scholarly journals PENATALAKSANAAN ULKUS KAKI DIABETES SECARA TERPADU

2013 ◽  
Vol 3 (2) ◽  
Author(s):  
Yuanita A. Langi
Keyword(s):  
Wound Healing ◽  
Growth Factors ◽  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Peripheral Arterial

Abstract: A diabetic foot ulcer is a common and fearful chronic complication of diabetes mellitus often resulting in amputation, and even death. A diabetic foot ulcer can be prevented by early screening and education in high risk individuals, and the management of underlying conditions such as neuropathy, peripheral arterial disease, and deformity. The prevalence of diabetic foot ulcer patients is 4-10% of the general population, with a higher prevalence in elderly people. Around 14-24 % of diabetic foot ulcer patients need amputations with a recurrence rate of 50% after three years. The main pathogenesis of diabetic foot ulcer is neuropathy and peripheral arterial disease (PAD). PAD contributes to diabetic foot ulcers in 50% of cases; however, it rarely stands alone. Other factors such as smoking, hypertension, and hyperlipidemia may contribute, too. In addition, PAD reduces the access of oxygen and antibiotics to the ulcers. Management of diabetic foot ulcers includes treatment of ischemia by promoting tissue perfusion, debridement for removing necrotic tissues, wound treatment for creating moist wound healing, off-loading the affected foot, surgery intervention, management of the co-morbidities and infections, and prevention of wound recurrences. Other adjuvant modalities include hyperbaric oxygen treatment, GCSF, growth factors, and bioengineered tissues. Key words: diabetic ulcer, debridement, off loading.   Abstrak: Ulkus kaki diabetes (UKD) merupakan salah satu komplikasi kronik diabetes melitus yang sering dijumpai dan ditakuti oleh karena pengelolaannya sering mengecewakan dan berakhir dengan amputasi, bahkan kematian. UKD dapat dicegah dengan melakukan skrining dini serta edukasi pada kelompok berisiko tinggi, dan penanganan penyebab dasar seperti neuropati, penyakit artei perifer dan deformitas. Prevalensi pasien UKD berkisar 4-10% dari populasi umumnya, dengan prevalensi yang lebih tinggi pada manula. Sekitar 14-24% pasien UKD memerlukan amputasi dengan rekurensi 50 % setelah tiga tahun. Patogenesis utama UKD yaitu neuropati dan penyakit arteri perifer (PAP). PAP berkontribusi 50% pada pasien UKD, tetapi hal ini jarang dijumpai tunggal. Terdapat faktor-faktor lain yang turut berperan seperti merokok, hipertensi dan hiperlipidemia. Selain itu PAP menurunkan akses oksigen dan antibiotik ke dalam ulkus. Penatalaksanaan UKD meliputi penanganan iskemia dengan meningkatkan perfusi jaringan, debridemen untuk mengeluarkan jaringan nekrotik, perawatan luka untuk menghasilkan moist wound healing, off-loading kaki yang terkena, intervensi bedah, pananganan komorbiditas dan infeksi, serta pencegahan rekurensi luka. Terapi ajuvan meliputi terapi oksigen hiperbarik, pemberian granulocyte colony stimulating factors (GCSF), growth factors dan bioengineerd tissues. Kata kunci: ulkus diabetes, debridemen, off loading.

scholarly journals PEDIS Classification in Diabetic Foot Ulcers Patients

2020 ◽  
Vol 1 (2) ◽  
pp. 50-54
Author(s):  
Radi Noorsyawal ◽  
Fahmi Jaka Yusuf ◽  
Kemas Dahlan ◽  
Ratna Maila Dewi
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
The United States ◽  
Classification Systems ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Peripheral Arterial

Introduction: Diabetic foot ulcer are one of several serious complications of diabetes progression. Up to 15% of patients with diabetes have diabetic foot ulcer and these ulcers lead to more than 80,000 amputations per year in the United States. Many DFU classification systems have been proposed to predict clinical outcome; however, almost of these systems have limitations. To categorize and define DFU objectively, the International Working Group of the Diabetic Foot (IWGDF) developed the PEDIS classification system. These collective findings and because of there is no findings of characteristic of DFU based on PEDIS classification in Mohammad Hoesin Hospital indicate that this research is needed to do. Method: This is a prospective study at Mohammad Hoesin hospital, Palembang. The aim is to describe the characteristic of diabetic foot ulcers based on PEDIS classification. There were 41 cases evaluated under this study. Results: Peripheral arterial disease is the most problem in perfusion. 1-3 cm2 is the most happen in extent. Wound depth on fascia or muscle or tendon is the most happen. Abscess or fascitis is the most problem in infection. Loss of sensation is the most happen. PEDIS score ≥ 7 is the most happen. Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of diabetic foot ulcers patient. Keywords: Diabetic Foot Ulcer, PEDIS classification, Peripheral Arterial Disease

Wound management of chronic diabetic foot ulcers: From the basics to regenerative medicine

2015 ◽  
Vol 39 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Karen L Andrews ◽  
Matthew T Houdek ◽  
Lester J Kiemele
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Current Treatment ◽  
Foot Ulcers ◽  
Foot Deformities ◽  
Minor Trauma ◽  
Diabetic Foot Ulcers ◽  
Number Of Patients ◽  
Peripheral Arterial

Background: Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers. Objective: To assess the etiology and management of chronic diabetic foot ulcers. Study design: Literature review. Methods: Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality. Results: Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation. Conclusion: Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed. Clinical relevance Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading.

Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage

2021 ◽  
pp. 153473462110270
Author(s):  
Ahmed Azhar ◽  
Magdy Basheer ◽  
Mohamed S. Abdelgawad ◽  
Hossam Roshdi ◽  
Mohamed F. Kamel
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Negative Impact ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Cross Sectional ◽  
Peripheral Arterial

Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD −ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender ( P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD ( P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation ( P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.

scholarly journals Integrative Analysis of miRNA Expression Profiling of Diabetic Foot Ulcers Wound Treated With Zizhu Ointment

2021 ◽  
Author(s):  
Xiaoming Hu ◽  
Renyan Huang ◽  
Wenhui Li ◽  
Xiao Yang ◽  
Weijing Fan ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chinese Medicine ◽  
Diabetic Foot ◽  
Expression Profiling ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Differentially Expressed Mirnas ◽  
Mirna Expression Profiling

Abstract Background: A major complication of diabetes is diabetic foot ulcers. Millions of patients suffer from the physiological and psychosocial effects of diabetic foot ulcers. However, the current treatment is not effective, and the patients’ prognosis has not been significantly improved.Results: Traditional Chinese medicine-Zizhu ointment exhibited its own characteristics and advantages in treating diabetic foot ulcer by promoting wound healing. The mechanism of Zizhu ointment promoting diabetic foot ulcer wound healing was explored by detecting its miRNA expression profiling. Eighty-three differentially expressed miRNAs were identified, 30 of which were upregulated and 53 were downregulated in diabetic cutaneous wounds treated with Zizhu ointment. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differentially expressed miRNAs showed that they were involved in several pathways that could regulate the proliferation, differentiation, apoptosis, migration, and secretion of tissue repair cells, and were linked to inflammatory cells, the extracellular matrix, growth factors, and other relevant factors related to wound healing. Furthermore, miRNA-Target regulatory network and protein-protein interaction network were constructed. Twenty hub genes of networks were obtained.Conclusions: Our preliminary study provides a new alternative drug treatment for diabetic foot ulcers by traditional Chinese medicine, and will assist in better understanding its therapeutic targets.

scholarly journals Peripheral arterial disease in patients with renal-diabetic foot ulcers

2021 ◽  
Vol 30 (8) ◽  
pp. 660-664
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Valerio Da Ros ◽  
Daniele Morosetti ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Independent Predictor ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Anterior Tibial Artery ◽  
Diabetic Foot Ulcers ◽  
Arterial Lesions ◽  
Patient Groups ◽  
Peripheral Arterial

Objective: To describe the angiographic characteristics of peripheral arterial disease (PAD) in persons with diabetic foot ulcers (DFUs) on dialysis treatment. Method: The study is a retrospective analysis of patients with DFUs and PAD who had been referred to our diabetic foot clinic. All patients had been managed by a pre-set limb salvage protocol including revascularisation of the affected limb. Arterial lesions (stenosis between 50–99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence or not of dialysis, patients were divided into two patient groups: renal-diabetic foot (RDF) and diabetic foot (DF). Distribution of PAD and immediate revascularisation outcome (technical revascularisation outcome) for RDF and DF were separately reported and compared. Results: The sample included 239 patients: mean age was 71.8 years; 72.4% were male; 87.4% had type 2 diabetes; mean diabetes duration was 21.4 years; and the mean HbA1c was 63±22mmol/mol. The RDF group compared with the DF group reported higher numbers of vessels affected (n=5±1.6 versus 3.9±1.5, respectively, p<0.0001), greater involvement of the superficial femoral artery (90.2% versus 75.8%, respectively, p=0.003), the tibial-peroneal trunk (53.7% versus 25.5%, respectively, p=0.01), the anterior tibial artery (93.9% versus 80.9%, respectively, p=0.03) and below-the-ankle (BTA) arteries (70.7% versus 35.7%, respectively, p=0.0001). The RDF group showed a higher rate of revascularisation failure in comparison to DF patients (43.9% versus 15.3%, respectively, p<0.0001). BTA arterial disease (odds ratio 9.5; 95% Confidence Interval: 3.5–25.4; p=0.0001) resulted as the only independent predictor of revascularisation failure. Conclusion: In this study, RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison with DF patients. BTA arterial disease was found to be an independent predictor of revascularisation failure.

scholarly journals Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Marie Louise Buhl Sørensen ◽  
Rasmus Bo Jansen ◽  
Therese Wilbek Fabricius ◽  
Bo Jørgensen ◽  
Ole Lander Svendsen
Keyword(s):  
Wound Healing ◽  
Median Time ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Healing Time ◽  
Foot Ulcers ◽  
Time Range ◽  
Diabetic Foot Ulcers ◽  
One Year

Aim. To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods. A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results. Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p=0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p=0.6), 14% were amputated (p=0.2), and 12.8% were dead within one year in 2011/2012 (p<0.001). The single factor found significantly associated with longer ulcer duration was infection. Related to shorter ulcer duration were toe localization of the ulcer and good glycemic control. Conclusion. The median time to healing of a diabetic foot ulcer was long, around 6 months and with a high recurrence rate in 1999/2000 as well as in 2011/2012. Some factors were found to be significantly related to healing time, and intervention addressing these may improve the time to heal, although such interpretations must be taken with precaution from the present study and should be proven in randomized prospective intervention trials.

scholarly journals The Evaluation and Treatment of Diabetic Foot Ulcers and Diabetic Foot Infections

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141878886 ◽  
Author(s):  
Michael A. Del Core ◽  
Junho Ahn ◽  
Robert B. Lewis ◽  
Katherine M. Raspovic ◽  
Trapper A. J. Lalli ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Immune System Dysfunction ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Peripheral Arterial

Diabetic foot ulcers and infections are common complications of diabetic foot disease. Additionally, these complications are a common cause of morbidity and impose a substantial burden to the patient and society. It is imperative to understand the major contributing factors, namely, diabetic neuropathy, peripheral arterial disease, and immune system dysfunction in order to guide treatment. Management of diabetic foot disease begins with a detailed history and thorough physical examination. This examination should focus on the manifestations of diabetic neuropathy and peripheral arterial disease, and, in particular, any evidence of diabetic foot ulcers or infection. Prevention strategies should include a multi-disciplinary approach centered on patient education.

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