Electric impedance and the healing of diabetic foot ulcers

Abstract

Diabetic foot (DF) is a complication of people suffering from diabetes mellitus (DM) with an overall prevalence estimated as 6.3%. Healing of diabetic ulcers takes several weeks, and follow up is needed both to assess the improvement of the wound and to detect possible complications. Ulcer diameter, pH and temperature have been used for such purpose and some authors have also proposed the use of Electric Bioimpedance (EBI). The results presented in this paper are taken from a small pilot study carried out to evaluate the healing effect of high quality, unrefined, whole cane sugar (“panela”) in people with unilateral diabetic foot ulcers in one of the legs. 6 volunteers (3 male and 3 female, aged between 51 and 85 mean age 71) were treated either with Triticum vulgare or with “panela” and EBI measurements (resistance or R, reactance or Xc, and phase angle or θ at 50 kHz) on both legs were taken during a follow up period of 5 weeks. Although the healing process ran well with no complications, EBI parameters did not rise during the treatment, as expected. Differences between the ulcerated and the not-ulcerated legs seem to be present (higher values for R in the affected side and lower for Xc and θ), but it does not seem to be a trend of the former towards the values of the latter. EBI values of the sample with DM are much lower than those of a sample of the 8 healthy volunteers measured for this study.

Ângulo de fase para avaliar risco ou cicatrização de lesões: revisão sistemática

“…Study E3, conducted in patients with pressure ulcer (PU), showed that PA was effective in the evaluation of lesions since it significantly decreased in these patients (17) . In another study (E4), which evaluated PA in foot ulcers, the authors could not demonstrate effectiveness in the use of PA related to the healing process (18) . Although there was healing in the patients, without complications, the EBI parameters did not increase during treatment, as expected.…”

“…After reading the full texts, 5 studies were included for the qualitative synthesis, as shown in Figure 1. In relation to the outcomes, four evaluated wound healing (E1, E2, E3, E4) (15)(16)(17)(18) .…”

“…Chart 3 shows the risk of bias by using the JBI's critical analysis tools. All the studies presented items that were not attended and/or that were not clearly described in the studies, and Study E4 obtained the highest percentage of positive answers (87.5%) and Study E1, the lowest percentage (66.7%) (15)(16)(17)(18) .…”

“…In the evaluation of Study E2, as in Study E3, it was not clear who the control group were (16) . In addition to that, in studies E2 and E4 it was not possible to identify if there were confounding factors (16,18) .…”

“…One study evaluated chronic wounds of varied etiologies (arterial, venous, neurotrophic, traumatic, surgical and infectious) (15) . The other evaluated patients with burns and two studies addressed PUs (17,18,19) . Only one scientific production addressed acute lesions caused by small burns of recent onset, less than four days.…”