Diabetic neuropathic foot ulcers: predicting which ones will not heal

Margolis, David J.; Allen-Taylor, Lynne; Hoffstad, Ole; Berlin, Jesse A.

doi:10.1016/j.amjmed.2003.06.006

Cited by 122 publications

(125 citation statements)

References 22 publications

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“…A complicação neuropática é preocupante pois, particularmente nos membros inferiores, pode causar úlceras plantares que, sem tratamento adequado, culminam com amputações. A úlcera no pé acomete 15% dos indivíduos diabéticos no decorrer de sua doença e mais de 80% das amputações são precedidas de úlcera (3,4).…”

Section: Introductionunclassified

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Porciúncula

Rolim

Garofolo

et al. 2007

Arq Bras Endocrinol Metab

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Analysis of Factors Associated with Extremity Ulceration in Diabetic Subjects with Peripheral Neuropathy.Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 ± 0.06 vs. 1.63 ± 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 ± 13.0 vs. 30.6 ± 12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.

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Section: Introductionunclassified

Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica

Porciúncula

Rolim

Garofolo

et al. 2007

Arq Bras Endocrinol Metab

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“…[55][56][57] Third, a persistent increase in nitric oxide in wound fluid was demonstrated in wound fluid of diabetic ulcers that was associated with increased granulation tissue formation and wound closure in patients receiving HBO therapy. 58 Finally, increased release of stem, or progenitor, cells from bone marrow through a nitric oxide-dependent mechanism was also demonstrated in patients receiving HBO therapy. 59 Oxidation appears to be among the most important signals that control the healing process, and this may be another mechanism for the benefits of HBO therapy in hypoxic wounds.…”

Section: Correction Of Hypoxia (Role Of Hyperbaric Oxygenation Of Woumentioning

confidence: 99%

“…58 Ulcers with a poor prognosis should be treated with a more advanced therapy. 57,58,[64][65][66][67][68] Rapid identification of patients who are unlikely to respond to conventional care will allow for earlier interventions with advanced therapies. 57,[69][70][71][72][73][74] I propose the timely use of HBO therapy in wound bed preparation for wounds that have a poor prognosis and wounds that have not shown significant signs of healing in the first 4 weeks of standard wound care.…”

Section: Guidance On When To Use Advanced Therapy With Hbomentioning

confidence: 99%

“…58,59 If initial healing rates are , 0.1 cm/week at the 4-week interval, then advanced therapy should be considered. 58 Ulcers with a poor prognosis should be treated with a more advanced therapy. 57,58,[64][65][66][67][68] Rapid identification of patients who are unlikely to respond to conventional care will allow for earlier interventions with advanced therapies.…”

Section: Guidance On When To Use Advanced Therapy With Hbomentioning

confidence: 99%

“…[57][58][59] The initial rate of healing during the first 4 weeks can predict whether ulcers are likely to heal by 24 weeks. 58,59 If initial healing rates are , 0.1 cm/week at the 4-week interval, then advanced therapy should be considered. 58 Ulcers with a poor prognosis should be treated with a more advanced therapy.…”

Section: Guidance On When To Use Advanced Therapy With Hbomentioning

confidence: 99%

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Correction of Hypoxia, a Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation

Shah

2011

The Journal of the American College of Certified Wound Speciali

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Wound bed preparation is an organized approach to create an optimal environment for wound healing by the use of the most cost-effective therapeutic options. It has become an essential part of wound management and seeks to use the latest findings from molecular and cellular research to maximize the benefits of today's advanced wound care products. The international advisory panel on wound bed preparation met in 2002 to develop a systemic approach to wound management. These principles of this approach are referred to by the mnemonic TIME, which stands for the management of nonviable or deficient tissue (T), infection or inflammation (I), prolonged moisture imbalance (M), and nonadvancing or undermined epidermal edge (E). One critical element of pathophysiology, understanding of the hypoxic nature of the wound and correction of hypoxia as a critical element of wound bed preparation, is not covered. This article proposes to add correction of hypoxia to the TIME principle (TIMEO 2 principle) based on the evidence. The evidence that will support the reason and the need for modification of the wound bed preparation protocol is discussed.

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