MEDIAL SURAL ARTERY FLAP RECONSTRUCTION FOR DIABETIC FOOT ULCER : A CASE REPORT

2021 ◽  
pp. 20-21
Author(s):  
Tannistha Chakraborty ◽  
Manimaran Manimaran ◽  
K. S Ravishankar

Diabetes is the leading cause of non traumatic lower extremity amputations resulting from atherosclerosis of the arteries. According to the International Working Group on the Diabetic Foot (IWGDF), a diabetic foot ulcer (DFU) is a fullthickness wound penetrating through the dermis (the deep vascular and collagenous inner layer of the skin) located below the ankle in a diabetic patient. The sural fasciocutaneous ap is useful for the treatment of severe and complex injuries in diabetic lower limbs. It is simple to dissect , does not compromise a major artery and has low donor morbidity. We present the case of a 38 year old gentleman who presented to us with Right foot diabetic ulcer progressing over a duration of 2 months . After initial debridement of wound patient underwent a trans metatarsal (foot) amputation followed by vacuum dressing and a delayed primary closure of wound using a medial sural artery ap.

Author(s):  
Nuh Huda ◽  
Dini Mei Widayanti

Increasing the number of patients with DM, complications are also increasing, one of them is ulceration of the lower limbs, with or without infection and cause damage to the underlying tissue, hereinafter referred to as diabetic foot (KD) or diabetic foot wound. In the world, the number of diabetic foot patients is expected to continue to rise. Diabetic wound care also creates difficulties for the nurse. The purpose of this study is to analyze the level of ease of simple foot elevator (SFE) tools in the treatment of diabetic wounds. This type of research is quasi experimental Pre and Post Test Without Control Design by creating a prototype called SFE. This tool was then tested on 12 diabetic patient nurses with diabetic ulcer complications in the lower extremity area. The variable of this study is to measure the degree of ease of nurses in performing the treatment of Diabetic Injuries through the questionnaire. Data processing research with Mann Withney test with significance level (α = 0,05) or CI = 95%. The result of statistical test by using Mann-Whitney test is 0.014, the result p is less than α, meaning that statistically shows that the use of SFE (Simple Foot Elevator) tool is easy to be used by nurses when performing diabetic foot ulcer treatment in Room 3 Rumkital Dr. Ramelan Surabaya. The use of SFE is easy to use. So it can be recommended as one alternative tool that can be used in wound care.Keyword : Diabetes Mellitus, Diabetic Foot Wounds, SFE


2018 ◽  
Vol 5 (12) ◽  
pp. 4031
Author(s):  
Hanumanthaiah C. S. ◽  
V. Sharath Kumar ◽  
Suhas N. Gowda

Background: India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. A significant number of such patients will require long-term hospital treatment and amputations. Objective is to assess the predisposing factor and various modes of clinical presentation and management of Diabetic foot ulcer.Methods: An observational and prospective Hospital based Study was conducted at AIMS, B G Nagara, Bellur Cross from January 2018 to June 2018. A total of 40 patients with Diabetes Mellitus and suffering from diabetic foot ulcer admitted in the department of surgery were included in the study.Results: The mean age was 61+ 13.9 years. The male constituted nearly 26 (65%) and 14 (35%) females. Nearly 31(78%) of the cases had some of the predisposing factors for the diabetic ulcer of the foot The involvement of peripheral Vascular Disease was seen in 6 (16%) of the cases and 9(22%) had. The levels of HbA1C more than 7 mg % was seen in nearly 82 % of the case showing poor glycaemic control.Conclusions: Diabetic patients have always suffered from complications affecting the lower limbs. Foot infection and the subsequent amputation of a lower extremity are the most common cause of hospitalization among diabetic patients.


2021 ◽  
Vol 11 (6) ◽  
pp. 88-96
Author(s):  
Chhajed Shweta ◽  
Arora Asha

Diabetic Foot Ulcer (DFU) is one of the major complications of Diabetes. Patients with Diabetic Foot ulcers have a high susceptibility to microbial infections and are the leading cause of hospitalization and amputation of lower limbs. In the era of increased prevalence of bacterial resistance and outbreak of resistant infectious diseases, it is very essential to develop effective therapeutic strategies towards multi-drug resistant pathogens. The antimicrobial properties of silver nanoparticles have been well studied, therefore their use in biomedicine and pharmacology is a trend. Herein we present the use of Phyto-mediated synthesized AgNPs for the treatment of diabetic foot ulcers by topical administration. The nanoparticles were synthesized by reducing silver nitrate using Terminalia chebula fruit extract. The nanoparticles were analyzed and characterized using UV-Visible Spectrophotometer, FTIR, XRD, SEM with EDAX, TEM, and DLS. The synthesized silver nanoparticles were assayed for antimicrobial activity against five Diabetic Foot Ulcer bacterial isolates i.e. Escherichia coli, Klebsiella Pneumoniae, Pseudomonas aeruginosa, Streptococcus aureus, and Bacillus subtilis. The bactericidal property of synthesized nanoparticles was analyzed by the Agar well diffusion method, which revealed the remarkable antimicrobial effects against all the selective pathogenic bacterial isolates of Diabetic foot ulcers in the present study. These results constituted the basis for further studies on the use of plant-based silver nanoparticles for the treatment of Diabetic Foot ulcers from different origins


2017 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Wen-xia Wu ◽  
Dan Liu ◽  
Yi-wen Wang ◽  
Chuan Wang ◽  
Chuan Yang ◽  
...  

Diabetic foot and subsequent diabetic ulcer infections are the most devastating complication of diabetes. This study was conducted to explore the bacterial spectrum, sensitivity of microbials, and analysis of the empirical antibiotic regimens in our health center. The study included patients with diabetic foot ulcer infection (DFI) seen from 2009 to 2014. The patients included had all information covering the physical examination, laboratory tests, and image examinations. We sent appropriately obtained specimens for culture prior to starting empirical antibiotic therapy in all participants. A total of 312 patients were included: 52, 112, 95 and 53 patients within uninfected, mild, moderate, and severe infection groups. The total percentages of Gram-positive cocci (GPCs) and Gram-negative rods (GNRs) were 54% and 48.8% ( P = 0.63). The most common GPC was Staphylococcus aureus (22.4%) and GNR was Pseudomonas aeruginosa (11.9%). Methicillin-resistant Staphylococcus aureus was isolated from 21 patients (6.7%). Even in the mild infection group, there was no significant difference between GPC and GNR infection, irrespective of recent antibiotic use ( P = 0.053). The most frequently used empirical antibiotics in our center were second-/third-generation cephalosporin ± clindamycin, both in the mild and moderate/severe infection groups. In our center, the amoxicillin/clavulanate or ampicillin/sulbactam (β-L-ase 1) and second-/third-generation cephalosporins were highly resistant to the common GNR (30%-60%). The ticarcillin/clavulanate, piperacillin/tazuobactam (β-L-ase 2), fluoroquinolone, and group 2 carbapenem had good sensitivity. This study presents a comprehensive microbiological survey of diabetic foot ulcers in inpatients and provides reliable evidence of the local microbial epidemiology and sensitivity of antibiotics, which may help us improve clinical outcomes in DFI patients.


2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Susan Thomas ◽  
Yuan-Xiang Meng ◽  
Vijaykumar G. Patel ◽  
Gregory Strayhorn

Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion’s location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer.Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark’s Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy.Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients.Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.


2021 ◽  
Vol 9 ◽  
pp. 2050313X2110467
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Fábio Correa Fonseca ◽  
Cesar de Cesar-Netto ◽  
Katrina Bang ◽  
Eduardo Araujo Pires ◽  
...  

We present a stepwise surgical approach that can be used, in lieu of a transtibial amputation, to preserve the lower limb in the setting of severe diabetic foot infections. A 63-year-old male status post left midfoot (Lisfranc’s) amputation presented to our hospital with a 4-year history of a left foot diabetic ulcer with associated purulent drainage and intermittent chills. On initial exam, the patient’s left foot amputation stump was plantarflexed, grossly erythematous, and edematous. The associated diabetic foot ulcer was actively draining purulent fluid. Following workup with radiography and ultrasound, the patient was diagnosed with a post-operative infection of the midfoot at the level of the amputation stump secondary to diabetic neuropathy. Our approach to management was a staged and included (1) surgical irrigation and debridement of the distal stump wound, (2) provisional negative pressure therapy, (3) a second-look procedure, and (4) a tibiotalocalcaneal fusion was performed using a lateral transfibular and plantar approach, after wound closure and resolution of active infection was achieved. At 36-month follow-up, the patient was fully weight-bearing in stiff sole sneakers with no gross overt alteration of gait pattern. The patient scored 79 points when assessed by the hindfoot American Orthopaedic Foot and Ankle Society Ankle-Hindfoot outcome score. In the patient with diabetes and cardiological restrictions, a Chopart amputation is preferred due to the decreased level of energy expenditure required for ambulation as compared to over more proximal levels of amputation.


2019 ◽  
Vol 6 (3) ◽  
pp. 669
Author(s):  
Byomokesh Patro ◽  
Pankaj Surana ◽  
Kailash Chandra Mahapatra

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.


2020 ◽  
pp. 19-21
Author(s):  
Aarushi Mishra ◽  
Anilkumar P. Bellad ◽  
M.I. Uppin

INTRODUCTION : Diabetes mellitus is a common metabolic disorder, prevalence steadily increasing over the past few decades. The complications associated with it , hence , has also increased. Diabetic foot ulcer is one of the most serious complications , utilizing resources, significantly contributing to the morbidity of the patient. There is hence, a need to correctly identify the severity of the diabetic foot ulcer so as to plan the appropriate management and to help in counselling of such patients. AIM : To assess severity in diabetic foot ulcer using diabetic ulcer severity score. MATERIAL AND METHODOLOGY : This is a hospital based longitudinal study , conducted on 93 study subjects admitted with diabetic foot ulcers. Diabetic ulcer severity score was calculated for each patient . The score was calculated by adding scores of the respective parameters constituting site of ulcer, number of ulcers, presence/absence of pedal pulsations, presence/ absence of bone involvement. Each patient was followed up for a period of 6 months , or earlier in case of patient undergoing minor/major amputation. After the study was conducted , analysis was done by calculating various percentages of healing /amputation with respect to the score. RESULTS : Out of the total 93 study subjects , 74.2% were males. The mean age was calculated to be 59.6 years with maximum number of subjects being in 55-60 years of age group range. Majority of them had diabetic ulcer severity score of 2 (42%). Out of the total study subjects , 58% had a complete healing , 28% underwent minor amputation whereas 14% underwent major amputation. 100% of the study participants with score 0 had healing of ulcer which decreased to 85% for score 1 , 53.8% for score 2 , 6.25% for score 3 and 0% for score 4. This was suggestive of poorer chances of healing as the diabetic ulcer severity score increases. CONCLUSION : With the increasing incidence of patients diagnosed with diabetes mellitus , the rate of complications of diabetes has also increased over the past few decades including the risk and occurence of diabetic foot ulcers There is an increasing need for diabetic foot ulcer prognostication systems and universal use of the same. Thus ,we recommend the use of diabetic ulcer severity score as a prognostic tool to assess the severity of the diabetic foot which will further enhance communication and counselling of the patient and will help in providing the appropriate treatment to such patients.


2021 ◽  
Vol 8 (12) ◽  
pp. 3553
Author(s):  
Bharti Saraswat ◽  
Kapil Kumar Gill ◽  
Ashok Yadav ◽  
Krishan Kumar

Background: A number of scoring systems and classifications are available for diabetic foot ulcers with intention to compare the treatment modalities and future outcomes. Many of them are complex and don’t predict future outcome within the patients. Aim and objectives of current study were to establish a wound-based clinical scoring systems (DUSS) as daily clinical practice by assessing the efficacy of diabetic ulcer severity score.Methods: A total of 73 diabetic patients with foot ulcers were included in this prospective observational study conducted at Dr. S.N. Medical college, Jodhpur and attached hospitals from July 2018 to August 2020. Ulcers were assessed and DUSS score created. Patients were followed up for six months or until healing or amputation if either.Results: In this prospective study of 73 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean age group was 58.57±12.66 years. Mean duration of diabetes was 7.61±5.72 years. Most commonly ulcers were of DUSS score 2. Mean DUSS score was 1.97±1.15. Majority of diabetic foot ulcer patients (37 out of 51) with DUSS score 0, 1 and 2 healed by primary intention after wound debridement. Those with score 3 & 4 majority of them (20 out of 22) had amputation.Conclusions: This is a very simple scoring system that provides an easily accessible and a streamlined approach in the clinical setting without need of any advanced investigative equipment. Hence this can be applied in any set up.


2020 ◽  
Vol 6 (1) ◽  
pp. 128-136
Author(s):  
Fahruddin Kurdi ◽  
Anja Hesnia Kholis ◽  
Nurul Hidayah ◽  
Maya Fitriasari

ABSTRACT Diabetic foot ulcer is a complication of mellitus. The complication can cause psychological problems that cause stress for patient. The severity of diabetic foot ulcer will increase stress in patients. To deal with stress that needs to be overcome by reducing stress independently, besides the support system of the family is needed to help reduce stress and psychological burden. The purpose of this research is to explore how stress is experienced by diabetic foot ulcer patient.                 This research is a qualitative research with phenomenology approach. Participants were diabetic ulcer who come for wound care treatments at Al Hijrah wound care center, as well as the nuclear family as additional informants. Data is taken with a thorough interview, observation.                 The results obtained from two participants that stress due to diabetic ulcers is a condition related to physical and psychological conditions that cause participants to increase stress, such as: body image disorders, immobility, fear to amputation and cost difficulties.                 The main effort to reduce stress is pray, read the Al Quran, dzikr and ask for help to health services in the hope that the stress can reduced independently and does not cause worse complications. It is hoped that further research will examine more deeply the stress experienced by patients with diabetic ulcers.  


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