Wound Dressings in Diabetic Foot Disease

INTRODUCTIONIndia, is ranked first in the list of the ten nations most affected with diabetes, foot ulceration is the most common complication, affecting approximately 15% of diabetic patients during their lifetime. This can be attributed to several social and cultural practices such as barefoot walking, inadequate facilities for diabetes care and education, and poor socioeconomic conditions. 1 Diabetic foot ulceration followed by amputation contributes dramatically not only to the morbidity among persons with diabetes but is also associated with severe clinical depression. 2 ABSTRACTBackground: Diabetic foot ulcers are chronic wounds which are difficult to heal, due to ischemia and intrinsic defects in angiogenesis and impaired immunity against infection. VAC therapy influences positive mechanical forces on the growth of tissues, especially in stimulating cell migration and mitosis, optimizes blood flow, decreases local tissue edema from the wound bed and provides an occlusive environment for wound healing under moist, clean and sterile conditions. Aims and objective was to compare the effectiveness of low cost hospital made VAC dressing with conventional dressings in healing of diabetic foot ulcers. Methods: This study was a prospective, randomized controlled trial and included 60 patients with diabetic foot ulcers admitted over 3 months. Patients were randomly allocated to two groups: odd numbered patients to VAC therapy and the even numbered patients to conventional dressings. Wound swab was taken before the start of the study. The data was analyzed and presented in percentages or proportions using Chi-square test and Student-t-test wherever applicable. Results: In this study it was found that in the VAC dressing group 76.7% of the ulcers had red granulation tissue at the end of therapy compared to 46.7% in conventional group. The mean wound bed preparation time was found to be 15.60 days in the conventional dressing group and 8.50 days in the VAC therapy group. In the VAC group 72.73% ulcers had no bacteria at the end of therapy. Conclusion: In this study, it was found that Vacuum Assisted Closure therapy was more effective than conventional dressings in the wound bed preparation of diabetic foot ulcers.

show abstract

“…and prevention of recurrence. 11 Our study is revolving around the aspect of wound care hence it can be discussed under following headings. …”

Section: Discussionmentioning

confidence: 99%

“…Diabetic neuropathy directly contributes in genesis of non-healing diabetic ulcers, ischemic necrosis leads to tissue breakdown. 11 The patient may not seek treatment until after the wound has advanced. 4 VAC therapy influences positive mechanical forces on the growth of tissues, especially in stimulating cell migration and mitosis.…”

Section: Wound Healingmentioning

confidence: 99%

A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

et al. 2017

View full text Add to dashboard Cite

show abstract

“…It can work for a sustained period of time, thus reducing the frequency of dressing changes. It also assists autolysis of necrotic materials [40]. Due to its extra absorbent nature, it is widely used in the treatment of cavity wounds [41]. "…”

Section: Wound Dressingsmentioning

confidence: 99%

Antimicrobial Dressings for Improving Wound Healing

Sarheed¹,

Ahmed²,

Shouqair³

et al. 2016

Wound Healing - New Insights Into Ancient Challenges

View full text Add to dashboard Cite

Wound healing occurs by a series of interrelated molecular events which work together to restore tissue integrity and cellular function. These physiological events occur smoothly in normal healthy individual and/or under normal conditions. However, in certain cases, these molecular events are retarded resulting in hard-to-heal or chronic wounds arising from several factors such as poor venous return, underlying physiological or metabolic conditions such as diabetes as well as external factors such as poor nutrition. In most cases, such wounds are infected and infection also presents as another complicating phenomenon which triggers inlammatory reactions, therefore delaying wound healing. There has therefore been recent interests and signiicant eforts in preventing and actively treating wound infections by directly targeting infection causative agents through direct application of antimicrobial agents either alone or loaded into dressings (medicated). These have the advantage of overcoming challenges such as poor circulation in diabetic and leg ulcers when administered systemically and also require lower amounts to be applied compared to that required via oral or iv administration. This chapter will review and evaluate various antimicrobial agents used to target infected wounds, the means of delivery, and current state of the art, including commercially available dressings. Data sources will include mainly peer-reviewed literature, clinical trials and reports, patents as well as government reports where available.

show abstract

“…Additionally, health practitioners worldwide have over utilized antimicrobials, particularly topical antiseptics as a result of coining the controversial idea of excess wound bio burden in the medical literature, despite little evidence substantiating any benefit of these dressings over conventional therapy. [33][34][35][36][37] In addition to their potential for causing local reactions and expense, bacterial resistance may emerge as a consequence to the arbitrary use of these antimicrobials. 38,39 Due to these inherent risks, and a lack of sound clinical evidence of any advantages, the use of topical antimicrobials for clinically uninfected wounds is not recommended.…”

Section: -14 Days)mentioning

confidence: 99%

Triangle of Wound Assessment Made Easy: Revisited

Mohamed¹,

Lenjawi²

2016

Dermatol Open J

View full text Add to dashboard Cite

Objective : We have provided evidence based critical review of the "Triangle of wound assessment made easy". Background: Wound assessment is a vital step in managing patients with acute and chronic wounds in daily clinical practice. The natural progression of most wounds is to heal naturally in a coherent and timely manner, although a minority of wounds will fail to heal. The aim of treating recalcitrant wounds that fail to heal is to control symptoms and delay or prevent complications. One vital step in managing wounds is proper and comprehensive evidence based wound assessment. Methods: We have carried out literature review including systemic reviews, met analysis pertaining wound assessment including international guidelines. Results:We have found few gaps in the proposed "Triangle of wound assessment made easy" which have been addressed accordingly. We have revised the concept of (infection) i.e. "raised white blood cell (WBC) count as a sign of infection" and argued that in up to one-half of patients, even with severe diabetic foot infection raised temperature, WBC count, or sedimentation rate are absent. A second point of concern is the omission of "probing to bone sign" in the diagnostic criteria of local signs of infection. Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive Probe-to-Bone Test (PTB) test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. Lastly, the authors have suggested reducing wound bio burden/manage infection through the use of topical antimicrobial therapy-including antiseptic agents. Topical antiseptics have inconclusive proof of efficacy in various etiology wounds and concern remain regarding their residual cytotoxicity when in contact with newly forming granulating tissues especially when highly concentrated rinse solutions is the common practice in developing countries of the world. Conclusion: On the basis of these analysis, we propose revising the "Triangle of wound assessment made easy" in order to address these gaps and maximize its utility in clinical practice.

show abstract

Wound Dressings in Diabetic Foot Disease

Cited by 170 publications

References 18 publications

A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

A randomized controlled trial comparing low cost vacuum assisted dressings and conventional dressing methods in the management of diabetic foot ulcers

Antimicrobial Dressings for Improving Wound Healing

Triangle of Wound Assessment Made Easy: Revisited

Contact Info

Product

Resources

About