Use of Pressure Offloading Devices in Diabetic Foot Ulcers

Wu, Stephanie; Jensen, Jeffrey L.; Weber, Anna K.; Robinson, Daniel E.; Armstrong, David G.

doi:10.2337/dc08-0771

Cited by 173 publications

(158 citation statements)

References 7 publications

(1 reference statement)

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“…Os pacientes portadores de diabetes possuem deficiência cicatricial apresentando evolução mais lenta na reparação de lesões quando comparados a pessoas saudáveis. Isto explica o fato dos diabéticos serem mais susceptíveis a morbidades inerentes a doença o que dificulta o processo cicatricial, como o risco aumentado para infecções, evolução da ferida, podendo levar a amputação do membro afetado [18][19][20][21][22] . Diante tal realidade, esclarecimentos sobre a doença, modelos animais portadores de diabetes vêm sendo utilizados em pesquisas na busca de respostas sobre as complicações inerentes à doença e meios de evitá-la 12,13 .…”

Section: Discussionunclassified

Inibição da expressão de ciclooxigenase 2 em feridas cutâneas de camundongos NOD submetidos à terapia a laser de baixa intensidade

Rocha

Júnior²,

Aarestrup

et al. 2012

J. vasc. bras.

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ResumoContexto: A terapia a laser de baixa intensidade (LLLT) tem sido relatada como importante moduladora da cicatrização de feridas cutâneas aumentando a proliferação fibroblástica associada ao aumento da expressão da citocina fator transformador de crescimento-β2 (TGF-βB2). Objetivo: No presente estudo foram avaliados os efeitos da LLLT sobre a expressão da enzima ciclooxigenase 2 (COX2) no sítio do reparo tecidual utilizando o modelo experimental com camundongos diabéticos não obesos (NOD) para estudar a cicatrização de feridas cutâneas. Métodos: Foram utilizados 30 camundongos NOD, destes 14 ficaram diabéticos e foram divididos em dois grupos: o grupo I (n=7) foi submetido a um procedimento cirúrgico de feridas cutâneas e o grupo II (n=7) foi submetido a um procedimento cirúrgico de feridas cutâneas e tratados com LLLT. O grupo II foi submetido à LLLT nos seguintes parâmetros: 15 mW de potência, dose de 3,8 J/cm 2 e tempo de aplicação de 20 segundos. Após sete dias do ato cirúrgico e após aplicação do laser, os animais foram eutanasiados com sobredose de anestesia e amostras das feridas foram colhidas para posterior análise histopatológica, histomorfométrica e imuno-histoquímica. Resultados: A LLLT promoveu a inibição da expressão da COX2 em feridas cutâneas de camundongos diabéticos. Conclusão: Em conjunto, os resultados sugeriram que a LLLT é capaz de modular negativamente a expressão da enzima COX2 contribuindo para o controle da resposta inflamatória em feridas cutâneas de camundongos NOD.Palavras-chave: camundongos endogâmicos NOD; ciclooxigenase 2; terapia a laser de baixa intensidade. AbstractBackground: Low-level laser therapy (LLLT) has been reported to modulate the healing of wounds by inducing an increase in fibroblast number associated with increased expression of the cytokine transforming growth factor-β 2 (TGF-β 2 ). Objective: In the present study, the effect of LLLT on expression of COX2 at the site of tissue repair was evaluated, using an experimental model with non obese diabetic mice (NOD) to study cutaneous wound healing. Methods: Thirty NOD mice were used, of which 14 were diabetic and were divided into two groups: group I (n=7) underwent a surgical procedure of skin wounds and group II (n=7) underwent a surgical procedure of skin wounds and treated with LLLT. Group II was submitted to LLLT in the following parameters: 15 mW of power, dose of 3.8 J/cm 2 and exposure time of 20 seconds. Seven days after surgery and after laser application, animals were euthanized with an overdose of anesthesia and tissue samples were collected for subsequent histological analysis, histomorphometry and immunohistochemistry. Results: The LLLT has promoted the inhibition of COX2 expression in skin wounds in mice diabetic. Taken together the results suggest that LLLT modulate the expression of COX2 improved the control of inflammatory reaction in cutaneous wound lesions in NOD mice. Conclusion: Taken together, the results suggested that LLLT is able to negatively modulate the expression of COX2 enzyme contri...

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Section: Discussionunclassified

Inibição da expressão de ciclooxigenase 2 em feridas cutâneas de camundongos NOD submetidos à terapia a laser de baixa intensidade

Rocha

Júnior²,

Aarestrup

et al. 2012

J. vasc. bras.

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“…112 Similarly in the USA, most HP's reported use of total contact casts in <25% of patients. 113 While lack of training and experience may be implicated, this was not considered a major driver in choosing other offloading devices in the Australian survey. In practice, irremovable devices are not prescribed for all patients for a range of reasons including nonacceptance by the patient or unsuitability of the treatment based on wound factors (infection, ischemia, fluctuating edema, depth, and location), patient behaviors that render an irremovable device unsafe, instability of gait, vision impairment, or the need to drive or a physical environment not conducive to wearing a cast.…”

Section: Neuropathy Deformity and Offloadingmentioning

confidence: 99%

“…A lack of reimbursement for devices was suggested as a barrier in the USA and Australia. 113,114 A lack of transferability of research to the clinic population may exist due to the nature of clinical trials, whereby researchers may need to exclude the very patients who clinicians have difficulty treating. The use of practical trials, which increase the applicability of research outcomes to real world, has been proposed to address this issue.…”

Section: Neuropathy Deformity and Offloadingmentioning

confidence: 99%

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

Nubé¹,

Frank²,

White³

et al. 2016

CWCMR

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Diabetes-related foot ulceration is a frequent cause for hospital admission and the leading cause of nontraumatic lower limb amputation, placing a high burden on the health system, patient, and their families. Considerable advances in treatments and the establishment of specialized services and teams have improved healing rates and reduced unnecessary amputations. However, amputation rates remain high in some areas, with unacceptable variations within countries yet to be resolved. Specific risk factors including infection, ischemia, ulcer size, depth, and duration as well as probing to bone (or osteomyelitis), location of ulcer, sensory loss, deformity (and high plantar pressure), advanced age, number of ulcers present, and renal disease are associated with poor outcome and delayed healing. To assist in prediction of difficult-to-heal ulcers, more than 13 classification systems have been developed. Ulcer depth (or size), infection, and ischemia are the most common risk factors identified. High-quality treatment protocols and guidelines exist to facilitate best practice in the standard of care. Under these conditions, 66%-77% of foot ulcers will heal. The remaining proportion represents a group unlikely to heal and who will live with a non-healing wound or undergo amputation. The authors have applied their experience of managing patients in this discussion of why some ulcers are harder to heal. The article explores the effects of patient non-adherence to treatment, comorbid mental illness, a failure of research to be translated into the everyday practice of many clinicians, and the impact of delayed access to specialized treatment. These factors when combined with the main published risk factors of size, infection, ischemia and pressure are perceived as critical barriers to healing.

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“…4,8 Numerous offloading methods are available and include bed rest, therapeutic shoes, felted foam, total contact casts, removable cast walkers, etc. [6][7][8][9][10][11] Felted foam padding is one such offloading method used commonly in clinical practice. 12 Amit Jain's offloading technique is an alternative to felted foam used to offload diabetic foot wounds.…”

Section: Introductionmentioning

confidence: 99%

Offloading of diabetic foot wounds using Amit Jain’s offloading system: an experience of 23 cases

Dath¹,

Rao²,

Kumar³

et al. 2017

Int Surg J

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Background: It is a well-known fact that around 15% of patients with diabetes are likely to be affected by foot ulcers during their lifetime. The aim of this study was to evaluate and analyze Amit Jain’s offloading system used in diabetic foot wounds.Methods: A cross-sectional, retrospective study was done at 3 centres namely Brindhavvan Areion Hospital, Synergy Centre for Diabetes and South City hospital in Bangalore, India. The study period was for 1 year from April 2016 to March 2017.Results: 23 cases were included in the study. 16 patients (69.57%) had right foot involved whereas 7 patients (30.43%) had left foot involved. Majority of the patients had foot problems located at forefoot (86.96%). The most common condition where Amit Jain’s offloading was used was in trophic ulcer (61%). In 22 patients (95.65%), the microcellular rubber and ethyl vinyl acetate combination was used whereas in one patient (4.35%), 7 mm of single layered EVA was used. 9 patients (39.13%) had their wounds healed within 8 weeks whereas 11 patients (47.83%) had their wounds healed within 8-16 weeks.Conclusions: Amit Jain’s offloading device is a new offloading device that can be effectively used as an alternative to felted foam. It is based on deflective technique just like felted foam. In this series, 86.98% of the wounds had healed by 16 weeks with this new offloading device. The Amit Jain’s offloading device, which has a scientific rationale based on the deflective offloading as well as usage of visco-elastic material that is accepted worldwide, produces effective wound healing without any complication and without inhibiting patient’s mobility. Amit Jain’s offloading is a level one recommendation for diabetic foot wounds.

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Use of Pressure Offloading Devices in Diabetic Foot Ulcers

Cited by 173 publications

References 7 publications

Inibição da expressão de ciclooxigenase 2 em feridas cutâneas de camundongos NOD submetidos à terapia a laser de baixa intensidade

Inibição da expressão de ciclooxigenase 2 em feridas cutâneas de camundongos NOD submetidos à terapia a laser de baixa intensidade

Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

Offloading of diabetic foot wounds using Amit Jain’s offloading system: an experience of 23 cases

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