5)-20-29 ◽

2021 ◽

Vol 2 (3(5)) ◽

pp. 20-29

Author(s):

S.Ya. Ivanusa ◽

◽

B.V. Risman ◽

A.V. Yanishevsky ◽

R.E. Shayakhmetov ◽

...

Keyword(s):

Surgical Treatment ◽

Magnetic Resonance ◽

Diabetic Foot ◽

Local Treatment ◽

Diagnostic Algorithm ◽

Ultrasonic Cavitation ◽

Diabetic Foot Syndrome ◽

Control Group ◽

Physical Methods ◽

Purulent Wounds

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

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Burden of metastatic hormone-sensitive prostate cancer to identify men more likely to benefit from early docetaxel.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.136 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 136-136 ◽

Cited By ~ 4

Author(s):

Gwenaelle Gravis ◽

Jean-Marie Boher ◽

Yu-Hui Chen ◽

Glenn Liu ◽

Karim Fizazi ◽

...

Keyword(s):

Overall Survival ◽

De Novo ◽

Local Treatment ◽

Local Therapy ◽

High Volume ◽

Curative Intent ◽

Consistent Effect ◽

Visceral Metastases ◽

Definition Of

136 Background: Patients with a low burden of metastatic disease and who relapse after localized therapy with curative intent have a longer overall survival. It is unclear whether these patients benefit from early docetaxel (D). Methods: Patients in GETUG-AFU15 (N = 385, median follow-up 84 mo) and CHAARTED (N = 790, median follow up 54 mo) were randomized to ADT alone or ADT + D and outcomes described using the same definition of high volume (HV) and low volume (LV) disease. (HV: visceral metastases and/or 4 or more bone metastases with at least one outside the axis) and whether the patients had prior local therapy or not. Results: Table 1 details across both studies that de novo HV group treated with ADT alone has the shortest overall survival and D has a consistent effect in improving OS. In contrast, in both studies patients with LV disease had a much longer OS with no evidence that D improved OS. Conclusions: There was no apparent survival benefit in CHAARTED and GETUG-15 studies with D for LV whether patients had prior local treatment or not. Across both studies, early D had a consistent effect and improved OS in HV pts especially those with no prior local therapy. Partial Support and drug supply by Sanofi. Clinical trial information: NCT00104715, NCT00309985. [Table: see text]

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Biological Mechanisms of Chronic Wound and Diabetic Foot Healing: The Role of Collagen

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2018-0077 ◽

2018 ◽

Vol 19 (4) ◽

pp. 373-382 ◽

Cited By ~ 5

Author(s):

Victor Alexandrovich Stupin ◽

Ruslan Borisovich Gabitov ◽

Tatiana Georgievna Sinelnikova ◽

Ekaterina Vladimirovna Silina

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

World Literature ◽

Chronic Wounds ◽

Chronic Wound ◽

Treatment Algorithm ◽

Diabetic Foot Syndrome ◽

Results Of Treatment ◽

Native Collagen ◽

Chronic Ulcers

Abstract The treatment of chronic wounds is a continuously developing research focus. The problems of excessive mechanical forces, infection, inflammation, reduced production of growth factors, and lack of collagen will affect the results of treatment. The purpose of this study was to analysse the elements that lead to long-term non-healing of chronic wounds and trophic ulcers, including diabetic foot syndrome, by determining the optimal treatment algorithm. The paper presents an analysis of the world literature on the etiopathogenesis and principles of chronic wound treatment in diabetic foot syndrome. The epidemiology of chronic wounds of different genesis is presented. The issues of physiological and metabolic disorders in chronic ulcers affecting the process of wound healing are discussed. Particular attention is paid to collagen, which is a protein that forms the basis of connective tissue; collagen ensures the strength and elasticity of the skin, which confirms the importance of its role not only in aesthetics but also in the process of wound healing. Different types of collagen and their roles in the mechanisms of chronic wound healing in diabetic foot syndrome are described. The results of clinical studies evaluating the effectiveness of medical products and preparations, consisting of collagen with preserved (native collagen) and fractionated structures, in treating chronic wounds of diabetic foot syndrome are analysed. It has been shown that the use of native collagen preparations is a promising treatment for chronic ulcers and wounds, including diabetic foot syndrome, which makes it possible to increase the effectiveness of treatment and reduce the economic costs of managing these patients.

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Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome

Kazan medical journal ◽

10.17816/kmj2314 ◽

2012 ◽

Vol 93 (2) ◽

pp. 301-303

Author(s):

L E Slavin ◽

B N Godzhaev ◽

A Z Zamaleev

Keyword(s):

Wound Healing ◽

Diabetic Foot ◽

Healing Process ◽

Local Treatment ◽

Water Soluble ◽

Diabetic Foot Syndrome ◽

Layered System ◽

Second Phase ◽

Bathing Solution ◽

Optimal Conditions

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.

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Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

Reports of Morphology ◽

10.31393/morphology-journal-2021-27(3)-03 ◽

2021 ◽

Vol 27 (3) ◽

pp. 22-28

Author(s):

Yu.M. Babina ◽

D.V. Dmyrtriiev ◽

O.A. Nazarchuk ◽

P.P. Hormash

Keyword(s):

Diabetes Mellitus ◽

Wound Healing ◽

Granulation Tissue ◽

Diabetic Foot ◽

Povidone Iodine ◽

Local Treatment ◽

Lower Extremities ◽

Diabetic Foot Syndrome ◽

Patients With Diabetes ◽

Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

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Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by Pseudomonas sp: A Pilot Study

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619848573 ◽

2019 ◽

Vol 18 (3) ◽

pp. 262-268 ◽

Cited By ~ 2

Author(s):

Vladimíra Fejfarová ◽

Hana Tibenská ◽

Jitka Niklová ◽

Robert Bém ◽

Michal Dubský ◽

...

Keyword(s):

Pilot Study ◽

Diabetic Foot ◽

Local Treatment ◽

Local Therapy ◽

Study Groups ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Pseudomonas Sp ◽

Group 2 ◽

Group 1

Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.

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Treatment of Diabetic Foot Gangrene Using the STAGE Principle: A Case Series

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619840584 ◽

2019 ◽

Vol 18 (2) ◽

pp. 200-207 ◽

Cited By ~ 1

Author(s):

Chaojun Zhu ◽

Ping Yue ◽

Jiakang Lü ◽

Xianzhou Liu ◽

Lei Huo ◽

...

Keyword(s):

Lower Extremity ◽

Blood Supply ◽

Diabetic Foot ◽

Ankle Brachial Index ◽

Case Series ◽

Interventional Therapy ◽

Wound Treatment ◽

Lower Extremity Ischemia ◽

Extremity Ischemia

Diabetic foot gangrene with lower extremity ischemia can preclude amputation. However, wound treatment principles based on the Wagner classification system are lacking. We proposed the STAGE principle for the surgical management of diabetic foot wounds. The STAGE principle guides surgical intervention during the wound treatment of diabetic foot ulcers and emphasizes that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” We applied the STAGE principle for the treatment of 7 patients with an ankle brachial index <0.5 and Wagner grade 4 diabetic foot gangrene. The average ankle brachial index was 0.42 (0.32-0.48; SD = 0.06), and male patients smoked an average of 1.28 packs/day (0.4-2; SD = 0.63). The average wound duration was 45.86 days (14-63 days; SD = 18.46). The average wound healing time was 8.86 months (5-13 months; SD = 2.36). The follow-up time was 37.71 months (3-84 months; SD = 25.04; median = 36 months). Patient 1 received endovascular interventional therapy twice for the lower extremity artery, and the wound healed. After 3 months of follow-up, the patient exhibited recurrence. After the third application of endovascular interventional therapy for the lower extremity artery, the blood supply was improved, and the wound healed after 1 month. In summary, the treatment of 7 cases of diabetic foot gangrene with severe lower extremity ischemia using the STAGE principle resulted in remarkable efficacy.

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CYTOLOGICAL STUDY OF THE DYNAMICS OF THE WOUND PROCESS IN PURULENT LESIONS OF THE DIABETIC FOOT SYNDROME WITH THE USE OF PROGRAMMABLE REHABILITATION TECHNOLOGIES

Periódico Tchê Química ◽

10.52571/ptq.v18.n37.2021.15_sergeev_pgs_212_227.pdf ◽

2021 ◽

Vol 17 (37) ◽

pp. 212-227

Author(s):

Vladimir Anatolievich SERGEEV ◽

Alexander Anatolyevich GLUKHOV ◽

Alexander Sergeevich SOROKIN

Keyword(s):

Diabetic Foot ◽

Local Treatment ◽

Diabetic Foot Syndrome ◽

Limb Amputation ◽

Control Group ◽

Critical Ischemia ◽

Results Of Treatment ◽

Purulent Wounds ◽

Cytological Method ◽

Experimental Group

Background: Purulent lesions of the feet in diabetes mellitus bring excruciating suffering to the patient, reduce the quality of life and often lead to limb amputation and possible death. The disappointing results of the treatment of purulent complications of diabetes encourage the search for both new approaches to treatment and methods for assessing the reparative potential of wound defects. Aim: This study aimed to improve the treatment of purulent-necrotic complications of the diabetic foot by studying the morphological assessment of healing processes when using promising treatment methods such as then programmed debridement. Methods: Over the past 10 years, the results of treatment of 106 patients with purulent-necrotic complications of diabetic foot syndrome (DFS) without critical ischemia have been analyzed. The patients were randomized into two groups. In the experimental group (n = 55), after surgical treatment, the wound was sutured tightly, and in the postoperative period, programmed debridement was carried out using the original AMP-01 device. In the control group of patients (n = 51), the purulent wound was not sutured after the operation, and local treatment was carried out with solutions of iodophors, ointments based on polyethylene glycol. To assess the dynamics of reparative processes in purulent wounds, a cytological method was used, which makes it possible to quickly and reliably assess the stage of the wound process and the effectiveness of the treatment. The simplicity and availability of the method allows it to be recommended to all practicing specialists. Results and Discussion: In the experimental group, by day 9 after surgery, the number of degenerative forms of neutrophils in cytological smears was 2.9 times lower than in the control group - 12.3 ± 0.3% versus 36.4 ± 0.4% (p 0.001) - and the RDI indicator in experimental group was 3.4 times higher compared with the control group - 2.6 ± 0.1 and 0.9 ± 0.1, respectively (p 0.001). This indicated more active phagocytosis, more rapid cleansing of the purulent cavity. An earlier appearance of cells of young connective tissue was observed in the experimental group. The number of fibroblasts by day 9 after surgery was 4.6 times higher (6.4 ± 0.4%) than in the control group - 1.4 ± 0.1% (p 0.001), which confirmed the presence of active regenerative processes in the wound. Conclusions: The use of programmable sanitation technologies in treating purulent complications of a diabetic foot leads to a more significant reduction in the duration of the inflammation phase and acceleration of reparative processes

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