scholarly journals CHOICE OF REVASCULARIZATION TECHNIQUE IN PATIENTS WITH ISCHEMIC DIABETIC FOOT

2021 ◽  
Vol 4 (18) ◽  
pp. 18-26
Author(s):  
D. Shapovalov
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Support Function ◽  
The United States ◽  
Limb Amputation ◽  
Free Survival ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Patients With Diabetes

Background Ischemic diabetic foot is determined by trophic disorders of the foot due to a combination of atherosclerosis of the arteries and diabetic lesions. In the United States and some European countries, among major non-traumatic amputations, amputations in patients with diabetes are 45-70%. The use of revascularization can significantly improve the results of treatment of patients with diabetic foot. Features of ischemic diabetic foot require a separate approach to revascularization. There are no generally accepted guidelines for revascularization in diabetic foot in the world today. The choice of revascularization technique remains an open question. The aim of the study. To analyze the effectiveness of differentiated application of intervention techniques of revascularization for the treatment of ischemic diabetic foot. Steps of differentiated choice of revascularization We identified seven steps: determination of indications for revascularization, determination of the critical arterial segment. the level of hemodynamic compensation, determination of the feasibility of revascularization, the choice of revascularization technique, the perform revascularization, the active postoperative monitoring. Materials and methods Diabetic ischemic foot was diagnosed in 133 observations. 123 revascularizations of 94 lower extremities were performed in 91 patients with ischemic diabetic foot. Patients underwent angioplasty, surgical revascularization or hybrid intervention. Results Revascularization was performed in revascularization was performed in 92,4% of patients with ischemic diabetic foot. Amputation-free survival was noted in 85.4% of cases, wound-healing in 62.6%, preservation of foot support function in 79.7%, avoidance of repeated interventions in 78.9%. 5 (5.5%) patients died, 2 of them (2.2:%) within 30 days after revascularization. Conclusions: Differentiated choice of revascularization technique allows to increase the number of patients to be revascularized 92,4%, to reach of the level amputation-free survival to 85,4%, to reach of the level wound-healing to 62,6%, to salvage of foot support function to 79,7%, to perform revascularizations in patients with a high probability of limb amputation.

scholarly journals NEGATIVE PRESSURE WOUND THERAPY (NPWT) FOR THE MANAGEMENT OF DIABETIC FOOT WOUND

2015 ◽  
Vol 6 (2) ◽  
Author(s):  
Wesiana Heris Santy
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Healing Process ◽  
The United States ◽  
Limb Amputation ◽  
Wound Healing Process ◽  
Wound Therapy ◽  
Protease Enzyme

Complications often experienced by people with diabetes are complications in the feet ( 15 % ) called diabetic foot ( Akhtyo , 2009) . Where the injury to the leg if not treated properly will lead to infections and ultimately need to be amputated .The purpose of writing articles is to review and discuss the evidence-based literature bersadarkanpraktice of Negative Pressure Wound Therapy Effectiveness ( NPWT ) ) on the healing of diabetic foot ulcers.One technology that is used to prevent and avoid lower limb amputation is the technique of negative pressure or Negative Pressure Wound Therapy ( NPWT ) ) . This negative pressure technique has grown rapidly and now has been widely used in many countries , especially in Western European countries ( Germany ) and the United States . Negative pressure technique has the advantage that it is relatively cheaper cost than the use of hyperbaric oxygen . Results obtained by several studies that the use of NPWT may improve wound healing process through efforts to create a moist wound environment and decrease edema that becomes optimal wound healing , throw that out of the wound exudate so that the protease enzyme in the exudate also go wasted , this enzyme is known to interfere wound healing process . The other benefit is that it can stimulate cell growth by increasing angiogenesis physically , so that the growth of new cells will be maximal

scholarly journals Biofilms in Diabetic Foot Ulcers: Significance and Clinical Relevance

2020 ◽  
Vol 8 (10) ◽  
pp. 1580
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Sophie Schuldiner ◽  
Albert Sotto ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Infection ◽  
Current Knowledge ◽  
Bacterial Species ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Main Role ◽  
Diabetic Foot Ulcers ◽  
Patients With Diabetes

Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

Risk factors associated with diabetic foot ulcer-free survival in patients with diabetes

2018 ◽  
Vol 12 (6) ◽  
pp. 1039-1043 ◽  
Author(s):  
Leila Yazdanpanah ◽  
Hajieh Shahbazian ◽  
Iraj Nazari ◽  
Saeed Hesam ◽  
Fatemeh Ahmadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Free Survival ◽  
Factors Associated ◽  
Patients With Diabetes

scholarly journals Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Anton Petrovich Ostroushko ◽  
Alexander Alekseevich Andreev ◽  
Alexander Alexandrovich Shmarin ◽  
Vladislav Valeryevich Novomlinsky ◽  
Anastasia Yurievna Laptiyova ◽  
...  
Keyword(s):  
Treatment Option ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Treatment Method ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Results Of Treatment ◽  
Patients With Diabetes ◽  
After Cancer

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

scholarly journals Offloading of diabetic foot wounds using Amit Jain’s offloading system: an experience of 23 cases

2017 ◽  
Vol 4 (8) ◽  
pp. 2777
Author(s):  
Roshan Dath ◽  
U. Venkatkrishna Rao ◽  
Kishore Kumar ◽  
Harish Kumar ◽  
Suresh Kumar
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
City Hospital ◽  
Common Condition ◽  
Ethyl Vinyl ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Foot Problems ◽  
Scientific Rationale

Background: It is a well-known fact that around 15% of patients with diabetes are likely to be affected by foot ulcers during their lifetime. The aim of this study was to evaluate and analyze Amit Jain’s offloading system used in diabetic foot wounds.Methods: A cross-sectional, retrospective study was done at 3 centres namely Brindhavvan Areion Hospital, Synergy Centre for Diabetes and South City hospital in Bangalore, India. The study period was for 1 year from April 2016 to March 2017.Results: 23 cases were included in the study. 16 patients (69.57%) had right foot involved whereas 7 patients (30.43%) had left foot involved. Majority of the patients had foot problems located at forefoot (86.96%). The most common condition where Amit Jain’s offloading was used was in trophic ulcer (61%). In 22 patients (95.65%), the microcellular rubber and ethyl vinyl acetate combination was used whereas in one patient (4.35%), 7 mm of single layered EVA was used. 9 patients (39.13%) had their wounds healed within 8 weeks whereas 11 patients (47.83%) had their wounds healed within 8-16 weeks.Conclusions: Amit Jain’s offloading device is a new offloading device that can be effectively used as an alternative to felted foam. It is based on deflective technique just like felted foam. In this series, 86.98% of the wounds had healed by 16 weeks with this new offloading device. The Amit Jain’s offloading device, which has a scientific rationale based on the deflective offloading as well as usage of visco-elastic material that is accepted worldwide, produces effective wound healing without any complication and without inhibiting patient’s mobility. Amit Jain’s offloading is a level one recommendation for diabetic foot wounds.

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

2018 ◽  
Vol 19 (4) ◽  
pp. 373-382 ◽  
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.

scholarly journals Peculiarities Of Treatment Of Purulent-Necrotic Complications In Patients With Diabetic Foot Syndrome

2021 ◽  
Vol 03 (06) ◽  
pp. 116-121
Author(s):  
Abdullaev R.N. ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Septic Complications ◽  
Complications Of Diabetes ◽  
Surgical Infection ◽  
Number Of Patients ◽  
Patients With Diabetes

The number of patients with diabetes mellitus in the Andijan region who were registered according to endocrinologists from 2000 to 2015 increased almost fourfold from 26,000 to more than 110,000 in 2016 (14). This also shows that the number of patients with various purulent-necrotic complications of diabetes mellitus also increases proportionally, in addition, there is an increase in patients with severe purulent-septic complications of these processes, with widespread, deep purulent-necrotic fasciitis [3]. Of patients in the department of surgical infection of the ASMI clinic, patients with purulent-necrotic complications of diabetes mellitus account for almost 78%, which indicates a significant increase in the number of these patients. This tendency continues and goes up every year. According to the WHO, by 2030 every 15 people will have diabetes, and by 2050 this figure will be equal to every 6 people.

scholarly journals 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

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.

scholarly journals A multicenter randomized placebo controlled trial of rifampin to reduce pedal amputations for osteomyelitis in veterans with diabetes (VA INTREPID)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mary T. Bessesen ◽  
Gheorghe Doros ◽  
Adam M. Henrie ◽  
Kelly M. Harrington ◽  
John A. Hermos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Adjunctive Therapy ◽  
The United States ◽  
Quality Data ◽  
Free Survival ◽  
Primary Hypothesis ◽  
Diabetic Foot Osteomyelitis

Abstract Background The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. Methods/design This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. Discussion VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. Trial registration Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.

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

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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