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 Emerging Diabetic Foot Ulcer Microbiome Analysis using Cutting Edge Technologies

2021 ◽  
pp. 193229682199009
Author(s):  
Brian M. Schmidt
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Standard Of Care ◽  
Molecular Techniques ◽  
Foot Ulcers ◽  
Care Practice ◽  
Antibiotic Administration ◽  
Diabetic Foot Ulcers ◽  
Conventional Culture

One of the most prevalent complications of diabetes mellitus are diabetic foot ulcers (DFU). Diabetic foot ulcers represent a complex condition placing individuals at-risk for major lower extremity amputations and are an independent predictor of patient mortality. DFU heal poorly when standard of care therapy is applied. In fact, wound healing occurs only approximately 30% within 12 weeks and only 45% regardless of time when standard of care is utilized. Similarly, diabetic foot infections occur in half of all DFU and conventional microbiologic cultures can take several days to process before a result is known. DFU represent a significant challenge in this regard because DFU often demonstrate polymicrobial growth, become resistant to preferred antibiotic therapy, and do not inform providers about long-term prognosis. In addition, conventional culture yields may be affected by the timing of antibiotic administration and collection of tissue for analysis. This may lead to suboptimal antibiotic administration or debilitating amputations. The microbiome of DFU is a new frontier to better understand the interactions between host organisms and pathogenic ones. Newer molecular techniques are readily available to assist in analyzing the constituency of the microbiome of DFU. These emerging techniques have already been used to study the microbiome of DFU and have clinical implications that may alter standard of care practice in the near future. Here emerging molecular techniques that can provide clinicians with rapid DFU-related-information and help prognosticate outcomes in this vulnerable patient population are presented.

The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery

2021 ◽  
pp. 153473462110225
Author(s):  
Marta Carmena-Pantoja ◽  
Francisco Javier Álvaro-Afonso ◽  
Esther García-Morales ◽  
Yolanda García-Álvarez ◽  
Aroa Tardáguila-García ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Calcification ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Time To Recurrence ◽  
Artery Disease ◽  
Clinical Records

The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.

scholarly journals Characterization Of Phyto-Synthesized Silver Nanoparticles And Their Antimicrobial Activity Against Diabetic Foot Ulcer Bacterial Isolates

2021 ◽  
Vol 11 (6) ◽  
pp. 88-96
Author(s):  
Chhajed Shweta ◽  
Arora Asha
Keyword(s):  
Antimicrobial Activity ◽  
Silver Nanoparticles ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limbs ◽  
Diffusion Method ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Bacterial Isolates

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

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

Inter-rater reliability assessment of new diabetic foot ulcers (The Diabetic Foot Ulcer Assessment Scale) based on photograph

2020 ◽  
Vol 30 ◽  
pp. 433-438 ◽  
Author(s):  
Hasniati Haeruddin ◽  
Saldy Yusuf ◽  
Ilhamjaya Patellongi ◽  
Kaharuddin Abdul Rasid ◽  
Harbaeni Harkam ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Reliability Assessment ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Assessment Scale ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Rater Reliability

scholarly journals Stem cell transplantation therapy for diabetic foot ulcer: a narrative review

2021 ◽  
Vol 15 (1) ◽  
pp. 3-18
Author(s):  
Sahar Shafiee ◽  
Maryam Heidarpour ◽  
Sima Sabbagh ◽  
Elham Amini ◽  
Hanieh Saffari ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Cell Based Therapy ◽  
Cell Transplantation Therapy ◽  
Transplantation Therapy

AbstractDiabetes mellitus is a chronic metabolic disease associated with high cardiovascular risk. A vascular complication of diabetes is foot ulcers. Diabetic foot ulcers are prevalent and substantially reduce the quality of life of patients who have them. Currently, diabetic foot ulcer is a major problem for wound care specialists, and its treatment requires considerable health care resources. So far, various therapeutic modalities have been proposed to treat diabetic foot ulcers and one of them is stem cell-based therapy. Stem cell-based therapy has shown great promise for the treatment of diabetic foot ulcers. This strategy has been shown to be safe and effective in both preclinical and clinical trials. In this review, we provide an overview of the stem cell types and possible beneficial effects of stem cell transplantation therapy for diabetic foot ulcers, and an overview of the current status of stem cell research in both preclinical and clinical trial stages of treatment strategies for diabetic foot ulcers.

scholarly journals Wound Myiasis in Diabetic Foot Ulcer: Calliphoridae and Sar-cophagidae Family

2021 ◽  
Author(s):  
Evren Tileklioğlu ◽  
İbrahim Yildiz ◽  
Fürüzan Bozkurt Kozan ◽  
Erdoğan Malatyali ◽  
Mustafa Bülent Ertuğrul ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Wound ◽  
Developmental Stages ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Foot Infections ◽  
Third Stage ◽  
Wound Myiasis

Background: Myiasis is a parasitic infestation of tissues or body cavities of mammals with dipterous larvae. The patients with diabetic foot ulcers are more vulnerable to acquiring infestation; however, the infestation may be neglected and mistreated in some cases.  Methods: Data were collected of twelve myiasis cases with diabetic foot ulcers in Nazli-Selim Eren Chronic Wound and Infections Care Unit, Aydin, Turkey between 2017 and 2019. Demographic, clinical characteristics of the patients and clinical examination of the wound were recorded. To morphology-based identification method of the agents, the developmental stages of the maggots were examined. Results: The cases aged between 46 and 81 years (10 males, two females). Eight of the larvae collected from wounds had Calliphoridae and four had Sarcophagidae family. The larvae were infested right/left foot sole, thumb, ankle, and mostly left toes. The number of larvae collected from the cases ranged from 2 to 48. Third-stage larvae (L3) were mostly detected. Mixed (L1-L2, L2-L3) larvae were detected in a patient. The infestations were more common in July and August. According to the score of Infectious Diseases Society of America (IDSA), ten (83%) cases had moderate and two (17%) cases were mild diabetic foot infections (DFIs). Conclusion: Diabetic foot ulcers should be evaluated in terms of myiasis. This was the first study in our province indicating that myiasis should not be neglected and different species of flies were responsible for myiasis cases.

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)

scholarly journals Korelasi antara Gambaran Spektral Doppler Arteri Tibialis Posterior dan Arteri Dorsalis Pedis dengan Skor PEDIS pada Penderita Ulkus Kaki Diabetik

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Leise Limpeleh ◽  
Richard Sumangkut ◽  
Djoni E. Tjandra
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Posterior Tibial Artery ◽  
Foot Ulcers ◽  
Tibialis Posterior ◽  
Diabetic Foot Ulcers ◽  
Doppler Examination ◽  
Posterior Tibial ◽  
Dorsalis Pedis Artery

Abstract: Diabetic foot ulcer is still a major health problem worldwide due to its increasing prevalence. This study was aimed to prove the correlation between PEDIS score and vascular Doppler examination performed on dorsalis pedis and posterior tibial arteries of patients with diabetic foot ulcers. This was an observational study with a cross sectional design. The results showed that during the period of August 2017 until January 2018, there were 62 patients with diabetic foot ulcers at the wards of Surgery Department and Internal Medicine Department of Prof. Dr. R. D. Kandou Hospital Manado. Most patients were in the age group of 60-69 years, had leukocytosis (74.1%), poor blood sugar control (70.9%), and hypoalbuminemia (98.3%). Moreover, smoking history in 20.9% of patients; hypertension in 35.4% of patients; and dyslipidemia in 20.9% of patients. The Doppler examination resulted in biphasic waveform in posterior tibial artery (40.3%) as well as in dorsalis pedis artery (41.9%). Perfusion score showed 50% of subjects had PAD. Most subjects (90.3%) had ulcers of >3 cm2 and were infected superficially in the subcutaneous area (56.4%). Most subjects (58%) suffered from severe infection with high leucocyte counts, however, only 29% of subjects had lost of sensoric ability. The correlation Spearman test obtained r = -0.486 and P = 0.000 in the posterior tibial artery; and r = -0.281 and P = 0.0027 in the dorsalis pedis artery. Conclusion: There was a significant correlation between vascular Doppler result and PEDIS score. The higher the PEDIS score, the worse the vascular Doppler result.Keywords: diabetic foot ulcer, PEDIS score, vascular DopplerAbstrak: Ulkus kaki diabetik masih merupakan masalah kesehatan utama sedunia dengan prevalensi yang terus meningkat. Penelitian ini bertujuan untuk membuktikan apakah terdapat hubungan antara skor PEDIS dan pemeriksaan spektral Doppler vaskuler pada arteri poplitea, dorsalis pedis, dan tibialis posterior pada pasien dengan ulkus kaki diabetik. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 62 pasien dengan ulkus kaki diabetik di bangsal Bagian Bedah dan Penyakit Dalam RSUP Prof. Dr. R. D. Kandou Manado selama periode Agustus 2017 sampai Januari 2018. Ukus diabetik tersering ditemukan pada kelompok usia 60-69 tahun dengan rerata usia 58,5 tahun. Sebagian besar pasien mengalami leukositosis (74,1%), kontrol gula darah buruk (70,9%), dan hipoalbuminemia (98,3%). Riwayat merokok didapatkan sebesar 20,9%; hipertensi 35,4%; dan dislipidemia 20,9%. Hasil pemeriksaan Doppler bifasik pada arteri tibialis posterior (40,3%) dan arteri dorsalis pedis (41,9%). Skor perfusi menunjukkan 50% subyek mengalami penyakit arteri perifer (PAD). Sebagian besar (90,3%) subjek memiliki ulkus >3 cm2 luas area. Infeksi sebagian besar superfisial di subkutan (56,4%), selebihnya menderita infeksi hingga fasia, otot, dan tendon. Sebagian besar subyek penelitian menderita infeksi berat (58%) dengan angka leukosit tinggi. Hanya 29% dari subjek penelitian mengalami kehilangan kemampuan sensorik. Hasil uji korelasi Spearman mendapatkan pada arteri tibialis posterior: r = -0,486 dengan P = 0,000 dan pada arteri dorsalis pedis: r = -0,281 dengan P = 0,0027. Simpulan: Terdapat hubungan bermakna antara hasil pemeriksaan spektral Doppler dan skor PEDIS. Semakin tinggi skor PEDIS semakin buruk hasil spektral Doppler.Kata kunci: ulkus kaki diabetik, skor PEDIS, Doppler spektral vaskular

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