Benchmarking healing times for diabetic foot ulcerations and investigating the influence of peripheral arterial disease and infection

Milne, Tamara E; Schoen, Deborah; Bower, Virginia M; Gurr, Joel M

doi:10.1186/1757-1146-4-s1-o31

Cited by 10 publications

(14 citation statements)

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“…Benchmarking [32] of antimicrobial use and clinical outcomes among centers, and publicly reporting their results, would be challenging and potentially produce erroneous results because of the variations in case-mix of DFI seen in different centers. In contrast, regional or international guidelines, some of which have been amply validated and are updated, are available and published [2,33,34].…”

Section: The Community Settingmentioning

confidence: 99%

Principles and practice of antibiotic stewardship in the management of diabetic foot infections

Uçkay¹,

Berli

Sendi³

et al. 2019

Current Opinion in Infectious Diseases

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Purpose of review Systemic antibiotic therapy in persons with a diabetic foot infection (DFI) is frequent, increasing the risk of promoting resistance to common pathogens. Applying principles of antibiotic stewardship may help avoid this problem. Recent findings We performed a systematic review of the literature, especially seeking recently published studies, for data on the role and value of antibiotic stewardship (especially reducing the spectrum and duration of antibiotic therapy) in community and hospital populations of persons with a DFI.

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Section: The Community Settingmentioning

confidence: 99%

Principles and practice of antibiotic stewardship in the management of diabetic foot infections

Uçkay¹,

Berli

Sendi³

et al. 2019

Current Opinion in Infectious Diseases

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“…4,20 Even with the available advanced wound care products, technologies and improved methods of accurate diagnosis, prolonged duration of treatment and an increased morbidity related to infection and amputation continue to occur. 2,3,25,26 …”

mentioning

confidence: 99%

Wound Closure in Smoking Peripheral Arterial Disease Patients With Treatment-Refractory Ulcerations

Smedley

Michael

Tamire

2016

The International Journal of Lower Extremity Wounds

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Despite ongoing smoking cessation efforts and optimized perfusion, failed wound closure in the presence of peripheral arterial disease (PAD) and diabetes are common. A clinical effectiveness review was conducted in actively smoking diabetic patients diagnosed with PAD, treated with serial applications of a viable intact cryopreserved human placental membrane (vCPM) (Grafix, Osiris Therapeutics Inc, Columbia, MD) for recalcitrant lower extremity ulcerations (n = 6). More than half of the patients were not candidates for revascularization. Baseline vascular status in 5 of 6 lower-extremity wounds remained unchanged throughout the entire course of vCPM treatment. Daily cigarette consumption averaged 18 cigarettes per patient. Mean wound duration and mean surface area was 53 weeks and 4.6 cm2, respectively. Mean number of vCPM applications and time to closure was 7.0 grafts in 7.8 weeks. There were no wound-related infections or amputations and no vCPM-related adverse events. All 6 wounds remained closed at the 12-month follow-up visit. In conclusion, vCPM demonstrated clinically effective outcomes in 6 previously nonhealing ulcerations despite ongoing smoking habits in the presence of PAD and diabetes.

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“…Например, результаты исследования с участием 261 больного СДС показал, что среднее время заживления язвенного дефекта составляет 49 дней, однако наличие раневой инфекции или остеомиелита сопровождается увеличением сроков заживления в среднем до 83 и 115 дней. В то же время у пациентов с преобладанием ишемического компонента среднее время заживления составило 58 дней, а при его отсутствии -46 [14]. Ввиду этого включение в настоящее пилотное исследование пациентов с неглубокими язвенными дефектами 1-2 стадии по Вагнеру было обусловлено стремлением нивелировать многочисленные факторы, которые влияют на процесс репаративной регенерации, и достичь, таким образом, максимальной объективности при оценке влияния генноопосредованной индукции ангиогенеза на сроки заживления язвенного дефекта.…”

Section: Discussionunclassified

Pilot study of the safety and efficacy of angiogenic therapy in diabetic foot syndrome

Plaksa¹,

Mzhavanadze²,

Каlinin³

et al. 2020

Diabetes mellitus

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BACKGROUND: The syndrome of diabetic foot remains the main cause of non-traumatic amputation of the lower extremity in the world. Even with the provision of comprehensive medical care in the conditions of a specialized center, 10-15% of patients do not succeed in healing the ulcerative defect due to the ischemic component. AIMS: The objective of this study is evaluation of safety and efficacy of pl-VEGF165 transfer in patients with neuroischemic type of diabetic foot syndrome. METHODS: The pilot study included 35 diabetic patients with neuroischemic foot ulcers (Wagner stage 1-2) who were not candidates for revascularization procedures (NCT02538705). The patients were closely monitored after repeated pl-VEGF165 intramuscular gene transfer (2,4 mg) at 1, 3, and 6 months after treatment. The primary efficacy endpoint was the surface area of the ulcers (sq.cm), the secondary endpoints were transcutaneous oxygen tension (Tcp02), ankle-brachial index (ABI), neuropathy disability score (NDS), neuropathy symptoms score (NSS), and Michigan neuropathy screening instrument (MNSI). Adverse events were monitored throughout the study. RESULTS: The use of pl-VEGF165 as part of complex treatment allowed to achieve wound healing in 65,7% of patients with chronic ulcerative defects, the safety of the target limb was 84%. Carrying out therapeutic angiogenesis as a part of the combined therapy ensured a reduction in the average area of the resistant to treatment defects from 3.6 [1.0; 7.05] cm2 to 0.0 [0.0;2.0] cm2 (p=0,001), which correlated with an increase in the TcPo2 index by 15% from 35 [29.5; 40.5] to 40.5 [36.0; 46.5] mm Hg (p= p=0,005) and in the ABI by 16% from 0.96 [0.82;1.08] to 1.11 [0.85; 1.24] (p=0,062). The decrease in the signs of diabetic neuropathy was determined - the scores of NSS scales and VAT decreased from 6,5 [5.75; 8.0) to 6.0 [5.25; 7.0] (p=0,004) and from 9.0 [8.0; 13.5] to 8.0 [7.0; 12.7] (p=0,001), respectively. No adverse effects associated with the use of pl-VEGF165 were recorded. CONCLUSIONS: Thus, preliminary results of the pilot study show that the use of pl-VEGF165 gene transfer in combination therapy allows for complete healing of neuroischemic diabetic foot ulcers in the majority of patients.

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Benchmarking healing times for diabetic foot ulcerations and investigating the influence of peripheral arterial disease and infection

Cited by 10 publications

References 0 publications

Principles and practice of antibiotic stewardship in the management of diabetic foot infections

Principles and practice of antibiotic stewardship in the management of diabetic foot infections

Wound Closure in Smoking Peripheral Arterial Disease Patients With Treatment-Refractory Ulcerations

Pilot study of the safety and efficacy of angiogenic therapy in diabetic foot syndrome

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