Early debridement and skin grafting in diabetic ulcer to reduce morbidity.

Background: Negative pressure wound therapy (NPWT) is a non-invasive wound closure system that uses controlled, localized negative pressure to help heal chronic and acute wounds. The objective of the present study was to compare home based NPWT and moist wound dressing in home care setting with respect to wound healing and time taken for healing among diabetic ulcer patients and the comparison of cost involved for the treatment.Methods: A hospital based prospective observational study where all patients were presented to the Department of Surgery at MES Medical College with diabetic ulcer between 1st January 2016 and 30th March 2017 were included in the study; ulcer size and surface area were measured using vernier calipers and Wagner’s grade between the two groups were evaluated at the time of enrollment.Results: Complete ulcer healing by primary intention was achieved in 86.8% in home based NPWT group vs. 44.3% in conventional moist dressing group. Average duration taken for healing in home based NPWT patient was 3.03 months and in moist dressing group was 4.58 months. Split skin grafting was needed in 2 patients in HB-NPWT group vs. 7 in moist dressing group. 9.3 hospital visits in HB-NPWT group vs 136.8 sessions in moist dressing group.Conclusions: The present study states that NPWT is superior to conventional moist dressing for the management of chronic diabetic foot ulcers. Cost is approximately 1/10th of standard NPWT.

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A study to test the validity of diabetic ulcer severity score (DUSS) at tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20175401 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4010

Author(s):

V. Hari Kumar ◽

Abdul Ghader Barazandeh Moghadam

Keyword(s):

Classification System ◽

Severity Score ◽

Low Cost ◽

Tertiary Care ◽

Skin Grafting ◽

Diabetic Patients ◽

Care Hospital ◽

Diabetic Ulcer ◽

The Mean ◽

Mean Time

Background: For classification of ulcer of feet in diabetes, various systems of classification are in use. Notable among them are the University of Texas (UT) system and the Wagner system. One of the most recent such type of classification system is DUSS (Diabetic Ulcer Severity Score). Studies are required to validate the same. Objective was to test the validity of Diabetic Ulcer Severity Score (DUSS).Methods: Present follow up study was carried out among 50 known cases of diabetes having ulcer over foot. DUSS scoring was applied. Ulcer was graded into five grades. Patients were followed till the outcome was noted.Results: Most common ulcers were of DUSS score of 3. Major amputation was done in 15 (30%) patients and minor amputation in 12 (24%) patients. Toe amputation was done in total of 15 patients. None of the patients had forefoot amputation. Below knee amputation was done in total of 11 (22%) patients. Majority of the foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intension or skin grafting i.e., 1 (100%), 3 (75%) and 6 (46.15%) respectively. However, among those with score 3 and 4 majority required amputation i.e., 14 (70%) and 10 (83.33%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P=0.004). The probability of healing with DUSS score 0 was 100%, 75% with DUSS score 1, 84.61% with DUSS score 2, 30% with DUSS score 3, 16.67% with DUSS score 4. The mean time for healing was 77 days. The mean time for amputation was 100 days.Conclusions: The proposed score classification system for the diabetic foot may enable better quality of life for diabetic patients and promote better low-cost care for millions of individuals worldwide.

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532 Early Debridement and Cultured Allogenic Keratinocyte Dressing Prevent Hypertrophic Scarring in Infants with Deep Dermal Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.161 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S103-S104

Author(s):

SeungJe Lee

Keyword(s):

Functional Disability ◽

Skin Grafting ◽

Healing Time ◽

The Body ◽

Hypertrophic Scarring ◽

Burn Scar ◽

The Mean ◽

Patients Experience ◽

Early Debridement

Abstract Introduction Deep dermal burns are frequently treated with excision and skin grafting. Otherwise, wound healing may take up to 4 to 6 weeks, with serious scarring. Especially in pediatric patients, post-burn scarring could result in psychologic trauma and functional disability. We aimed to investigate the efficacy of early debridement and dressing using cultured allogenic keratinocytes in infants with deep dermal burns to prevent hypertrophic scarring. Methods From April 2016 to April 2018, 18 infants were treated for deep dermal burns. Except for 5 infants who underwent skin grafting or excision, 13 infants were included in this study. We performed early debridement in these patients using Hydrosurgery device and serial dressings using cultured allogenic keratinocytes. Results The average operative date was 8.3 days after the accident. The mean healing time was 18.3 days after the accident. The patients did not experience any contraction, but 3 patients had hyperpigmentation, 2 patients had mild hypertrophic scarring, and 1 patient had mixed pigmentation (hyperpigmentation and hypopigmentation). Conclusions Our prophylactic scar therapy, using early debridement with VersajetTM and dressings with Kaloderm®, may be beneficial for infants with dermal burns. This method was able to shorten the healing time, resulting in better scar outcomes. Our follow-up findings revealed that the scars had an aesthetically pleasing appearance and patients were able to perform normal activities without restrictions. Applicability of Research to Practice Burn scars are painful regardless of their seriousness. They restrict the function of the body, are aesthetically unappealing, and may feel unpleasant. Patients with a post-burn scar may have aesthetic, functional, and psychological problems. In particular, infant patients experience difficulties due to scarring as they grow up.

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Comparative study on management of diabetic ulcer with platelet-rich plasma and conventional dressing

International Surgery Journal ◽

10.18203/2349-2902.isj20205371 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4148

Author(s):

Uma Dhanasekaran ◽

Ramesh Arumugam ◽

Latha Jayasubramaniyar

Keyword(s):

Hospital Stay ◽

Wound Dressing ◽

Platelet Rich Plasma ◽

Skin Grafting ◽

Necrotic Tissue ◽

Diabetic Ulcer ◽

Wound Debridement ◽

Duration Of Hospital Stay ◽

Split Skin Grafting ◽

Split Skin

Background: About 15% of diabetic patients will develop a chronic ulcer, and about 25% of those will have to undergo foot amputation. Despite evidence of the effectiveness of autologous protein C (PC) in diabetic ulcers, efficacy and feasibility of this treatment in the general population remain unclear. Aim of the study was to compare the efficiency of management of diabetic ulcer with platelet-rich plasma (PRP) and conventional dressing.Methods: A total of 40 patients who divided into two groups: group I comprising 20 patients received homologous platelet concentrate and group II comprising 20 patients received conventional wound dressing, and the results had statistically discussed.Results: Out of total 40 patients, 20 received homologous platelet dressings, and the 20 patients received conventional moist wound dressings. 7 patients had operated for split skin grafting, 7 patients had 0-10% of the area covered with necrotic tissue, mean duration of hospital stay was 18 days, mean duration of wound debridement was 3 days and mean number of wound dressing was 6. In conventional wound dressing group, 15 patients had operated for split skin grafting, 4 patients had 0-10% of the area covered with necrotic tissue, mean duration of hospital stay was 39 days, mean duration of wound debridement was 18 days and mean number of wound dressing was 48.Conclusions: Patients operated for split skin grafting, number of wound debridement, duration of hospital stay, and duration of wound debridement, necrotic tissue coverage was less in platelet group compared to the conventional wound dressing.

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Epidemiological Study of Ulcers of the Lower Limb in a Tertiary Care Teaching Institute

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0802.14 ◽

2020 ◽

Vol 8 (2) ◽

pp. 64-67

Author(s):

sudhir adepu

Keyword(s):

Diabetes Mellitus ◽

Lower Limb ◽

Tertiary Care ◽

Skin Grafting ◽

Leg Ulcers ◽

Age Group ◽

Venous Valve ◽

Cross Sectional ◽

Diabetic Ulcer ◽

Left Limb

Lower limb ulcers are common in old age group there are several causes which includes venous valve insufficiency, diabetes mellitus, skin malignancies. We in the present study tried to evaluate the epidemiology of population affected with lower limb ulcers and treatment and outcome of such conditions. Methods: This cross-sectional study was conducted in the Department of General Surgery, Prathima Institute of Medical Sciences, Nagnur, Karimnagar. All cases of leg ulcers reporting to this institute except those which occur due to trauma and in children < 12 years of age were included in the study. Result: In the study n=50 cases of both sexes with leg ulcers were included. The most commonly involved age group was > 70 years. Diabetic ulcers were detected in 44% of cases in males and 18% of cases in females. In the cases right limb was involved in n=24(48%) cases and left limb was involved in n=23(46%) of cases and bilateral involvement was found in n=3(6%) of cases. The predominating organism found was Staphylococcus aureusfollowed by Klebsiellaand streptococcus. Conclusion: The study found that found to be ulcer of the leg associated with diabetes mellitus, ulcer due to venous valve incompetence. The diabetic ulcer was more common in males, more prevalent in patients above the age of 51 years. Venous ulcers are commonly seen are saphenofemoral junction incompetence and perforator incompetence. As far as the treatment of these cases is concerned the use of antibiotics and dressings helps to a great deal in management. Skin grafting may be considered with wide defects where healing is difficult without grafts.

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Boxed Warning Added to Diabetic Ulcer Treatment

Family Practice News ◽

10.1016/s0300-7073(08)70795-3 ◽

2008 ◽

Vol 38 (13) ◽

pp. 4

Author(s):

ELIZABETH MECHCATIE

Keyword(s):

Boxed Warning ◽

Diabetic Ulcer ◽

Ulcer Treatment

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The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive malignant skin lesion in the temporal region

Orvosi Hetilap ◽

10.1556/oh.2013.29535 ◽

2013 ◽

Vol 154 (6) ◽

pp. 225-227 ◽

Cited By ~ 1

Author(s):

Csaba Halmy ◽

Zoltán Nádai ◽

Krisztián Csőre ◽

Adrienne Vajda ◽

Róbert Tamás

Keyword(s):

Surgical Treatment ◽

Skin Lesion ◽

Surgical Management ◽

Skin Grafting ◽

Skin Tumor ◽

Temporal Region ◽

Aesthetic Result ◽

Malignant Skin ◽

Dermal Regeneration Template ◽

Dermal Regeneration

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull. Orv. Hetil., 2013, 154, 225–227.

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