Current concepts for the evaluation and management of diabetic foot ulcers

Mavrogenis, Andreas F.; Megaloikonomos, Panayiotis D.; Antoniadou, Thekla; Igoumenou, Vasilios G.; Panagopoulos, Georgios N.; Dimopoulos, Leonidas; Moulakakis, Konstantinos G.; Sfyroeras, George S.; Lazaris, Andreas

doi:10.1302/2058-5241.3.180010

Cited by 80 publications

(62 citation statements)

References 99 publications

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“…12 The risk of amputation may be increased when a timely and effective revascularisation is not performed and surgical debridement and antibiotic regimen are not promptly started, with a 5-year mortality up to 60%. 13 Complications such as osteomyelitis, endocarditis and sepsis may also occur leading to a high mortality.…”

Section: Discussionmentioning

confidence: 99%

Surgical wound dehiscence complicated by methicillin-resistant Staphylococcus aureus infection in a diabetic patient with femorotibial vascular bypass occlusion

et al. 2020

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Diabetic patients with critical limb ischaemia may be affected by severe wound and skin ulcer infections. We report a case of a patient with bilateral femorotibial occlusion and methicillinresistant Staphylococcus aureus infection. The patient was treated with femoroperoneal vascular bypass, debridement of wound dehiscence and targeted antimicrobial therapy for symptom resolution and healing of the wound.

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Section: Discussionmentioning

confidence: 99%

Surgical wound dehiscence complicated by methicillin-resistant Staphylococcus aureus infection in a diabetic patient with femorotibial vascular bypass occlusion

et al. 2020

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“…The increased morbidity associated with diabetic wounds and the costs associated with long-term care of affected individuals have a significant negative economic impact on the healthcare economy in China [ 3 ]. Conventional treatments of diabetic wounds include debridement and frequent dressing changes; these modalities often do not result in a reliable or satisfactory outcome in terms of rapid wound closure [ [4] , [5] , [6] , [7] ]. As such, incremental improvements in diabetic wound care and treatment could result in significant benefits not only to patients but also to the country's entire healthcare economy.…”

Section: Introductionmentioning

confidence: 99%

Flexible electrical stimulation device with Chitosan-Vaseline® dressing accelerates wound healing in diabetes

Wang

Fang

et al. 2021

Bioactive Materials

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The healing process of diabetic wounds is typically disordered and prolonged and requires both angiogenesis and epithelialization. Disruptions of the endogenous electric fields (EFs) may lead to disordered cell migration. Electrical stimulation (ES) that mimics endogenous EFs is a promising method in treating diabetic wounds; however, a microenvironment that facilitates cell migration and a convenient means that can be used to apply ES are also required. Chitosan-Vaseline® gauze (CVG) has been identified to facilitate wound healing; it also promotes moisture retention and immune regulation and has antibacterial activity. For this study, we created a wound dressing using CVG together with a flexible ES device and further evaluated its potential as a treatment for diabetic wounds. We found that high voltage monophasic pulsed current (HVMPC) promoted healing of diabetic wounds in vivo . In studies carried out in vitro , we found that HVMPC promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) by activating PI3K/Akt and ERK1/2 signaling. Overall, we determined that the flexible ES-chitosan dressing may promoted healing of diabetic wounds by accelerating angiogenesis, enhancing epithelialization, and inhibiting scar formation. These findings provide support for the ongoing development of this multidisciplinary product for the care and treatment of diabetic wounds.

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“…Ultimately the primary aim of surgical management of diabetic foot ulcer is revascularization, wound debridement, and eradication of the infection. 17 DUSS helps the surgeon to decide which patients require admission and which can be managed by out-patient care. It helps in risk stratification, planning treatment and in triage such that those patients with higher DUSS receive more intensive care and aggressive surgical wound management.…”

Section: Discussionmentioning

confidence: 99%

Clinical utility of diabetic ulcer severity score in surgical practice

Menezes¹,

Sreenidhi²,

Vani³

2019

Int Surg J

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Background: In surgical practice we come across many diabetic foot ulcer patients who often present late, leading to limb loss and even death. In the search for an effective screening tool to assess the severity of the disease and predict the outcome we have adopted the DUSS.Methods: Prospective study from October 2016 to April 2018 including 200 patients with diabetic foot ulcers conducted at Surgery Department in KIMS, Bangalore. DUSS was applied at the time of admission. DUSS comprises 4 clinical parameters: 1) pedal pulses, 2) probing to bone, 3) ulcer site and 4) ulcer number. These wounds were graded into score 0, 1, 2, 3, 4. Standard management was given to all patients according to a protocol. The outcome of treatment was recorded as healed ulcer, minor amputations, (toe or forefoot) or major amputations (below or above knee). Co-relation between the DUSS scores and final outcome was done.Results: Healing rates were higher in those with lower DUSS scores (88.9% in score 0 compared to 0% in Score 4). Minor amputation rates for scores 0, 1, 2,3 were 11.1%, 30.5%,28.3% and 44.1% respectively. Major Amputation rates were higher in patients with high DUSS scores i.e. 3 (41.8%) and 4 (100%).Conclusions: DUSS is an effective clinical tool to assess the severity of diabetic foot ulcers. DUSS scores help in predicting the outcome of treatment hence it can be used to counsel the patient regarding the disease and its prognosis. Patients with higher DUSS scores should require a more aggressive approach to minimise morbidity and mortality.

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Current concepts for the evaluation and management of diabetic foot ulcers

Cited by 80 publications

References 99 publications

Surgical wound dehiscence complicated by methicillin-resistant Staphylococcus aureus infection in a diabetic patient with femorotibial vascular bypass occlusion

Surgical wound dehiscence complicated by methicillin-resistant Staphylococcus aureus infection in a diabetic patient with femorotibial vascular bypass occlusion

Flexible electrical stimulation device with Chitosan-Vaseline® dressing accelerates wound healing in diabetes

Clinical utility of diabetic ulcer severity score in surgical practice

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