Avoidance of lower limb amputation from a diabetic foot ulcer: The importance of multidisciplinary practice and patient collaboration

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 19-27
Author(s):  
Margaret Mungai ◽  
Emmy Sirmah
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Amputation ◽  
Nursing Interventions ◽  
Multidisciplinary Practice ◽  
Sugar Levels ◽  
Care Nursing

This article explores wound care nursing interventions and inter-professional collaboration for a patient referred with a stage 3 diabetic foot ulcer (DFU). To the patient’s distress, he had been informed that he may require an amputation due to the severity of his DFUs. On initial presentation, the patient was symptomatic for peripheral neuropathy, infection and hyperglycaemia. The left lower limb was oedematous and there was a DFU at the metatarso-phalangeal joint of the big toe on his left foot secondary to haemorrhagic callus. Progressive healing of the DFU was realised over time by repetitive debridement; incision and drainage of the DFUs; antibiotic therapy; appropriate footwear; dietary instructions; control of the blood sugar levels (BSLs); and patient and family education. Wound care nursing interventions were applied in conjunction with medical management of the DFUs. The DFUs were managed using a locally made, two-part zinc oxide gauze dressing known as the Unna boot. A family member was instructed how to continue applying the dressings at home in between clinic visits. Complete wound healing was eventually achieved within four months, thus avoiding the need for amputation.

Jaloukavacharana in diabetic foot ulcer - A Case Study

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Nivedita Rampure ◽  
Channabasavanna B. M. ◽  
Mallikarjun Mallikarjun
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Large Sample Size ◽  
Prolonged Stay ◽  
Bloodletting Therapy

Diabetic foot is the one of the commonest chronic complications of diabetes. It is leading indication for hospital admission and prolonged stay. A classical triad of neuropathy, ischemia and infection characterizes the diabetic foot. The presence of infection rapidly worsens the clinical picture, often requiring limb amputation. Diabetic foot ulcers are common and estimated to effect 15% of all diabetics. Mainstay of treatment includes antibiotics, debridement. and local wound care and footwear improvisation. In spite of all advances in health sciences, statistics reveals that about 3% patients yet have to undergo lower limb amputation. In Sushruta Samhita. we get the most scientific description of wound and its management. Similarly, Sushruta has given the importance to Bloodletting therapy and considered Leech as the most unique and effective method of bloodletting even in infected wounds and abscesses. Patient with Diabetic foot ulcer was advised to continue anti diabetic medicine along with weekly application of Leech around the ulcer which was followed by washing the wound with Panchavalkala Kashaya and dressing with Jatyadi Ghrita. This Leech therapy proved very effective and the ulcer healed completely within 30 days. However, further evaluation is required to be done by taking a large sample size to prove its significance in treating Diabetic foot ulcer and avoiding lower limb amputation.

Treatment Strategies Against Diabetic Foot Ulcer: Success so far and Road Ahead

2020 ◽  
Vol 16 ◽  
Author(s):  
Ankit Awasthi ◽  
Sachin Kumar Singh ◽  
Bimlesh Kumar ◽  
Monica Gulati ◽  
Rajesh Kumar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Treatment Strategies ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Current Status ◽  
Limb Amputation ◽  
Bibliographic Databases ◽  
Inflammatory Phase

Background: Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It isassociated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. Basically, there are four stages of wound healing namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Traditionally the dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer from many years. Introduction: In this review the global prevalence as well as etiopathogenesis related to diabetic foot ulcer has been discussed. Potential role of various synthetic and herbal drugs as well as their conventional dosage form for the effective management of diabetes foot ulcer has been highlighted. Methods: Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was culminated in terms of various approaches that are used for the treatment of diabetic foot ulcer. Results: About 142 papers including both, research and review articles, were included in this review in order to produce a comprehensive as well as readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. Conclusion: DFU has become one of the most common complications in patients having more than ten years of diabetes. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as judicious selection of drug as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemics or, they have been repositioned. Moreover, in clinical practice, much focus has been given towards dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that a combination therapy of herbal and synthetic drug with multiple treatment pathway could be able to overcome the disease.

Inflammatory Biomarkers as Predictors of Infected Diabetic Foot Ulcer

2021 ◽  
Vol 17 ◽  
Author(s):  
Mariya Dmitriyeva ◽  
Zhanar Kozhakhmetova ◽  
Saltanat Urazova ◽  
Saken Kozhakhmetov ◽  
Dulat Turebayev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Inflammatory Biomarkers ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers

: Diabetic foot ulcer infection is a crucial complication associated with lower-limb amputation and postoperative mortality in individuals with diabetes mellitus. Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Early detection of infected diabetic foot ulcers can reduce the frequency of hospitalizations, the occurrence of disability, and chances of mortality. Inflammatory biomarkers are predictors of infected diabetic foot ulcers and lower-limb amputation. Procalcitonin, CRP, pentraxin-3, interleukin-6, and calprotectin may help to distinguish uninfected from mildly infected diabetic foot ulcers and diagnose soft tissue infections, bone lesions, and sepsis in diabetic patients. Moreover, these biomarkers may be predictors of lower-limb amputation and postoperative mortality. The current management of infected diabetic foot ulcers is disappointing and unsatisfactory, both in preventing its development and in halting and modifying its progression. The use of new (molecular) techniques for the identification of the IDFU have not yet proven superior to classic cultural techniques for the management of such patients. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients the hospitalization, disability, and mortality rate will be reduced. For practical application of these biomarkers, it is important to correlate these quantitative parameters with clinical symptoms. Based on clinical observations and inflammatory biomarker evaluation, it can be used to guide clinical treatment methods. This review details clinical information published during the past several decades and discusses inflammatory biomarkers that may determine the risk and level of infection of diabetic foot ulcers.

scholarly journals A Review of Diabetic Foot Ulcer Infections and Lyophilized Wafer Formulation

2021 ◽  
pp. 13-25
Author(s):  
Rupalben Kaushalkumar Jani ◽  
Goswami Kaushal Puri ◽  
Shrestha Ubana
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Drug Release Profile ◽  
Scanning Calorimetry ◽  
Patients With Diabetes

Diabetic foot difficulties are the most usually occurring problems globally, resulting in economic disasters for the patients, families, and society. In patients with diabetes, the risk of emerging foot ulcers is 25% high. It has also been in the record that one lower limb amputation occurs every 30 seconds in patients with diabetes worldwide. Novel methods of drug delivery and wound dressing have to develop to solve the lower limb amputation crisis. One such novel method is "Lyophilized wafer formulation." It is an upcoming medicated dressing material that can enhance wound healing and the potential to ingest vast quantities of exudates from Chronic wounds. That can have been formulating by lyophilizing hydrogel of absorbent polymers such as Calcium Alginate, Carrageenan, Thiolated Chitosan, and plasticizer to enhance flexibility withstand the day to day mechanical stress, covered with some adhesive and protective backing layer. Unless it passes evaluation tests such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), Scanning electron microscopy (SEM), Exudate handling property, Folding endurance, In-vitro, In-vivo drug release profile, and Gamma-irradiation sterilizes wafer formulation, and it should not administrate directly. Lyophilized wafer formulation will be the most acceptable medicated dressing material in the future that will be useful to treat the normal wound. The wound formation because of diabetic foot ulcer (DFU) infections as there will be site-specific delivery of the drug, packed with an advantage to self administer and easy termination of the drug that can achieve just by removing the wafer case of drug toxicity.

ICD-10 Diagnostic Coding for Identifying Hospitalizations Related to a Diabetic Foot Ulcer

2021 ◽  
Vol 44 (4) ◽  
pp. E11-16
Author(s):  
Muzammil H. Syed ◽  
Mohammed Al-Omran ◽  
Jean Jacob-Brassard ◽  
Joel G. Ray ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Reference Standard ◽  
Diagnostic Coding ◽  
Icd 10

Purpose: To estimate the positive predictive value (PPV) of Canadian ICD-10 diagnostic coding for the identification of hospitalization related to a diabetic foot ulcer (DFU). Methods: Hospitalizations related to a neuropathic and/or ischemic DFU were identified from the Discharge Abstract Database (DAD) records of a single Canadian tertiary care hospital between April 1, 2002 and March 31, 2019. The first coding approach required a most responsible diagnosis (MRDx) code for diabetes-specific foot ulceration or gangrene (DSFUG group). Three alternative coding approaches were also considered: MRDx code for lower-limb osteomyelitis (osteomyelitis group); lower-limb ulceration (LLU group); or lower-limb atherosclerotic gangrene (atherosclerosis group)—each in conjunction with a non-MRDx DSFUG code on the same DAD record. From all eligible DAD records, random samples were drawn for each coding group. DAD records were independently compared by a masked reviewer who manually abstracted data from the entire hospital record (reference standard). The PPV and 95% CI were generated. Results: Out of 1,460 hospitalizations, a total of 300, 50, 33 and seven records were included from the DSFUG, osteomyelitis, LLU and atherosclerosis samples, respectively. Compared to the reference standard, the PPV for all 390 records was 88.5% (95% CI 84.9 to 91.5). The DSFUG group had the highest PPV (90.0%, 95% CI 86.0 to 93.2), followed by the atherosclerosis (85.7%, 95% CI 42.1 to 99.6), LLU (84.9%, 95% CI 68.1 to 94.9) and osteomyelitis (82.0%, 95% CI 68.6 to 91.4) groups. Conclusion: Based on data from a Canadian tertiary care hospital, the specified coding algorithms can be used to identify and study the management and outcomes of people hospitalized with a DFU in Ontario.

scholarly journals THE RELATIONSHIP OF THE INITIAL WOUND WITH THE WOUNDS LONG TREATMENT IN DIABETICUM PATIENTS AT CIBINONG HOSPITAL BOGOR

2020 ◽  
Vol 11 (2) ◽  
pp. 35-40
Author(s):  
Ranti Ranti
Keyword(s):  
General Hospital ◽  
Diabetic Foot ◽  
Wound Care ◽  
Day Treatment ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Stage I ◽  
Stage Iii ◽  
P Value ◽  
Early Wound

According to the survey data of American Diabetes Association (ADA) in 2014, the global prevalence rate of DM patients in 2014 was 8,3% out of total population of the world, and it has increased to 387 cases in 2014. Sulistyowati, D. A. stated that in 2015 for the prevalence of the patients suffering from diabetic foot ulcer was 15% with the risk of amputation of 30%, mortality rate of 32%, and in Indonesia, diabetic foot ulcer is the disease whose probability to be hospitalized is 80%. This research aims at finding out the relation between the early wound stage and the length of wound care towards the patients of ulcus diabeticum at Cibinong General hospital in 2018. This study is a quantitative analytic research with the approach of cross sectional. The population of this research is 40 respondents, and the research sample is 40 respondents by taking the technique of Total Sampling. The data collection is derived from the observation sheet. Based on the research findings, it is known that 14 respondents (77.8%) who suffered from the stage I-II wound needed 3-5 day treatment. Moreover, 19 respondents (86,4%) who suffered from stage III-IV wound needed 6-8 day treatment. The result of statistical test by taking cremer von mises test derived the value p=0,000 meaning that p value <0,05 signifies Ha received. This indicates that there is a significant relation between the early wound stage and the length of wound care towards the patients of ulcus diabeticum. Result analysis also obtains the value OR of 22.167 meaning that the wound stage III-IV will have the possibility of influencing the length of wound care of 22.167 times compared to the stage I-II. There is a relation between the early wound stage and the length of wound care towards the patients of ulcus diabeticum at Cibinong General Hospital. This research finding is expected to be a recommendation for the patients suffering from ulcus diabeticum, particularly those who suffer from stage III-IV with a long wound care.

scholarly journals Pathogenesis and management of diabetic foot ulcers

2018 ◽  
Vol 5 (11) ◽  
pp. 4953 ◽  
Author(s):  
Yousif Alsanawi ◽  
Hassan Alismail ◽  
Mustafa AlabdRabalnabi ◽  
Hattan Alturki ◽  
Abdullah Alsuhaibani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Management Strategies ◽  
Blood Glucose Control ◽  
Disease Process ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Limb Amputation ◽  
Wound Debridement ◽  
Significant Impairment

Diabetes mellitus is a major healthcare issue worldwide, and the trends keep rising. Diabetic foot ulcer is a morbidity associated with the disease process and causes significant impairment in quality of life due to its severe complications including infection, gangrene, and amputation. In this study, we aim to understand the pathogenesis of diabetic foot ulcer, its complications, and management strategies. We conducted this review using a comprehensive search of MEDLINE, PubMed and EMBASE from January 1970 to March 2017. The following search terms were used: diabetic foot ulcer, complications of diabetes mellitus, foot gangrene, surgical debridement of foot ulcer, osteomyelitis. Diabetic foot ulcer is a common morbidity in patients with diabetes mellitus, which can lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Proper management can ensure successful and fast healing which includes patient education, blood glucose control, wound debridement, advanced dressing, offloading, and surgery.

scholarly journals A randomized controlled trial of the safety and efficacy of a topical gentamicin–collagen sponge in diabetic patients with a mild foot ulcer infection

2018 ◽  
Vol 6 ◽  
pp. 205031211877395 ◽  
Author(s):  
Ilker Uçkay ◽  
Benjamin Kressmann ◽  
Sébastien Di Tommaso ◽  
Marina Portela ◽  
Heba Alwan ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Wound Care ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Collagen Sponge ◽  
Diabetic Patients ◽  
Topical Antibiotic

Objectives: The initial phase of infection of a foot ulcer in a person with diabetes is often categorized as mild. Clinicians usually treat these infections with antimicrobial therapy, often applied topically. Some experts, however, believe that mild diabetic foot ulcer infections will usually heal with local wound care alone, without antimicrobial therapy or dressings. Methods: To evaluate the potential benefit of treatment with a topical antibiotic, we performed a single-center, investigator-blinded pilot study, randomizing (1:1) adult patients with a mild diabetic foot ulcer infection to treatment with a gentamicin–collagen sponge with local care versus local care alone. Systemic antibiotic agents were prohibited. Results: We enrolled a total of 22 patients, 11 in the gentamicin–collagen sponge arm and 11 in the control arm. Overall, at end of therapy, 20 (91%) patients were categorized as achieving clinical cure of infection, and 2 (9%) as significant improvement. At the final study visit, only 12 (56%) of all patients achieved microbiological eradication of all pathogens. There was no difference in either clinical or microbiological outcomes in those who did or did not receive the gentamicin–collagen sponge, which was very well tolerated. Conclusion: The results of this pilot trial suggest that topical antibiotic therapy with gentamicin–collagen sponge, although very well tolerated, does not appear to improve outcomes in mild diabetic foot ulcer infection.

scholarly journals A study of the efficacy of external fixation in healing large, deep and unstable diabetic foot wounds

2019 ◽  
Vol 6 (3) ◽  
pp. 669
Author(s):  
Byomokesh Patro ◽  
Pankaj Surana ◽  
Kailash Chandra Mahapatra
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Working Environment ◽  
Lower Limbs ◽  
Control Group ◽  
Study Group

Background: Infection of a diabetic foot wound heralds a poor outcome, early diagnosis and treatments are important. The aim of the study was to study the efficacy of external fixation in healing large, deep and unstable diabetic foot wounds.Methods: 50 patients with diabetic foot ulcer considered for the present study. Out of this 50 cases 25 are selected for external fixations (study group), after fulfilling the inclusion criteria and rest 25 cases are managed by posterior slab support. After reducing the infective load, the external fixator was applied as per application of external fixator procedure. The fixator is kept for 4 to 6 weeks. Daily dressings are done with advance dressing materials. Posterior slab group 25 patients are included having large, deep ulcers and unstable joints, to which posterior slabs were supported after proper and extensive debridement of wound under SA/LA.Results: DFU predominantly affects right lower limb than left lower limb. Both lower limbs affected in 4% cases. Because of different working environment males are more vulnerable to foot ulcerations. Out of 50 cases 48 (96%) of DFU are unilateral and 32 no of cases (64%) are predominantly occurs in right lower limb (Table 2). Out of 50 cases 38 no. of patient are males and 12 no. of patient are females. External fixator in exposed joint decreases the wounds in 52 days where as by posterior slab support 59 days. The mean surfaces are of the wound after therapy in study group is 75 cm2 and in control group it was 78 cm2.Conclusions: Large ulcers and exposed joints due to diabetic foot can be managed by external fixator for better prognosis than posterior slab method.

ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature

2019 ◽  
Vol 16 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Sumarno Adi Subrata ◽  
Rutja Phuphaibul ◽  
Nirobol Kanogsunthornrat ◽  
Apinya Siripitayakunkit
Keyword(s):  
Diabetic Foot ◽  
Topical Therapy ◽  
Experimental Studies ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Integrative Review ◽  
Treatment Modalities ◽  
Nursing Interventions ◽  
Wound Fluid

Background and Aims: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation. Methods: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study. Results: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated. Conclusion: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

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