scholarly journals Clinical, pathomorphological and immunohistochemical evaluation of tissue repair in diabetic foot ulcers

2019 ◽  
Vol 21 (6) ◽  
pp. 490-496 ◽  
Author(s):  
Alla Y. Tokmakova ◽  
Ekaterina L. Zaitseva ◽  
Iya A. Voronkova ◽  
Marina V. Shestakova
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Tissue Repair ◽  
Chronic Wounds ◽  
Soft Tissues ◽  
Local Treatment ◽  
Surgical Debridement ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Before And After

Background: It is known that wound healing is Impaired in diabetes mellitus. Possible reasons are widely being searched. However, despite all the available data, reliable markers of reparative processes in diabetes mellitus are needed to be found. Aim: To study morphological and some immunohistochemical markers of tissue repair in patients with diabetic foot ulcers after local treatment. Materials and methods: 70 patients with diabetic foot ulcers before and after surgical debridement were included. Histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) characteristics of tissue repair processes in soft tissues of the lower extremities in patients with diabetes mellitus were analyzed. Histological and immunohistochemical examination of soft tissues were performed in 63 patients before and after surgical debridement and 10 days after local treatment. Results: After the surgical debridement a significant reduction in the area of wounds was registered by 23.4% (p 0.05), wound depth by 29.4% (p 0.05). Based on the results of the morphological study, the presence of mature granulation tissue in the wounds was confirmed. Immunohistochemical study of wound biopsies demonstrated a significant decrease in proteolytic activity in the wound as a decrease in MMP-9 expression (p 0.05). Statistically significant changes in the number of macrophages against the initial data were not found, as well as increased expression of TIMP-1 was observed (p 0.05 and 0.05, respectively). Conclusion: According to the data, there was a significant decrease in the area and depth of wounds during local treatment. The intensity of tissue repair was confirmed by the results of histological and immunohistochemical studies. However, the absence of a statistically significant change in the amount of macrophages on the background of treatment suggests that this repair link is disrupted in diabetes mellitus, which is the reason for the "chronic" wounds and requires further studies.

scholarly journals Effectiveness of topical insulin in the management of diabetic foot ulcers.

2019 ◽  
Vol 26 (09) ◽  
pp. 1487-1490
Author(s):  
Shafaatullah ◽  
Sadaf Iqbal ◽  
Bushra Zulfiqar ◽  
Shayan Zufishan
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Blood Glucose ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Ulcer Size ◽  
Before And After ◽  
Mean Size ◽  
The Mean

Introduction: Diabetes mellitus is one of the most common metabolic disorders affecting a large part of our population. Apart from its effect on all organ systems, these metabolic derangements affect other processes in the body as well. Diabetic wounds are difficult to treat with conventional treatments. Delayed wound healing has led to increased morbidity and mortality in the population. Increased blood glucose leads to ineffective angiogenesis and less collagen deposition. In various studies long acting insulin zinc suspension has been shown to augment wound healing without any harmful effects. Objectives: To find out the advantages of topical insulin in the management of diabetic foot ulcers. Study Design: Observational study. Setting: Plastic Surgery and General Surgery Department, Baqai Medical University Karachi. Period: January 2014 to December 2016. Material and Methods: Patients visiting the Surgical OPD with diabetes mellitus and concomitantly having foot ulcers were included in the study. Diabetics having blood glucose levels of 110-130 gm/dl and ulcers measuring more than one cm on the dorsum of the foot were included in the study. All patients having foot ulcers were treated by daily topical spray of 1cc saline mixed with 5 units of insulin. This treatment was continued for 12 weeks or till the time ulcer was completely healed (whichever was earlier) and ulcer size was measured weekly. Ulcer size and depth before and after treatment was measured. Results: We had a total of 65 participants, among them there were 52 males and 13 females presenting with diabetic foot ulcer. Around 87.6% (n=57) patients had type 2 diabetes mellitus whereas 12.3% (n=8) patients had type 1 diabetes mellitus. Upon examination of the patient the location, size and depth of the ulcer was measured as well. These parameters were measured before and after treatment by topical insulin spray. Right foot ulcers were present in 64.6% of the patients and 35.38% patients had left foot ulcers. The mean size and depth of ulcer was 5.1 + 1.1 cm2 and 8.7 + 0.12 mm respectively. After treatment the mean size and depth of ulcer was found to be 1 + 0.04cm2 and 1.4 + 0.12mm respectively. Conclusion: There was significant improvement after treatment of diabetic foot ulcers with topical insulin spray. The wound size and depth were considerably decreased. This treatment had more promising results than conventional treatment methods for diabetic foot ulcers.

scholarly journals Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

2013 ◽  
Vol 20 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Teodora Chiţă ◽  
Delia Muntean ◽  
Luminiţa Badiţoiu ◽  
Bogdan Timar ◽  
Roxana Moldovan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Resistance Pattern ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Bacterial Strains ◽  
Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

scholarly journals Preliminary Evaluation of a Cycling Cleat Designed for Diabetic Foot Ulcers

2017 ◽  
Vol 107 (6) ◽  
pp. 475-482 ◽  
Author(s):  
Ryan T. Crews ◽  
Steven R. Smith ◽  
Ramin Ghazizadeh ◽  
Sai V. Yalla ◽  
Stephanie C. Wu
Keyword(s):  
Blood Flow ◽  
Diabetic Foot ◽  
Plantar Pressure ◽  
Tissue Perfusion ◽  
Foot Ulcers ◽  
Preliminary Evaluation ◽  
Diabetic Foot Ulcers ◽  
Time Integral ◽  
Traditional Health ◽  
Before And After

Background: Offloading devices for diabetic foot ulcers (DFU) generally restrict exercise. In addition to traditional health benefits, exercise could benefit DFU by increasing blood flow and acting as thermotherapy. This study functionally evaluated a cycling cleat designed for forefoot DFU. Methods: Fifteen individuals at risk of developing a DFU used a recumbent stationary bicycle to complete one 5-minute cycling bout with the DFU cleat on their study foot and one 5-minute bout without it. Foot stress was evaluated by plantar pressure insoles during cycling. Laser Doppler perfusion monitored blood flow to the hallux. Infrared photographs measured foot temperature before and after each cycling bout. Results: The specialized cleat significantly reduced forefoot plantar pressure (9.9 kPa versus 62.6 kPa, P < .05) and pressure time integral (15.4 versus 76.4 kPa*sec, P < .05). Irrespective of footwear condition, perfusion to the hallux increased (3.97 ± 1.2 versus 6.9 ± 1.4 tissue perfusion units, P < .05) after exercise. Infrared images revealed no changes in foot temperature. Conclusions: The specialized cleat allowed participants to exercise with minimal forefoot stress. The observed increase in perfusion suggests that healing might improve if patients with active DFU were to use the cleat. Potential thermotherapy for DFU was not supported by this study. Evaluation of the device among individuals with active DFU is now warranted.

scholarly journals THE EFFICACY OF HONEY AS AN ALTERNATIVE TO STANDARD ANTISEPTIC CARE IN THE TREATMENT OF CHRONIC PRESSURE ULCERS AND DIABETIC FOOT ULCERS IN ADULTS

2021 ◽  
pp. 37-47
Author(s):  
GF PEREIRA ◽  
M BALMITH ◽  
M NELL
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Bacterial Infections ◽  
Chronic Wounds ◽  
Pressure Ulcers ◽  
Keyword Search ◽  
Selection Process ◽  
Foot Ulcers ◽  
Published Data ◽  
Diabetic Foot Ulcers

Objective: A chronic wound fails to progress through the phases of wound healing in an orderly and appropriate process, and poses a major challenge to wound care professionals. Pressure ulcers (PUs) and diabetic foot ulcers (DFUs) are classified as chronic wounds. Antiseptics, such as povidone-iodine (PVP-I), are often used to treat bacterial infections in chronic wounds; however, their efficacy and ability to accelerate wound healing has come into question. As a result, current medical research is now focusing on alternative and natural antiseptic agents, such as honey, for the treatment of chronic wounds. The aim of this study was to analyze the wound healing effects of honey in PU and DFU treatment in comparison to standard antiseptic care. Methods: A systematic literature search of PubMed, ScienceDirect, and ClinicalKey was conducted to identify all published data of clinical trials and narrative reviews that investigated or reported the use of honey and standard antiseptics in the treatment of PUs and DFUs in adults. A keyword search was then performed using the following keywords: “PUs”, “DFUs”, “antiseptics”, “PVP-I”, “honey”, “Manuka honey (MH)”, and “wound healing”. Database restrictions were implemented based on the inclusion and exclusion criteria, notably the report’s availability, completion status and language, the sample populations’ age, as well as, the date of publication. A preferred reporting item for systematic review and meta-analysis (preferred reporting items for systematic reviews and meta-analyzes) diagram was constructed illustrating the study selection process. The eligibility of articles was assessed by the screening of titles, abstracts and full texts. A total of 12 articles were included in this study comprising of 775 patients with PUs, DFUs or a combination of PUs and DFUs. Results: Results indicated that honey reduced bacterial infection, reduced pain and edema experienced by patients, reduced the odor of the wound and promoted wound healing in the treatment of chronic ulcers. Honey was also found to be effective in the process of debridement and exudate removal. Conclusion: Honey was found to be highly effective in the treatment of PUs and DFUs and should be considered as an alternative to standard antiseptic care in the treatment of chronic wounds. However, the literature in this study is limited and so further research into honey and its antiseptic-promoting activity in wound healing is recommended.

Pathology to define epidermal margin and depth of surgical debridement of diabetic foot ulcers

2008 ◽  
Vol 207 (3) ◽  
pp. S52
Author(s):  
Eashwar Balu Chandrasekaran ◽  
Michael Golinko ◽  
Sasa Vukelic ◽  
Renata Joffe ◽  
Olivera Stojanidovic ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Surgical Debridement ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers

scholarly journals Cellular Proliferation, Dermal Repair, and Microbiological Effectiveness of Ultrasound-Assisted Wound Debridement (UAW) Versus Standard Wound Treatment in Complicated Diabetic Foot Ulcers (DFU): An Open-Label Randomized Controlled Trial

2020 ◽  
Vol 9 (12) ◽  
pp. 4032
Author(s):  
José Luis Lázaro-Martínez ◽  
Francisco Javier Álvaro-Afonso ◽  
David Sevillano-Fernández ◽  
Yolanda García-Álvarez ◽  
Irene Sanz-Corbalan ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Cellular Proliferation ◽  
Controlled Trial ◽  
Surgical Debridement ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Randomized Controlled ◽  
Ultrasound Assisted ◽  
Surgical Group

We aimed to evaluate the effects of ultrasound-assisted wound (UAW) debridement on cellular proliferation and dermal repair in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical/sharp wound debridement. A randomized controlled trial was performed involving 51 outpatients with complicated diabetic foot ulcers that either received surgical debridement (n = 24) or UAW debridement (n = 27) every week during a six-week treatment period. Compared to patients receiving surgical debridement, patients treated with UAW debridement exhibited significantly improved cellular proliferation, as determined by CD31 staining, Masson’s trichrome staining, and actin staining. Bacterial loads were significantly reduced in the UAW debridement group compared to the surgical group (UAW group 4.27 ± 0.37 day 0 to 2.11 ± 0.8 versus surgical group 4.66 ± 1.21 day 0 to 4.39 ± 1.24 day 42; p = 0.01). Time to healing was also significantly lower (p = 0.04) in the UAW group (9.7 ± 3.8 weeks) compared to the surgical group (14.8 ± 12.3 weeks), but both groups had similar rates of patients that were healed after six months of follow-up (23 patients (85.1%) in the UAW group vs. 20 patients (83.3%) in the surgical group; p = 0.856). We propose that UAW debridement could be an effective alternative when surgical debridement is not available or is contraindicated for use on patients with complicated diabetic foot ulcers.

Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece

2017 ◽  
Vol 16 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Maria Demetriou ◽  
Nikolaos Papanas ◽  
Periklis Panagopoulos ◽  
Maria Panopoulou ◽  
Efstratios Maltezos
Keyword(s):  
Antibiotic Resistance ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Initial Choice ◽  
Gram Positive Cocci

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

scholarly journals A clinical study of platelet rich plasma versus conventional dressing in management of diabetic foot ulcers

2018 ◽  
Vol 5 (10) ◽  
pp. 3210 ◽  
Author(s):  
Nithyaraj Prakasam ◽  
Prabakar M.S. ◽  
Reshma S. ◽  
Loganathan K. ◽  
Senguttuvan K.
Keyword(s):  
Wound Healing ◽  
Tissue Regeneration ◽  
Diabetic Foot ◽  
Tamil Nadu ◽  
Chronic Wounds ◽  
Platelet Rich Plasma ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Group A ◽  
Group B

Background: Diabetic foot ulcers continue to pose significant global issue despite the advances made in the management of diabetes. It causes major foot complications if they are not addressed properly. It needs multidisciplinary approach for its care. While several advancements has taken place in wound care management, platelet rich plasma and stem cell therapy promises to offer a new hope in its management, aiding in cellular and tissue regeneration. The purpose of the present study was to compare Platelet-Rich Plasma versus conventional dressing in the management of diabetic foot ulcers.Methods: This prospective study was focused on 20 diabetic foot ulcers, carried out in a surgical unit of ACS Medical College and Hospital, Chennai, Tamil Nadu, from January 2018 to June 2018. Patients were divided into two groups; Group A received conventional ordinary dressing (N=10, 50%) and Group B received PRP dressing (N = 10, 50%). The mean follow-up period was 8 weeks.Results: The estimated time of wound healing was 8 weeks and healing was found to be more effective for patients in group B compared to patients in group A; the PRP group was found to be more effective in wound healing with fewer complications, less infection, exudates and pain.Conclusions: There have been considerable advances in the use of PRP in therapeutic processes in recent years in tissue regeneration therapy. PRP is a powerful tool for the treatment of chronic wounds and very promising for diabetic foot wounds; PRP enables healing, and reduces amputation rates, infection and exudates.

scholarly journals Diabetic Foot Ulcers and Risk Fall in People with Type 2 Diabetes Mellitus in BLUD RSUD Dr. Ben Mboi Manggarai Regency, NTT

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Oliva Suyen Ningsih ◽  
Kornelia Romana Iwa ◽  
Maria Getrida Simon ◽  
Kataria Anastasia Sinar
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
P Value ◽  
Diabetic Foot Ulcers ◽  
Risk Of Falling ◽  
Risk Of Falls

The prevalence of diabetes mellitus in Manggarai Regency in 2019 is 535 people and some of them have diabetic foot ulcers. Patients with diabetic foot ulcers had a higher risk of falling than others.This study was to determine the risk factors for diabetic foot ulcers and the risk of falls in patients with type 2 diabetes mellitus. A quantitative study using a cross-sectional study was conducted at BLUD RSUD dr. Ben Mboi  in April-June 2020 (n = 51).The sampling technique used was purposive sampling with a questionnaire of diabetic foot screening and risk stratification form and Morse scale. Logistic regression results showed that there was a significant relationship between claudication (AOR: 8.409, 95% CI 1.664-42.500, p value 0.010), history of previous diabetic foot ulcers (AOR: 5,680, 95% CI 1,151-28,035, p value 0.033) with diabetic foot ulcers. There was a significant relationship between hypertension (AOR: 0.152, 95% CI 0.028-0.834, p value 0.030), diabetic foot ulcers (AOR: 11.392, 95% CI 1.277-101.651, p value 0.029) with the risk of falling for patients with type 2 diabetes mellitus.  Assessment of the risk of diabetic foot ulcers and the risk of falls should be done in patients with diabetes mellitus with or without neuropathy peripheral

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