COMPARATIVE ASSESSMENT OF SALINE VERSUS OCTENIDINE DIHYDROCHLORIDE DRESSING IN DIABETIC FOOT ULCERS

2021 ◽  
pp. 3-4
Author(s):  
Sudip Chowdhury ◽  
Sharad Chandrika Mishra
Keyword(s):  
Diabetic Foot ◽  
Population Sample ◽  
Saline Group ◽  
Rural Populations ◽  
Undiagnosed Diabetes ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Coverage ◽  
Octenidine Dihydrochloride ◽  
The Mean

Diabetic foot ulcers are a common presenting complaint in many institutions catering to rural populations. The reasons for this can be the undiagnosed diabetes and lack of knowledge regarding complications. Care of diabetic foot ulcers involves systemic as well as local interventions. Among the local care methods is regular dressings using a good antimicrobial agent. Here Octenidine Dihydrochloride has shown promise. The present study was done to assess the efcacy of Octenidine Dihydrochloride in diabetic foot ulcers. The study used a pool of 80 subjects divided in two equal groups who were randomly subjected to saline and Octenidine Dihydrochloride dressings. The study observed that the mean rate of healing and wound coverage was signicantly better in Octenidine treated subjects when compared to saline group. Octenidine Dihydrochloride is a better topical agent when compared to saline in the present population sample.

scholarly journals Comparison of Efficacy of Alginate Filler Dressings with Conventional Saline Dressings for Cavity Wounds in Diabetic Foot Ulcer- A Prospective Cohort Study

2020 ◽  
Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Pradeep Joshua Christopher ◽  
Jeyakumar Sundaraj ◽  
Ramyasree Paladugu ◽  
Sundeep Selvamuthukumaran
Keyword(s):  
Cohort Study ◽  
Surface Area ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Saline Group ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
The Mean ◽  
Culture Positive

Introduction: Diabetic foot ulcers are associated with 25% of patients with Diabetes Mellitus (DM). These diabetic foot ulcers if not given appropriate care at the right time can lead to amputations and poor quality of life. Alginate dressings are newer and help in faster healing of cavity wounds in diabetic foot ulcer. Aim: To compare the advantages of alginate dressings over conventional saline dressings in cavity wounds of diabetic foot ulcer patients. Materials and Methods: A single centre prospective longitudinal cohort study was conducted on 88 patients with diabetic foot ulcers randomising equally into two groups containing 44 patients in each group in a tertiary care hospital. The wounds of all patients included in the study were thoroughly debrided and initial assessment was done using the Pressure Ulcer Scale for Healing (PUSH) scoring system. The patients were started on alginate dressings in one group and saline dressings in other group and were assessed after two and four weeks. The reduction in the surface area of the wound, reduction in the exudate amount, type of the tissue over the ulcer and reduction in the bacterial load (wound cultures) of the ulcers were studied. The statistical analysis were done using Statistical Package for the Social Sciences (SPSS) software version 21. The statistics were done using independent sample tests (Levene’s test for equality of variances and t-test for equality of means), Mann-Whitney test and Wilcoxon test. Results: The results of wound assessment before dressings, at two weeks and at the end of four weeks are as follows: The mean (SD) reduction in wound surface area was 9.07 (1.634) to 6.89 (1.434) to 4.68 (1.272) for alginate group and 9.25 (2.059) to 8.00 (1.905) to 6.50 (1.650) for saline group. The mean (SD) reduction of the exudate amount was 2.02 (0.505) to 1.09 (0.473) to 0.14 (0.347) for alginate group and 1.98 (0.590) to 1.43 (0.625) to 0.75 (0.615) for the saline group. The mean (SD) for tissue type of cavity wounds assessed via PUSH scoring was reduced from 2.30 (0.701) to 0.16 (0.370) for the alginate group in comparison to 2.32 (0.740) to 0.77 (0.743) for the saline group at the end of four weeks. On evaluation of the wound cultures; 6 out of 44 patients (13.6%) were culture positive in the alginate group while 30 out of 44 patients (68.2%) were culture positive from the saline group at the end of four weeks. All the above results were statistically significant with a p-value of 0.001. Conclusion: Alginates dressings are superior to saline dressings in terms of reduction in the size of the ulcer and control of microbial activity in diabetic foot. Alginate absorbs large amount of exudates and fill in irregular shaped cavities which are ideal in treating cavity wounds in diabetic foot syndrome.

scholarly journals Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Andrew Mganga ◽  
Jeff Van Baal ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Random Blood Glucose ◽  
North Eastern ◽  
The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

scholarly journals An Observational Clinical Trial Examining the Effect of Topical Oxygen Therapy (Natrox™) on the Rates of Healing of Chronic DiAbetic Foot Ulcers (OTONAL Trial)

2021 ◽  
pp. 153473462110536
Author(s):  
Tjun Yip Tang ◽  
Manfred Y. Q. Mak ◽  
C. J. Q. Yap ◽  
J. E. C. Boey ◽  
Sze Ling Chan ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Distribution System ◽  
Oxygen Therapy ◽  
Atmospheric Oxygen ◽  
Foot Ulcer ◽  
Glycated Haemoglobin ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Transcutaneous Oxygen ◽  
The Mean

Natrox™ topical oxygen therapy (TOT) ( Inotec AMD Ltd, Hertfordshire, UK) employs a small battery-powered “oxygen generator” to concentrate atmospheric oxygen and feeds pure, moist, oxygen through a fine, soft tube to a dressing-like “oxygen distribution system”, which is placed over the wound and is held in place by a conventional dressing. The aim was to determine the effectiveness of Natrox™ for non-healing diabetic foot ulcers (DFU) over a 3-month period.Longitudinal, single-arm, open prospective registry study using 12 weeks of TOT using a 4 week run-in period. 20 patients recruited to OTONAL had chronic DFU greater than 3 months duration or minor amputation sites with less than 50% healing in 4 weeks.There were 13 (65%) males and the mean age was 65.7 (±11.6) years. The mean glycated haemoglobin (HbA1c) was 6.9 (±1.3) mmol mol−1 and mean wound duration before TOT was 114 (±79.1) days. 18/20 (90.0%) patients had concomitant lower limb revascularization angioplasty for chronic limb threatening ischaemia. The mean size of the foot ulcer at baseline was 11.3 ± 14.8 cm2 and mean transcutaneous oxygen measurement value was 34.1 (±19.6) mm Hg. Wound closure of >75% was observed in 14/20 (70.0%) patients. There was a 91.3% (±14.9%) wound area reduction by 3 months (P = .001) and mean time for 100% closure was 77.6 ± 32.5 days. Mean pain scores reduced from 2.4 (±1.8) at baseline to .5 (±1.0) at 3 months (P = .008). All patients were very satisfied using the ambulatory device. Use of TOT in chronic diabetic foot wounds stimulates a healing state, underpinning the concept that oxygen plays a central role in wound healing. Our results are more compelling if you consider they started with relatively large-sized DFUs and majority of patients were frail with underlying peripheral artery disease. (NCT03863054)

Healing hard-to-heal diabetic foot ulcers: the role of dehydrated amniotic allograft with cross-linked bovine-tendon collagen and glycosaminoglycan matrix

2021 ◽  
Vol 30 (Sup7) ◽  
pp. S47-S53
Author(s):  
Grace L Tsai ◽  
Daniel Zilberbrand ◽  
Wei Jei Liao ◽  
Lawrence P Horl
Keyword(s):  
Amniotic Membrane ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Dermal Matrix ◽  
Increased Risk ◽  
The Mean ◽  
Prospective Case Series

The treatment of diabetic foot ulcers is complex and costly with an increased risk for infection, which may even lead to amputation. This prospective case series aims to assess the effectiveness of a dehydrated amniotic membrane allograft combined with a bilayer dermal matrix for healing complicated foot ulcers in patients with comorbidities. A total of six patients with complicated full-thickness ulcers and comorbidities, such as diabetes and peripheral vascular disease were treated with this technique. Each wound was measured intraoperatively just before graft application, at 14 days after application, and then at weeks 4, 8, and 12. Changes in wound volume and area were compared over time. One patient had complete wound closure by week eight, a second patient by week 12. The other four patients had wounds that decreased in size during the course of 12 weeks. The mean decrease in wound volume was 73.5% post-removal of the bilayer dermal matrix after two weeks of application. At week 12, the mean decrease in wound area and volume were 93.2% and 97.1%, respectively. This case series provides initial evidence that the combination of dehydrated amniotic membrane allograft with bilayer dermal matrix promotes complete wound closure in patients with comorbidities that may impede wound healing. Further clinical trials are needed to confirm these results.

Treatment of Diabetic Foot Ulcers With Necrotizing Fasciitis in the Lower Leg Using the STAGE Principles: A Report of 9 Cases With a Literature Review

2020 ◽  
pp. 153473462094302
Author(s):  
Ying Tian ◽  
Xu Sun ◽  
Chaojun Zhu ◽  
Hanchi Sun ◽  
Yue Shi ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Diabetic Foot ◽  
Ankle Brachial Index ◽  
Rapid Onset ◽  
Lower Leg ◽  
Foot Ulcers ◽  
Layer By Layer ◽  
Diabetic Foot Ulcers ◽  
Wide Range ◽  
The Mean

Diabetic foot ulcers (DFUs) combined with necrotizing fasciitis (NF) has rapid onset, involves a wide range of lesions, is difficult to treat, and has a high mortality rate. It has become a clinically critical disease. DFU patients are at high risk for NF. The STAGE principles guide surgical intervention in the treatment of DFU wounds 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.” This work reports the application of the STAGE principles for the treatment of 9 cases of DFUs combined with NF in the lower leg (Wagner grade 3-5). The mean ankle-brachial index was 0.55 (0-0.91, standard deviation [SD] = 0.33), the mean years of smoking were 19.56 years (0-50, SD = 17.83), and the mean cigarette consumption was 9.11 cigarettes/day (0-20, SD = 7.77). The mean duration of ulcers was 45.56 days (3-103, SD = 35.44). Among the 9 patients, only patient no. 9 died, and the mean follow-up time for the other 8 patients was 12 months (3-36, SD = 13.42). In short, the STAGE principles are also applicable to the treatment of DFUs combined with NF in the lower leg.

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.

Long Term Effects of Below-the-Knee Angioplasty in Diabetic Patients with Critical Ischemia of Lower Limbs Referred to Sina Hospital During 2010-2011

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Mohammad-Reza Zafarghandi ◽  
Iraj Nazari ◽  
Morteza Taghavi ◽  
Abbas Rashidi ◽  
Sanaz Karimi Dardashti ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Long Term Effects ◽  
Short Term ◽  
Critical Ischemia ◽  
Below The Knee ◽  
The Mean

AbstractDespite significant advances in the treatment of diabetic foot ulcers and below-the-knee critical ischemia, there are ongoing efforts to achieve a method with low complication, high success rate and persistence of long-term effects.was to examine the outcome of angioplasty in patients with below-the-knee critical ischemia referred to Hospital.. This semi-experimental study conducted on diabetics patients treated with PTA (Percutaneous transluminal angioplasty) with critical ischemia of lower limbs referred to Sina Hospital. After discharge, the patients were followed weekly for the first month and then monthly up to 12 months. The procedure short-term effects were examined through evaluation of wound healing as well as patients' recovery and pain relief, after one month. Given the distribution type, parametric and non-parametric test were used to compare the results before and after treatment. Pearson's correlation coefficient was used to determine the correlation between variables.. Twenty four patients participated in this study. The mean ankle-brachial index (ABI) at baseline was 0.55±0.17. A month after angioplasty, the index increased statistically significant to 0.93±0.16. The mean health score expressed by the patients at baseline was 5.48±1.39. A month after angioplasty, it was significantly increased (6.32±1.24). The mean pain score before enrollment was 6.68±2.52 (according to VAS scale). There was a significant decrease over time (3.45±1.13). The overall mean score of all patients at Rutherford Classification was 3.88±0.63 at baseline. During the 1st month and 6th month follow-up, it was changed to Class 0 that was statistically significant in the first month.. This study represents the mid-term outcomes of PTA. Although PTA treatment was associated with improved pain scores, satisfaction with health, classification of limb ischemia and diabetic foot ulcers, the effects only remain short-term and mid-term. However, long-term efficacy of PTA needs to be investigated further.

The MABAL Shoe, an Alternative Method in Contact Casting for the Treatment of Neuropathic Diabetic Foot Ulcers

2000 ◽  
Vol 21 (4) ◽  
pp. 320-323 ◽  
Author(s):  
Rutger Jan Hissink ◽  
Hendrik Anton Manning ◽  
Jeff G. van Baal
Keyword(s):  
Surface Area ◽  
Diabetic Foot ◽  
Gold Standard ◽  
Healing Time ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Plantar Ulcers ◽  
The Mean ◽  
Total Contact Casting ◽  
Methods Of Treatment

INTRODUCTION: Total Contact Casting (TCC) is considered the gold standard in the treatment of neuropathic diabetic foot ulcers. To overcome some disadvantages of TCC we developed a removable fiberglass combicast shoe - the MABAL shoe. PATIENTS AND METHODS: The MABAL shoe was used to treat 23 plantar ulcers. RESULTS: Before treatment the mean surface area was 2.0 cm 2 (0.5–7.1 cm 2 ). Twenty-one of 23 ulcers healed, with a mean healing time of 34 days (7–75 days). CONCLUSION: The MABAL shoe provides healing of neuropathic diabetic foot ulcers comparable to existing methods of treatment, while offering some potential advantages. The main advantages are mobilization of the ankle, removability of the cast and a less time consuming form of treatment.

scholarly journals Prospective observational study evaluating association of sociodemographic parameters, Wagner’s grading, peripheral arterial disease and diabetic peripheral neuropathy with the outcomes of diabetic foot ulcers

2020 ◽  
Vol 7 (7) ◽  
pp. 2129
Author(s):  
Vishnu S. Ravidas ◽  
Samadarsi P. ◽  
Ajayan G.
Keyword(s):  
Peripheral Neuropathy ◽  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Diabetic Peripheral Neuropathy ◽  
Arterial Disease ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
The Mean ◽  
Peripheral Arterial

Background: The present study was conducted to determine the association of sociodemographic parameters, comorbid conditions and complications of diabetes mellitus (DM) with the treatment outcomes of diabetic foot ulcers.Methods: The present prospective observational study enrolled 105 participants aged 30-85 years with diabetic foot ulcers presenting to general surgery department during a period of 18 months. Participants who were terminally ill, who had trophic ulcers of Hansen’s disease and filariasis and its sequelae were excluded. The study was approved by institutional ethics committee and written informed consent was obtained from all study participants. Data was analyzed using R and the test of significance was chi square test, p<0.05 was considered statistically significant.Results: Higher proportion of male participants and those aged between 50-69 years were encountered. Male participants were of higher age and the mean duration of DM in participants with diabetic foot ulcer was 8 years. The mean HbA1C of study participants was 8.1%, 38.1% participants had high plasma glucose. Food deformity was observed in 41% participants. 62.9% and 66.7% participants had diabetic peripheral neuropathy and peripheral arterial disease respectively. The mean time required for healing among participants with diabetic foot ulcers was 45.8 Significant association of major amputation with diabetic peripheral neuropathy (p=0.02), Wagner’s grading (p<0.001) and peripheral arterial disease (PAD) (p=0.006) was observed.Conclusions: The presence of diabetic peripheral neuropathy and PAD were risk factors for major amputations in diabetic foot ulcers. Lower Wagner’s grading was associated with lower chances of major amputation.

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