Management of Over-Granulation in a Diabetic Foot Ulcer: A Clinical Experience

2013 ◽  
Vol 24 (1) ◽  
pp. 19-22
Author(s):  
I.N Krishnaprasad ◽  
V Soumya ◽  
S Abdulgafoor
Keyword(s):  
Granulation Tissue ◽  
Diabetic Foot ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Surgical Excision ◽  
Long Term Effects ◽  
Short Term ◽  
Inflammatory Phase ◽  
Cost Effective Treatment

Abstract Over-granulation or exuberant granulation tissue is a common problem encountered in the care of chronic wounds, especially that of diabetic foot ulcers. There are several potential options for the treatment of this challenging problem. Some have an immediate short term effect but may have a longer term unfavourable effect, for example, silver nitrate application and surgical excision, which may delay wound healing by reverting the wound back to the inflammatory phase of healing. Other products, such as foams and silver dressings may offer some effect in short term, but their long term effects are questionable. The more recent research supports Haelan cream and tape as an efficacious and cost effective treatment for over-granulation in a variety of wound types. The future of treating over-granulation may lie with surgical lasers, since lasers can not only remove over-granulation tissue but will also cauterise small blood vessels and are very selective, leaving healing cells alone while removing excess and unhealthy tissue. Recently Drs Lain and Carrington have demonstrated the utility of imiquimod, an immune-modulator with anti-angiogenic properties, in the treatment exuberant granulation tissue, in a patient with long standing diabetic foot ulcer, resistant to other forms of therapy. We adapted a modified version of their protocol in the management of a similar patient in our hospital and achieved a good result in lesser time than the former.

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.

scholarly journals Maggot debridement therapy for the treatment of diabetic foot ulcers: robbing the rich past to give to the sore

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Joseph Cutteridge ◽  
Katarzyna Bera
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Multiorgan Failure ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Necrotic Tissue ◽  
Foot Care ◽  
Surgical Interventions ◽  
Wound Debridement ◽  
Maggot Debridement Therapy

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

scholarly journals Three-Dimensional Human Tissue Models That Incorporate Diabetic Foot Ulcer-Derived Fibroblasts Mimic In Vivo Features of Chronic Wounds

2015 ◽  
Vol 21 (5) ◽  
pp. 499-508 ◽  
Author(s):  
Anna G. Maione ◽  
Yevgeny Brudno ◽  
Olivera Stojadinovic ◽  
Lara K. Park ◽  
Avi Smith ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Human Tissue ◽  
Chronic Wounds ◽  
Three Dimensional ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Tissue Models

Bioactive and superabsorbent cellulosic dressing grafted alginate and Carthamus tinctorius polysaccharide extract for the treatment of chronic wounds

2020 ◽  
pp. 004051752093521
Author(s):  
Yassine El-Ghoul ◽  
Fahad M Alminderej
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Negative Impact ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Carthamus Tinctorius ◽  
Biological Properties ◽  
Attenuated Total Reflection ◽  
Curing Conditions ◽  
Textile Functionalization

Diabetic foot ulcers have a negative impact on the lives of patients and are highly vulnerable to infection, leading to amputation too often. It is essential that the patient with a diabetic foot ulcer receives the best possible care. Herein, we developed a new functionalized cellulosic wound dressing with high-improved healing properties, able to be a serious alternative for diabetic acute wounds. First, a bioactive polysaccharide was extracted from the Carthamus tinctorius plant. Then a new crosslinked polymer-based alginate/ C. tinctorius polymer extract was prepared and checked for combined antimicrobial and tissue regeneration properties. Afterward, the efficiency of the textile functionalization process was optimized through studying the influence of different grafting parameters: curing conditions and the concentration of the impregnating solution. The drop method wettability technique exhibited significant improvement in the hydrophilicity behavior of treated textile samples, which increased with the grafting rate. Attenuated total reflection Fourier-transform infrared spectroscopy and thermogravimetric analysis or differential thermal analysis were investigated to test whether the chemical permanent grafting resisted the severe standard washing conditions. The tensile strength characteristics showed that the grafting does not affect the original mechanical properties of treated textile dressings. A morphological study via scanning electron microscopy images confirmed the permanent textile finishing performance and permitted us to assess its chemical grafting approach onto the treated surfaces. The biological and the bacteriological investigations of functionalized dressings proved that the functional biomaterial could be used as a medical bioactive device with improved biological properties.

scholarly journals Treatment of Non-Healing Diabetic Foot Wounds with Vaporous Hyperoxia Therapy in Conjunction with Standard Wound Care

2021 ◽  
Author(s):  
Dustin Kruse ◽  
Kenneth Morgan ◽  
Jeremy Christensen ◽  
Brian Derner ◽  
Brett Sachs
Keyword(s):  
Diabetic Foot ◽  
Oxygen Therapy ◽  
Chronic Wounds ◽  
Wound Care ◽  
Historical Analysis ◽  
Low Frequency ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Closure Rate ◽  
Wound Debridement

Vaporous Hyperoxia Therapy (VHTTM), a patented FDA-510 (k) cleared technology, is an adjunct therapy used in conjunction with standard wound care (SWC). VHT is said to improve the health of wounded tissue by administering a low-frequency, non-contact, non-thermal ionic anti-microbial hydrating mist alternating with concentrated topical oxygen therapy (TOT). VHT was used to treat 36 subjects with chronic diabetic foot ulcers (DFUs) that were previously treated unsuccessfully with SWC. The average age of DFU in the study was 11 months old and the average size was over 3 cm2. Wounds were either Wagner Grade 2 or 3 and most commonly on the plantar surface around the midfoot. Treatment consisted of twice weekly applications of VHT and wound debridement. Subjects were followed to wound closure, 20 weeks, or 40 treatments, whichever came first. The combination of SWC and VHT in the group that met and maintained compliance throughout the study period achieved an 83% DFU closure rate within a 20-week time period. The average time for DFU closure in this study was 9.4 weeks. Historical analysis of SWC shows a 30.9% healing rate of all wounds, not differentiating chronic wounds. Accordingly, SWC/VHT increases chronic diabetic foot ulcer healing rates by 2.85 times compared with SWC alone. The purpose of this study was two-fold: first, to observe the effect of VHT on healing rates and time to healing in previously nonhealing DFUs and second, to compare VHT with SWC, TOT and hyperbaric oxygen therapy (HBOT) and ultrasound therapies.

scholarly journals The Application of 0.75% Metronidazole Gel for the Treatment of Chronic Wounds: Two Case Reports and Literature Review

2020 ◽  
Author(s):  
Ruijuan Si ◽  
Jing Han ◽  
Xue Zhang ◽  
Fang Ji ◽  
Xu Yang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Chronic Wounds ◽  
Case Reports ◽  
Anaerobic Bacteria ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Deep Wound ◽  
Infected Wounds ◽  
Large Wound

Abstract Objective: To explore the application of metronidazole gel in the healing of chronic foot wounds.Methods: On the basis of reviewing the previous literature, routine debridement care and local application of metronidazole gel were applied to two patients with foot wounds and observations of wound healing were made. The wound of patient A was a deep wound, and the wound of patient B was a diabetic foot ulcer complicated by gangrene.Results: The bleeding and exudate of the patient with a deep wound gradually disappeared, and the wound healed. In the patient with the diabetic foot ulcer, the bleeding and exudate decreased. This was followed by the gradual size reduction of the wound and the formation of a scab over the large wound size.Conclusion: Metronidazole gel was effective in wound resolution of anaerobic bacteria infected wounds. It can serve as a way to relieve patients' pain with a promising therapeutic effect. The effectiveness of metronidazole in the treatment of deep wounds and diabetic foot patients requires further and larger-scale research studies to confirm the findings shown here.

scholarly journals Honey clinically stimulates granulation and epithelialization in chronic wounds: a report of two cases

2018 ◽  
Vol 27 (1) ◽  
pp. 62-8 ◽  
Author(s):  
Putu E.P. Kefani ◽  
Ida B.A.D. Putra ◽  
Ratna R.N. Roosseno
Keyword(s):  
Side Effects ◽  
Sodium Bicarbonate ◽  
Diabetic Foot ◽  
Wound Dressing ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Ulcer Patient ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Treatment

Various studies have been widely reintroduced honey as a wound dressing in chronic wound treatment. However, its utilization in Indonesia is still very limited. This study reported the effect of honey in stimulating the epithelialization and granulation on chronic wound treatment in our center. Two chronic wound cases, diabetic foot ulcer patient and gangrenous extravasation due to sodium bicarbonate, were daily treated with honey applications. After six-week evaluation, clinically the tissue granulation and epithelization were seen at the edge of the observed wounds and decreased the wound size significantly with no reported side effects. Honey clinically stimulates the epithelialization and granulation on chronic wound treatment.

scholarly journals The Anti-Inflammatory and Antibacterial Action of Nanocrystalline Silver and Manuka Honey on the Molecular Alternation of Diabetic Foot Ulcer: A Comprehensive Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-19 ◽  
Author(s):  
Ka-Kit Tsang ◽  
Enid Wai-Yung Kwong ◽  
Kevin Y. Woo ◽  
Tony Shing-Shun To ◽  
Joanne Wai-Yee Chung ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Animal Studies ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
In Vivo Studies ◽  
Resistant Bacteria ◽  
Manuka Honey ◽  
Anti Inflammatory

Honey and silver have been used since ancient times for treating wounds. Their widespread clinical application has attracted attention in light of the increasing prevalence of antibiotic-resistant bacteria. While there have been a number of studies exploring the anti-inflammatory and antibacterial effects of manuka honey and nanocrystalline silver, their advantages and limitations with regard to the treatment of chronic wounds remain a subject of debate. The aim of this paper is to examine the evidence on the use of nanocrystalline silver and manuka honey for treating diabetic foot ulcers through a critical and comprehensive review of in vitro studies, animal studies, and in vivo studies. The findings from the in vitro and animal studies suggest that both agents have effective antibacterial actions. Their anti-inflammatory action and related impact on wound healing are unclear. Besides, there is no evidence to suggest that any topical agent is more effective for use in treating diabetic foot ulcer. Overall, high-quality, clinical human studies supported by findings from the molecular science on the use of manuka honey or nanocrystalline silver are lacking. There is a need for rigorously designed human clinical studies on the subject to fill this knowledge gap and guide clinical practice.

scholarly journals Diabetic Foot Infection, Biofilm & New Management Strategy

2019 ◽  
Vol 1 (1) ◽  
pp. 7-22
Author(s):  
Ruke MG ◽  
Savai J
Keyword(s):  
Diabetic Foot ◽  
Chronic Wounds ◽  
Wound Care ◽  
Treatment Strategies ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The Body ◽  
Health Concern ◽  
Diabetic Foot Infections ◽  
Ischemic Ulcers

The world is facing a major epidemic of diabetes mellitus (DM) & available reports suggest that all these patients are at risk of developing diabetic foot ulcer (DFU). Approximately 50 – 60% of all DFUs can be classified as neuropathic. Signs or symptoms of vascular compromise are observed in 40 to 50% of all patients with the vast majority having neuro-ischemic ulcers, and only a minority of patients has purely ischemic ulcers. Diabetic foot infections are usually polymicrobial in nature, involving both aerobes and anaerobes, which can decay any part of the body especially the distal part of the lower leg. However, one of the hidden barriers to wound healing is the presence of biofilm in chronic DFUs. Biofilms are difficult to identify & diagnose, recalcitrant to topical antibiotics & can reoccur even after sharp debridement. More than 90% of chronic wounds are complicated with biofilms. Hence, early identification and management of diabetic foot infections becomes imperative in order to prevent complications & amputation. Debridement is considered to be the gold standard treatment approach for managing DFU manifested with necrotic tissue. However, biofilm can reform even after sharp debridement and can delay healing & recovery. Also, antibiotics & few antiseptics have limited role in managing DFUs complicated with biofilm. Until recently, Cadexomer iodine, a new generation iodine formulation with microbead technology has taken a different profile in wound care. It can effectively manage biofilm along with exudate & possesses superior desloughing action. Additionally, appropriate ways of offloading, dressings & use of newer treatment strategies like negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT) and / or use of growth factors can ensure faster healing & early wound closure. Although, commendable efforts in recent years have been taken in the diagnosis and treatment of DFU, it still remains a major public health concern.

scholarly journals DIABETIC FOOT ULCERS;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
SOHAIL Farooq ◽  
Shaukat Javed ◽  
Nazish Jahan
Keyword(s):  
Granulation Tissue ◽  
Diabetic Foot ◽  
Controlled Trial ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Size ◽  
Group A ◽  
Group B

Introduction: Traditionally, moist dressings are being in used routinely by surgeons for management of diabetic foot ulcers. Recently, there is an encouraging trend of using VAC dressings in such patients. This study aimed to compare the outcome of VAC with moist dressing for management of diabetic foot ulcer. Study Design: Prospective randomized controlled trial. Setting: Department of Surgery, Al-Bukyriah General Hospital, Al-Bukayriah, Alqaseem KSA. Period: June 2012 to 07 December 2016. Methods and Material: 200 patients with diabetic foot ulcers. The patients were divided in two equal groups containing 100 patients each. In group A, 100 patients received VAC dressing treatment while in group B, 100 patients received wet dressings. Wound size, % reduction in wound size, appearance of granulation tissue and fate of wound were main outcome measured which were noted at start of study and at the end of study (4th week of therapy). Results: In group A, there were 73 (73%) men and 27 (27%) women with a mean age of 54.98+7.68 years and in group B, there were there were 75 (75%) men and 25 (25%) women with a mean age of 55.23+6.98 years. Size of wound before treatment in group A was 14.23± 6.78 cm2 which reduced to 5.11±1.91 cm2 at 4th wee and in group B it was 14.41±5.93 cm2 in the start which reduced to 11.29±3.63 cm2 at 4th week (p<0.05). Mean %reduction in wound size in group A was 63.22±9.19 and 22.92±7.18 in group B (p<0.05). In group A, 43 (43%) wounds healed spontaneously with shrinkage and group B only 2(2%) healed spontaneously (p<0.05). Conclusions: VAC therapy is superior to moist dressing in terms of achieving early granulation tissue, reduction in wound size and spontaneous wound shrinkage.

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