The wound/burn guidelines – 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene

Isei, Taiki; Abe, Masatoshi; Nakanishi, Takeshi; Matsuo, Koma; Asano, Yoshihide; Ishii, Takayuki; Ito, Takaaki; Inoue, Yoshio; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Ohtsuka, Mikio; Ogawa, Fumihide; Kadono, Takafumi; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Toru; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakamura, Yasuhiro; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Fujiwara, Hiroshi; Maekawa, Takeo; Madokoro, Naoki; Yoshino, Yutaka; Pavoux, Andres Le; Tachibana, Takao; Ihn, Hironobu

doi:10.1111/1346-8138.13285

Cited by 16 publications

(18 citation statements)

References 209 publications

(240 reference statements)

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“…This CPG also emphasized on the clinical implementation process, and also a user toolkit. One’s country of origin was Japan [22], it mainly covered the treatment of infections, management of osteomyelitis, peripheral neuropathy, peripheral arterial disease, wound management and information on offloading. And five CPGs were from international academic societies [23–27], and these five CPGs were targeted at five aspects of diabetic foot, including prevention, offloading, infection, peripheral arterial disease, and wound management.…”

Section: Resultsmentioning

confidence: 99%

The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument

Pei-ying

Lü

et al. 2019

PLoS ONE

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This study aims to evaluate the quality of clinical practice guidelines(CPGs) for patients with diabetic foot worldwide. A search of guidelines websites, databases and academic institutions websites was performed from January 1st, 2010, until June 30th, 2018. Four assessors independently rated the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Twelve CPGs satisfied the inclusion criteria. The median scores for the 6 AGREE II domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 92.5%, 72.5%, 71.5%, 89%, 47%, and 77%, respectively. The overall quality of the CPGs was good since the majority of the CPGs reached an overall guideline quality between 5 and 7 points. Different CPGs had widely varying scores in the same area, ranging from 25 to 94 points.

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Section: Resultsmentioning

confidence: 99%

The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument

Pei-ying

Lü

et al. 2019

PLoS ONE

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“…Hyperbaric oxygen is a less invasive therapy that is used for elevating the arterial dissolved oxygen concentration and relieving the hypoxia of skin tissue by placing the patient under an oxygen pressure higher than the atmospheric pressure [ 3 ]. The resultant elevated arterial dissolved oxygen levels accelerate neovascularization by stimulating new blood vessel growth by local endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy for digital ulcers due to Raynaud’s disease

Sato

Arai

Ichioka

2018

Case Reports in Plastic Surgery and Hand Surgery

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“…Sharp debridement is the removal of biofilm, slough, and necrotic tissue from the wound bed using surgical instruments to maintain an appropriate healing environment and stimulate ongoing wound repair. This process is recommended in all the diabetic foot guidelines, 3,27,39,49‐55,73 although the quality of clinical trials studying debridement is generally low. Wound care clinicians often use weekly sharp debridement in the outpatient clinic setting.…”

Section: Debridementmentioning

confidence: 99%

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

Allison

Flanagin

2020

Seminars in Dialysis

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Diabetic foot ulcers do not heal as well in ESKD as in the absence of kidney failure, and rates of lower extremity amputation (LEA) are higher. Foot ulcer is the root cause of the majority of LEA in diabetes mellitus, but with early detection, many amputations can be prevented by a comprehensive and multidisciplinary approach. Wound healing encompasses nutrition, smoking cessation, glycemic control, appropriate offloading, compliance with wound care visits and dressing changes, vascular work-up, and intervention as indicated, and antibiotics if needed. While many of these items are outside the scope of the dialysis visit, foot checks, foot care education, nutrition, and smoking cessation should be addressed as part of routine dialysis patient care. In addition, nephrologists who understand wound care principles can give additional support to their patients during the intensive phase of wound care treatments, which often comprises weekly sharp debridement. The evidence shows that integrating care into the dialysis treatment setting improves foot-related outcomes; dialysis team education and vigilance are essential, and nephrologists are uniquely positioned to lead this effort. We know enough to act to improve the outcomes of ESKD patients with foot ulcers. AbstractDiabetic foot ulcers do not heal as well in ESKD as in the absence of kidney failure, and rates of recurrent foot ulcers, as well as lower extremity amputation, are higher. This review of the literature highlights the vital role of the dialysis team in prevention, early detection, and support of treatment of diabetic foot ulcers. Our review has five goals-(a) increase nephrologists' understanding of the high morbidity and mortality associated with chronic foot ulcers and (lower extrimity) LE amputations in ESKD; (b) promote nephrologists' understanding of grading systems for diabetic foot ulcer severity, in order to expedite communication with local diabetic foot experts; (c) promote collaboration between nephrologists and infectious disease specialists regarding the dose, route, and delivery logistics of intravenous antibiotics for infected chronic foot ulcers, in particular in the presence of osteomyelitis and other deep-seated infections; (d) increase the awareness of dialysis nurses, technicians, dietitians, social workers and administrators regarding evidence-based and multidisciplinary approaches to patients' diabetic foot ulcers; (e) encourage the application of published works integrating patient-centered diabetic foot education into the dialysis setting to reduce lower extremity amputations.

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The wound/burn guidelines – 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene

Cited by 16 publications

References 209 publications

The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument

The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument

Hyperbaric oxygen therapy for digital ulcers due to Raynaud’s disease

How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations

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