Diabetic Foot: its grades and mode of presentation at a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan

Introduction: Diabetic foot is defined as the foot of diabetic patients with ulceration, infection, and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs of this disease. Objectives: To describe the presentation, distribute the diabetic foot lesions according to Wagner’s classification, and determine the outcome of diabetic foot ulceration in a tertiary care hospital of Peshawar, Pakistan. Materials & Methods: This study was conducted in the Surgery department of Rehman Medical Institute Peshawar. Thirty nine (39) patients with diabetic foot disease presenting from Jan 2018 to Dec 2019 were included in the study. The patients were evaluated and managed by classifying their disease according to Wagner’s classification for diabetic foot disease. Statistical analysis was done by using SPSS version 26 for descriptive statistics. Results: The most common age of presentation with diabetic foot lesion was between 41-70 years; out of 39 patients, 28 (71.8%) were males and 11 (28.2%) were females. Their mode of presentation was as follows- 22 cases (56.4%) with Ulcer, 9 cases (23.1%) with Cellulitis, 7 cases (17.9%) with Gangrene, and 1 case (2.6%) with Abscess. The most common grade of presentation were grades 3 and 4 Wagner’s lesion followed by Grade 1, and Grade 2. Debridement was the most common treatment modality (56.2%), followed by Amputation (41%). Conclusion: Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step towards lower extremity amputation. Diabetic foot lesions can be easily graded according to the Wagner classification and helps in correlating appropriate treatment to the grade of the lesion for a better outcome.

Verrucous Carcinoma Arising Secondary to Diabetic Foot Lesions: A Systematic Review of the Literature

Verrucous carcinoma is classically considered a variant of squamous cell carcinoma, most commonly occurring in the oral cavity in association with snuff and chewed tobacco. However, the association between verrucous carcinoma of the foot and diabetes is less well known. This study presents a systematic review of all articles containing the search term “verrucous carcinoma” and “diabetic foot ulcer” in the abstract or title that have been published in PubMed before September 2020. The requirement for inclusion in our report were that the patient data had been documented in a case‐related manner and the patient diagnosed with verrucous carcinoma secondary to diabetic foot lesion. Seven descriptions of verrucous carcinoma presenting in patients with diabetic foot ulcers were presented across six case reports, and clinical case descriptions are collected here along with treatment outcomes, where available, and discussion of common mimics of verrucous carcinoma of the foot. Due to treatability and potential for extensive invasion of local structures requiring resection with wide margins, verrucous carcinoma should be carefully considered in the differential diagnosis of a warty foot lesion in the setting of the diabetic foot.

Microvascular Complications of Diabetes Mellitus: Focus on Diabetic Retinopathy (DR) and Diabetic Foot Ulcer (DFU)

Diabetic retinopathy and diabetic foot ulcer are the most frequent, but also the most disabling complications of diabetes mellitus, with a sinister impact on patients’ quality of life. Microvascular changes related to the deleterious effect of chronic hyperglycemia play an important role in the pathophysiology of both clinical entities by multiple molecular pathways. Vision-threating diabetic retinopathy may be treated by laser photocoagulation, anti-vascular endothelial growth factor (VEGF) agents and vitreoretinal surgery. Diabetic foot lesions are best treated by revascularization if needed, off-loading, infection control and therapeutic adjuncts (e.g. special dressings). Treatment should ideally be offered by a multidisciplinary expert team. Prevention and early detection, along with adequate control of glucose, lipids and arterial hypertension are of paramount importance to avoid and mitigate these fearful complications.

Calcium Alginate (C12H14CaO12)n Value in the Cicatrisation of Diabetic Foot Lesions

The present article explores the usage of calcium alginate in the actual management of diabetic mellitus foot ulcers. A retrospective study was performed on 305 cases of patients with diabetic mellitus foot diagnostic, admitted to Surgery Clinic II of �Sf. Ap. Andrei� Emergency Clinical Hospital, Galati, in the period between 1st October 2015 and 31st October 2019, for which calcium alginate dressings had been used. Calcium alginate (C12H14CaO12)n dressings had been applied to all patients from the series (n=305), with favorable evolution in 97.7 % cases, the dressing being replaced at 48 hours and the average duration for injury�s healing oscillating from 21 up to 50 days.

The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey

Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.

The differential diagnostics and sepsis surgical treatment and induced metabolically diseases in diabetic foot lesions patients

Purpose of the study. The sepsis differentiation criteria and metabolically induced diabetic foot lesions must be established. Material and methods. The 115 patients were observed. Results and discussion. Sepsis by the qSOFA criteria was diagnosed in 3, heart failure of 3–4 class by NYHA classification estimated in 39 cases. High limb amputation had been performed to 18 patients, surgery on the foot to 97. Foot lesion relapse accompanied by unstable glycaemia had been observed in 25 cases. For the surgical correction of the diabetes ileoduodenoplasty had been performed in 7 cases, which resulted in uncomplicated wound healing in all patients. Conclusion. Sepsis progression in patient with diabetic foot case proof indicates the necessity high lower limb amputation. Foot lesion relapse after the effective surgical sanitation indicate on metabolic disorder, not on sepsis. Surgical correction of the diabetes by mean of ileoduodenoplasty performing seems to be the reliable method of foot lesion relapse preventing. Keywords: diabetic foot, sepsis, metabolism challenge, surgical correction, ileoduodenoplasty.