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Diabetic Foot Wounds (diabetic + foot_wound)

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Medical Sciences	100%

Selected Abstracts

The value of debridement and Vacuum-Assisted Closure (V.A.C.) Therapy in diabetic foot ulcers

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2008
Magnus Eneroth
Abstract Background Treatment of diabetic foot ulcers includes a number of different regimes such as glycaemic control, re-vascularization, surgical, local wound treatment, offloading and other non-surgical treatments. Although considered the standard of care, the scientific evidence behind the various debridements used is scarce. This presentation will focus on debridement and V.A.C. Therapy, two treatments widely used in patients with diabetes and foot ulcers. Methods A review of existing literature on these treatments in diabetic foot ulcers, with focus on description of the various types of debridements used, the principles behind negative pressure wound therapy (NPWT) using the V.A.C. Therapy system and level of evidence. Results Five randomized controlled trials (RCT) of debridement were identified; three assessed the effectiveness of a hydrogel as a debridement method, one evaluated surgical debridement and one evaluated larval therapy. Pooling the three hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers. Surgical debridement and larval therapy showed no significant benefit. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes. More than 300 articles have been published on negative pressure wound therapy, including several small RCTs and a larger multi-centre RCT of diabetic foot ulcers. Negative pressure wound therapy seems to be a safe and effective treatment for complex diabetic foot wounds, and could lead to a higher proportion of healed wounds, faster healing rates, and potentially fewer re-amputations than standard care. Conclusions Although debridement of the ulcer is considered a prerequisite for healing of diabetic foot ulcers, the grade of evidence is quite low. This may be due to a lack of studies rather than lack of effect. Negative pressure wound therapy seems to be safe and effective in the treatment of some diabetic foot ulcers, although there is still only one well-performed trial that evaluates the effect. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact

DIABETIC MEDICINE, Issue 7 2004
A. Hartemann-Heurtier
Abstract Aims The primary objective was to characterize factors allowing the colonization of diabetic foot wounds by multidrug-resistant organisms (MDRO), and the secondary objective was to evaluate the influence of MDRO colonization/infection on wound healing. Methods In 180 patients admitted to a specialized diabetic foot unit, microbiological specimens were taken on admission. Potential risk factors for MDRO-positive specimens were examined using univariate and multivariate analyses. Prospective follow-up data from 75 patients were used to evaluate the influence of MDRO colonization/infection on time to healing. Results Eighteen per cent of admission specimens were positive for MDRO. MDRO-positive status was not associated with patient characteristics (age, sex, type of diabetes, complications of diabetes), wound duration, or wound type (neuropathic or ischaemic). In the multivariate analysis, the only factors significantly associated with positive MDRO status on admission were a history of previous hospitalization for the same wound (21/32 compared with 48/148; P = 0.0008) or the presence of osteomyelitis (22/32 compared with 71/148; P = 0.025). In the longitudinal study of 75 wounds, MDRO-positive status on admission or during follow-up (6 months at least or until healing, mean 9 ± 7 months) was not associated with time to healing (P = 0.71). Conclusion MDROs are often present in severe diabetic foot wounds. About one-third of patients with a history of previous hospitalization for the same wound, and 25% of patients with osteomyelitis, had MDRO-positive specimens. This suggests that hygiene measures, or isolation precautions in the case of admission of patients presenting with these characteristics, should be aggressively implemented to prevent cross-transmission. Positive MDRO status is not associated with a longer time to healing. [source]

Maggot debridement therapy with Lucilia cuprina: a comparison with conventional debridement in diabetic foot ulcers

INTERNATIONAL WOUND JOURNAL, Issue 1 2009
Aaron G Paul
Abstract This is prospective case,control study of more than 18 months performed to assess the effectiveness of maggot debridement therapy (MDT) with the sterile larvae of Lucilia cuprina (a tropical blowfly maggot) for the treatment of diabetic foot ulcers. Literature thus far has only reported results with the temperate maggot, Lucilia sericata. This study documents outcome in diabetic foot wounds treated with maggot debridement versus those treated by conventional debridement alone. In this series of 29 patients treated with MDT, 14 wounds were healed, 11 were unhealed and 4 were classified under others. The control group treated by conventional debridement had 30 patients of which 18 wounds were healed, 11 unhealed and 1 classified under others. There was no significant difference in outcome between the two groups. The conclusion that can be made from this study is that MDT with L. cuprina is as effective as conventional debridement in the treatment of diabetic foot ulcers. It would be a feasible alternative to those at high risk for surgery or for those who refuse surgery. [source]

Outcomes of allogenic acellular matrix therapy in treatment of diabetic foot wounds: an initial experience

INTERNATIONAL WOUND JOURNAL, Issue 2 2005
Article first published online: 28 JUN 200
Résultats du traitement par matrice acellulaire allogénique dans le traitement des plaies du pied diabétique: expérience initiale. Le propos de cette étude était d'évaluer les résultats de patients présentant des plaies neuropathiques du pied diabétique UT grade 2A traités avec une matrice extracellulaire. Les données étaient tirées de 17 patients consécutifs présentant un diabète, 76.5% mâles, agés de 61.5 ± 8.5 ans et une hémoglobine glycée moyenne de 9.2 ± 2.2 se présentant pour traitement dans un grand centre de soins des plaies multidisciplinaire.Tous les patients ont bénéficié d'un débridement chirurgical pour leurs plaies du pied diabétique et recevaient un traitement consistant en une application unique d'un greffon de matrice acellulaire. (GraftJacket, Wright Medical Technologies, USA) le pansement étant changé toutes les semaines. Les résultats étaient évalués sur le temps de fermeture complète des plaies et la proportion de patients avec fermeture complète de la plaie en 20 semaines. Le traitement par matrice acellulaire était utilisé de première intention et fixé par sutures ou agraffage sous un pansement à base de silicone non adhérent. Le traitment incluait également un pansement retenant l'humidité jusqu'àépithélialisation complète. Au total, 82.4% des plaies mesurant en moyenne 4.6 ± 3.2 cm2 ont cicatrisé enmoyenne en 8.9 ± 2.7 semaines. Nous concluons que cette techniqueconsistant en application de pansement maintenant la plaie en milieu humide avec un pansement de matrice acellulaire peut être un appport utile dans la prise en charge appropriée des ulcères du pied diabétique dans les plaies profondes non infectées non ischémiques. Nus attendons la réalisation d'études complémentaires pour confirmer ou infirmer cette évaluation initiale. Ergebnisse einer allogenen azellulären Matrixtherapie in der Wundbehandlung bei diabetischem Fußsyndroms: Ein erster Erfahrungsbericht Ziel dieser Studie war die Evaluation einer Wundbehandlung mit einer azellullären Matrix bei Patientin mit Wunden infolge eines diabetischen Fußsyndroms im Stadium II a. Die Daten wurden von 17 Patienten mit einem Diabetes mellitus erhoben, die einem großen interdisziplinären Wundzentrum zur Weiterbehandlung vorgestellt wurden. 76,5% der Patienten waren männlich, das mittlere Alter betrug 61,5 + 8,5 Jahre; der durchschnittliche Hämoglobinwert wurde mit 9,2 + ,2,2% angegeben.. Alle Patienten wurden einem mechanischen Wunddebridement unterzogen, anschließend erfolgte die Applikation einer einfache Schicht einer azellullären Wundmatrix ( Graftjacket, Wright Medical Technologies, USA) Der Verbandswechsel erfolgte in wöchentlichen Abständen. Die Evaluation der Ergebnisse umfasste die Zeitspanne bis zum vollständigen Wundverschluss sowie den prozentualen Anteil der Probanden, bei denen eine vollständige Wundheilung innerhalb eines Zeitraums von 20 Wochen erzielt werden konnte. Dabei wurde die azelluläre Matrix als initiale Therapieform gewählt, eine Adaptation erfolgte durch Nähte oder Klammern unter einem nicht adhärentem Silikonverband. In der Folgezeit wurden saugfähige Wundverbände bis zur vollständigen Epithelialisierung angewandt. Zusammenfassend heilten 82,4% der Wunden bei einer mittleren Wundgröße von 4,6 + ,3,2 cm innerhalb der Evaluierungsperiode von 20 Wochen. Die durchschnittliche Heilungsdauer betrug 8,9 + ,2,7 Wochen. Es wurde gefolgert, das ein Regime aus feuchter Wundbehandlung kombiniert mit der Anwendung einer azellulären Matrix eine sinnvolle Ergänzung in der Therapie von Ulzerationen des nicht infizierten und nicht ischämischen diabetischen Fußes darstellt. Weitere Untersuchungen zur Bestätigung oder Widerlegung der Ergebnisse sind erforderlich. Risultati della terapia con matrice acellulare allogenica nel trattamento delle ulcere del piede diabetico: esperienza preliminare L'obiettivo di questo studio è stato di valutare i risultati di persone con ulcere diabetiche neuropatiche di grado 2° durante il trattamento con una matrice acellulare. I dati sono stati ottenuti da 17 pazienti consecutivi con diabete, 76.5% maschi, età media 61.5 ± 8.5 anni e con un valore medio di emoglobina glicata di 9.2 ± 2.2%, che si sono presentati per assistenza in un ampio centro multidisciplinare per la cura di lesioni. Tutti i pazienti hanno ricevuto un debridement chirurgico per le ulcere del piede diabetico e sono poi stati trattati con una terapia basata sulla applicazione singola di un innesto di matrice acellulare (GrftJacket, Wright Medical Technologies, USA) con un cambio di medicazioni settimanale. I risultati valutati includevano il tempo di guarigione completo delle lesioni e la proporzione dei pazienti che ottenevano una guarigione entro le 20 settimane. La terapia con matrice acellulare è stata utilizzata come trattamento iniziale ed è stata suturata o fissata con graffes con sovrapposizione di una medicazione non aderente a base di silicone. Il trattamento è quindi proseguito con una medicazione in ambiente umido fino a completa riepitelizzazione. In totale, 82.4% delle ulcere che misuravano in media 4.6 ± 3.2 cm2, sono guarite all'interno del periodo di valutazione di 20 settimane. Tra quelle guarite in questo periodo, la guarigione è avvenuta con una media di 8.9 ± 2.7 settimane. Noi concludiamo che il regime terapeutico comprendente la guarigione in ambiente umido mediante una medicazione con matrice acellulare può rappresentare una valida aggiunta per una corretta gestione delle ulcere del piede diabetico, per ulcere profonde, non infette, non ischemiche. Ulteriori trial saranno necessari per confermare o rifiutare questo protocollo. Resultados de la terapéutica matricial acelular alogénica en el tratamiento de heridas en el pie diabético: una experiencia inicial. El objetivo de este estudio era evaluar los desenlaces de sujetos con heridas neuropáticas en pies diabéticos de grado 2A UT, tratados con una matriz acelular. Los datos se obtuvieron de 17 pacientes diabéticos consecutivos, un 76,5% de hombres con 61,5 ± 8,5 años de edad y hemoglobina glucosilada media del 9,2 ± 2,2%, que acudieron para ser asistidos en un gran centro multidisciplinario para asistencia de heridas. En todos los pacientes se realizaron desbridamientos quirúrgicos de las heridas en sus pies diabéticos y recibieron tratamiento consistente en una aplicación única de un injerto matricial acelular (GraftJacket, Wright Medical Technologies, EE.UU.) con cambios de apósito cada semana. Entre los criterios de valoración evaluados destacan el tiempo hasta la cicatrización completa de la herida y la proporción de pacientes que consiguieron dicha cicatrización en 20 semanas. Se utilizó la terapéutica matricial acelular como tratamiento inicial y se fijó en la zona con sutura o grapas bajo un apósito no adherente basado en silicona. Ese tratamiento se siguió de la aplicación de un apósito retentivo de humedad hasta lograr la epitelización completa. En conjunto, durante el período de evaluación de 20 semanas, curó el 82,4% de las heridas, que medían en promedio 4,6 ± 3,2 cm2. De las que curaron durante este período, la curación se produjo en un promedio de 8,9 ± 2,7 semanas. Concluimos que una pauta consistente en la curación de heridas en medio húmedo utilizando un apósito matricial acelular puede ser un coadyuvante útil de la atención apropiada de úlceras en pies diabéticos para heridas profundas, no infectadas y no isquémicas. Quedamos a la espera de la conclusión de ensayos adicionales en este ámbito para verificar o refutar esta evaluación inicial. Resultat av Allogen Acellulär Matrix Terapi Vid Behandling Av Diabetes Fotsår: En Initial Upplevelse Målsättningen med denna studie var att utvärdera resultat av personer med UT grad 2A neuropatiska diabetes fotsår som behandlats med ett acellulärt matrix. Data sammanfattades för sjutton påvarandraföljande patienter med diabetes, 76.5% manliga, i åldern 61.5 ± 8.5 år, med ett medelvärde för glykolyserat hemoglobin på 9.2 ± 2.2% och som behandlats på ett multidisciplinärt sårvårdscentrum. Alla patienter genomgick kirurgisk debridement för sina diabetes fotsår och tillhandahölls terapi bestående av en enstaka applicering av ett acellulärt matrix transplantat (GraftJacket, Wright Medical Technologies, USA) med förbandsbyten varje vecka. Resultat som utvärderades var tid till fullständig sårläkning och proportionen av patienter som uppnådde sårläkning inom 20 veckor. Acellulär matrix terapi användes som initial terapi och suturerades eller fästades på plats med klammer under ett silikon baserat, icke-vidhäftande sårförband. Terapin åtföljdes därefter av ett fuktbevarande sårförband tills fullständig epitelialisering uppnåtts. Totalt, 82.4% sår vilka uppmätte ett medelvärde på 4.6 ± 3.2 cm2 läktes under den 20 veckor långa utvärderingsperioden. Läkning uppnåddes på en medeltid av 8.9 ± 2.7 veckor i de sår som läktes under loppet av utvärderingsperioden. Vi drar slutsatsen att en behandlingsregim bestående av fuktig sårvård och användandet av acellulärt matrix förband kan i fall av djupa, icke-infekterade, icke-iskemiska sår, vara ett nyttigt tillskott till tillbörlig vård av diabetes fotsår. Vi avväntar slutförandet av fortsatta studier på området för att stöda eller vederlägga denna initiala utvärdering. [source]

Enhanced healing of diabetic foot ulcers using local heat and electrical stimulation for 30 min three times per week

JOURNAL OF DIABETES, Issue 1 2010
Jerrold Scott PETROFSKY
Abstract Background:, Electrical stimulation (ES) with heating is effective in healing chronic wounds. However, it this effect due to ES alone or both heating and ES? The aim of the present study was to deduce the individual roles of heat and ES in the healing of chronic wounds. Methods:, The study was performed on 20 patients (mean age 48.4 ± 14.6 years) with non-healing diabetic foot ulcers (mean duration 38.9 ± 23.7 months) who received local dry heat (37°C; n = 10) or local dry heat + ES (n = 10) three times a week for 4 weeks. Patients were given ES using biphasic sine wave stimulation (30 Hz, pulse width 250 ,s, current approximately 20 mA). Results:, Skin blood flow in and around the wound was measured with a laser Doppler flow imager. In the ES + heat group, the average wound area and volume decreased significantly by 68.4 ± 28.6% and 69.3 ± 27.1%, respectively (both P < 0.05), over the 1-month period. During the average session, blood flow increased to 102.3 ± 25.3% with local heat and to 152.3 ± 23.4% with ES + heat. In the group receiving treatment with local heat only, wounds that had not healed for at least 2 months showed 30.1 ± 22.6% healing (i.e. a decrease in wound area) after 1 month. Although this level of healing was significant, it was less than that observed in the ES + heat group (P < 0.05). Conclusions:, Local dry heat and ES work well together to heal chronic diabetic foot wounds; however, local heat would appear to be a relevant part of this therapy because ES alone has produced little healing in previous studies. [source]

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps ,

MICROSURGERY, Issue 2 2006
Masayoshi Ohta M.D.
Soft-tissue reconstruction of the feet in diabetic patients with angiopathy, sensorial neuropathy, and immunopathy is a complicated problem. Until the mid-1980s, chronic foot ulcers in diabetic patients were treated conservatively, because flap surgery was regarded as too risky. However, in recent years, early debridement and flap coverage have become popular reconstructive methods for diabetic foot wounds. Several flap donor sites are available, depending on the nature of the defect. The deep inferior epigastric artery perforator (DIEP) flap is a relatively new flap that developed as a modification of the transverse rectus abdominis muscle (TRAM) flap. It provides a large amount of skin and subcutaneous tissue, without the donor-site morbidity of the ordinary TRAM flap. Furthermore, using the DIEP flap avoids the loss of major vessels. In this study, we report on the successful use of the DIEP flap in four cases of diabetic foot ulceration. © 2006 Wiley-Liss, Inc. Microsurgery 26: 87,92, 2006. [source]