A COMPARATIVE STUDY OF PLATELET RICH PLASMA DRESSING VS NORMAL SALINE DRESSING IN THE MANAGEMENT OF DIABETIC FOOT ULCER

2021 ◽  
pp. 19-22
Author(s):  
Vijay kumar Siddalingappa ◽  
Mohan kumar Kariyappa ◽  
Subhashish Das
Keyword(s):  
Diabetic Foot ◽  
Platelet Rich Plasma ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
Diabetic Ulcer ◽  
Plantar Aspect ◽  
Diabetic Wounds

90 patients with diabetic foot ulcer admitted in Department of General Surgery R. L. JALAPPA HOSPITAL, TAMAKA, KOLAR, in between the study period of December 2017 to June 2019. The study is estimated to include diabetic foot ulcer patients satisfying inclusion criteria who are admitted in surgical wards of RLJH and RC. A complete detailed history, as per standard proforma will be obtained and documented. All patients will undergo clinical examination with relevant investigations after obtaining an informed consent. Patients are divided into 2 groups using even-odd method to include similar type of cases in both groups, where even group is study group and odd group is control group. RESULTS: Predisposition of diabetic foot ulcer was common among males than in females, More number of diabetic patients presented with diabetic foot ulcer arising from trauma than those occurring spontaneously. The spontaneous onset ulcers healed better with PRP than those arising due to traumatic onset. The ulcers on dorsal aspect heal faster than on plantar aspect, PRP dressing improved the rate of healing in lower Wagner grade ulcer than in higher grade ulcer, Patients who were on insulin alone showed better healing than those on OHA. Over all PRP dressing group showed higher rate of ulcer size reduction than those on saline dressing. CONCLUSION: The diabetic ulcer in the study group treated with PRP dressing contracted in wound size more than in the control group. This indicates that PRP dressing is an effective method to facilitate wound contraction in diabetic patients with foot ulcer. PRP dressing is found to be more effective, cost efcient and safe promoter of ulcer wound healing and can be used as an adjunct to saline dressings for enhanced healing of diabetic wounds.

Efficacy of Intra-Lesional Platelet Rich Plasma in Diabetic Foot Ulcer

2020 ◽  
Author(s):  
Ajay Gupta ◽  
Chethan Channaveera ◽  
Satyaranjan Sethi ◽  
Sunil Ranga ◽  
Vijender Anand
Keyword(s):  
Normal Saline ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Platelet Rich Plasma ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Control Group ◽  
Study Group ◽  
Ulcer Area ◽  
Total Contact Casting

Background: Diabetic foot ulcer (DFU) is well managed by infection control, euglycemic state, debridement of ulcer followed by appropriate dressing and off-loading of the foot. Studies have reported that when DFU is properly off-loaded, about 90% of these would heal in nearly six weeks. Platelet rich plasma (PRP) serves as a growth factor agonist and has mitogenic and chemotactic properties which help in DFU healing. To evaluate the efficacy of local application of PRP with respect to healing rate and ulcer area reduction in treating diabetic foot ulcer. Materials and Methods: Sixty non-infected DFU patients with plantar ulcer of size less than 20cm2 and Wagner's Grade 1 & 2 were randomized to receive normal saline dressing (Control group - CG) or PRP dressing (Study group - SG) in conjunction with total contact casting for 6 weeks (or till complete ulcer healing), whichever was earlier. Evaluation was done at weekly interval for healing rate and change in ulcer area.Results: Mean ulcer area of study participants at baseline was 4.96 {plus minus} 2.89cm2 (CG) and 5.22 {plus minus} 3.82cm2 (SG) (p=0.77) which decreased to 1.15{plus minus}1.35cm2 (CG) and 0.96{plus minus}1.53cm2 (SG) (p=0.432) at 6wks. Percent reduction in mean healing area at 6wks was 81.72{plus minus}17.2% and 85.98{plus minus}13.42% in control group and study group respectively (p=0.29). Average rate of healing achieved at 6 weeks was 0.64{plus minus}0.36cm2 and 0.71{plus minus}0.46cm2 in control group and study group respectively (p=0.734). Conclusions: PRP dressing is no more efficacious than normal saline dressing in management of DFU in conjunction with total contact casting.

scholarly journals The Effects of Silver-Releasing Foam Dressings on Diabetic Foot Ulcer Healing

2021 ◽  
Vol 10 (7) ◽  
pp. 1495
Author(s):  
Yu-Chi Wang ◽  
Hsiao-Chen Lee ◽  
Chien-Lin Chen ◽  
Ming-Chun Kuo ◽  
Savitha Ramachandran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Early Period ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Control Group ◽  
Diabetic Patients ◽  
High Morbidity

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

scholarly journals A Rare Form of Melanoma Masquerading as a Diabetic Foot Ulcer: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Susan Thomas ◽  
Yuan-Xiang Meng ◽  
Vijaykumar G. Patel ◽  
Gregory Strayhorn
Keyword(s):  
Case Report ◽  
Diabetic Foot ◽  
Primary Care Clinic ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Care Clinic ◽  
Acral Lentiginous Melanoma ◽  
Diabetic Ulcer ◽  
Formidable Challenge

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.

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.

scholarly journals A prospective observation study on diabetic foot ulcer using diabetic ulcer severity score at tertiary care hospital

2021 ◽  
Vol 8 (12) ◽  
pp. 3553
Author(s):  
Bharti Saraswat ◽  
Kapil Kumar Gill ◽  
Ashok Yadav ◽  
Krishan Kumar
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Scoring Systems ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Age Group ◽  
Diabetic Foot Ulcers ◽  
Diabetic Ulcer

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.

scholarly journals Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
N. K. Chammas ◽  
R. L. R. Hill ◽  
M. E. Edmonds
Keyword(s):  
Cause Of Death ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Premature Mortality ◽  
Control Group ◽  
Diabetic Patients ◽  
Age At Death ◽  
College Hospital ◽  
Neuropathic Foot

Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King’s College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years,P=0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, andP=0.049).Conclusions.IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.

scholarly journals KEJADIAN DERAJAT LUKA DIABETES TIDAK BERHUBUNGAN DENGAN NILAI RISIKO DIABETIC FOOT ULCER

2017 ◽  
Vol 4 (2) ◽  
pp. 215-227
Author(s):  
Risma Anggraeni Yuliastuti ◽  
Megah Andriany ◽  
Eka Putri Y.
Keyword(s):  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Risk Level ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Diabetic Ulcer ◽  
Significance Level ◽  
Risk Levels

The highest diabetic complication percentage is neuropathy (54%) causing diabetic foot ulcer (DFU). The study aimed to know the relationship between diabetic foot ulcer risk levels with diabetic ulcer severity levels. Scope of the study was diabetic wound care, particularly on legs mostly experienced by diabetic patients. The method used was descriptive correlation with cross sectional design. Sampling method was non probability with purposive sampling. Respondent number was 16 persons with inclusion criteria was diabetic patients with ulcer in one leg and no ulcer on another side in the second visitation to a diabetic clinic in Bekasi,Indonesia and agreed to be involved in the study. DFU risk level instrument modified from Diabetes Foot Screening and Risk Stratification Form of New Zealand Society for Study of Diabetes (NZSSD) to measure the DFU degree on legs with no ulcer. Another tool was to measure severity level of legs with ulcer according to Wagner. Data analysis used Kendall’s tau with 0.05 of significance level. The result shows there is no relationship between DFU risk levels with severity degree of diabetic ulcers. From the study, we can conclude that nurses do not need provide specific DFU prevention based on diabetic ulcer severity grade. 

scholarly journals Efficacy of Vitamin C and Vitamin E as an add on therapy in diabetic foot ulcer and red blood cell morphology as a biomarker of oxidative stress: a randomized, open label, comparative pilot study

2018 ◽  
Vol 7 (3) ◽  
pp. 548
Author(s):  
Vasanthi B. ◽  
Ainsy Goldlin T. J.
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Vitamin E ◽  
Vitamin C ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Control Group ◽  
Study Group

Background: Diabetes mellitus is a major cause of increased morbidity and mortality in developing countries. Foot ulcer is one of the long term complications of diabetes. Oxidative stress plays a major role in pathogenesis of diabetes mellitus and its long term complications. Impaired wound healing in diabetic individuals is due to ischemia and hypoxia occurring as a consequence of oxidative stress. Vitamin C and E have antioxidant property. This study aims to assess their efficacy in healing of diabetic ulcer. Objective of the study was to evaluate the efficacy of Vitamin C and E in healing diabetic foot ulcer.Methods: 60 adult patients with diabetic foot ulcer were randomized to test and control groups (30 in each). Treatment period was 12 weeks + 4 weeks follow up per patient. After obtaining written informed consent, patients in test group received Vitamin C (500mg BD) and Vitamin E (400mg BD) for 12 weeks along with standard treatment for diabetes and antibiotics for foot ulcer.Results: At the end of 12 weeks, increase in healing of foot ulcer assessed by percent reduction of ulcer area in study group 72.50% than control group 39.67% (p<0.001) was observed. There was a significant reduction of fasting blood glucose, Oxidative stress induced damage to RBCs and BP in the study group compared to control group. No serious adverse effects occurred.Conclusions: Vitamin C and E reverse oxidative stress induced morphological changes in RBCs, improve anemia and increase blood flow to ulcer area. Hence they are highly effective in healing diabetic foot ulcer along with standard therapy. 

scholarly journals The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study

2017 ◽  
Vol 4 (10) ◽  
pp. 3311
Author(s):  
Vijay Gunasekaran ◽  
Saravanakumar Subbaraj ◽  
Tirou Aroul
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Bacterial Load ◽  
Foot Ulcer ◽  
Control Group ◽  
Study Group ◽  
Gingival Hyperplasia ◽  
Diabetic Ulcer ◽  
Wound Swab

Background: Diabetic foot infection constitutes up to 10 percent of diabetes-related hospital admissions and the prevalence of diabetes is 2.4% in rural and 12-17% in urban settings. The quest for better wound healing agents for diabetic ulcers is perhaps one of the oldest challenges for medical practice. One such agent that has been tried in wound healing is phenytoin. A common side effect of phenytoin (diphenylhydantoin) treatment for epilepsy is gingival hyperplasia. This stimulatory effect of phenytoin on connective tissue suggested a possibility for its use in wound healing.Methods: 60 patients with diabetic foot ulcer admitted in General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India were randomly assigned into two groups, the study group consisting of 30 patients who were treated with phenytoin dressing and 30 patients into control group who were treated with conventional saline dressing. Both groups underwent initial debridement and were started on parenteral antibiotics according to wound swab culture and sensitivity. Study group were treated with phenytoin dressing and the wound was assessed based on the rate of ulcer size reduction, the rate of granulation tissue, duration of hospital stays and antibacterial property of phenytoin. Patients were assessed weekly up to 21 days.Results: The rate of granulation tissue in phenytoin group was 90.36% which was statistically significant (p = 0.0011) as compared to control group which was 82.03%. Wound swab cultures repeated on day 21 revealed that there was 50% negative culture in phenytoin group when compared to control group of 24% which also was statistically significant. The mean hospital stay for the patient in phenytoin group was 29.2 days and in control group, it was 26.1 days. It was observed that surface area reduction in phenytoin group was 41.25cm2 to 18.38cm2 and in control group was 40.28cm2 to 20.23cm2 by the end of 21 days, but this was not statistically significant.Conclusions: Phenytoin dressing is effective in increasing the rate of granulation tissue by virtue of its action on stimulating fibroblast proliferation and decreasing collagenase activity. It not only hastens granulation tissue but also decreases bacterial load as compared to conventional dressing by virtue of its intrinsic antibacterial activity and indirectly through their effects on anti-inflammatory cells and neovascularization. Phenytoin prepares the foot ulcer for early grafting thereby improving the overall outcome.

scholarly journals Outcome of patients undergoing amputation for diabetic foot ulcer

2018 ◽  
Vol 6 (1) ◽  
pp. 88
Author(s):  
Ashokkumar D. ◽  
Vinothkumar S. ◽  
Heber Anandan
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Ulcer ◽  
Delay In Diagnosis

Background: Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs with this disease. Peripheral neuropathy, ulceration, infection, and peripheral vascular disease are the principal factors for ulcer complications and loss of a lower limb in diabetic patients. The aim of the present endeavor was to study the patients undergoing amputation for the diabetic foot ulcer.Methods: Total 150 patients with diabetic foot ulcer were included in this study. The variables investigated were related to diabetes, infection, and surgical treatment. In our series amputation were done at different levels anatomical levels ranging from toe level ranging from toe level to above knee amputation.Results: Pus culture and sensitivity done for diabetic foot ulcers reveal E. coil as the most common organism (40%). Skin biopsy done in these patients reveal neuropathic changes in 102 patients. 40% of patients had vaso-occlusive disease. Nine out of 150 patients showed osteomyelitis changes emphasizing those diabetic ulcer patients are prone for osteomyelitis of the underlying bone. 46% of patients with diabetic foot ulcer needed either minor or major amputation, which correlates with the standard study.Conclusions: Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center are all factors which led to the occurrence of diabetic foot ulcer.

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