Wound, pressure ulcer, and burn guidelines – 3: Guidelines for the diagnosis and treatment of diabetic ulcers and gangrene, second edition

Abstract

The Japanese Dermatological Association aimed to prepare a second edition of guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. This new edition serves as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of care for such skin conditions. All sections have been updated by collecting documents published since the publication of the first edition. In the antibacterial drug treatment for bacterial infection of ulcers, oral administration was added after consideration. In the treatment of antibacterial drugs for bacterial infection of ulcers, not only infusion but also oral administration was mentioned. In addition, clinical questions (CQs) for imaging tests for diagnosing ischemia of the limbs were newly created. The titles of some CQs were changed to conform to the actual clinical setting. (i) The content has been updated by adding and collecting documents for all sections; (ii) we have additionally included oral antibiotic treatment for bacterial infection of ulcers; (iii) we have added CQs pertaining to imaging tests for diagnosing ischemia of the limbs; and (iv) we have revised the titles of some CQs to conform to the actual clinical setting. In particular, the recommendation levels of dressing materials newly covered by Japanese national health insurance are mentioned. In addition, CQs regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and the use of escharotomy (CQ22) have been created.

Augmented Marshmallow Extract Lipid Nanoparticles with Clove Oil Embedded in Collagen Sponge for Ultimate Antimicrobial Healing of Diabetic Mouth Ulcer

“…Surfactant type also played an important role, with poloxamer 407-based formulations achieving the highest EE%, most likely due to its stabilizing effect on the lipid core, which prevents drug leakage, as shown in Figure 3 d. The HLB value is essential for emulsification and nanoparticle stability as it influences the self-assembly and dispersion of lipid-based systems. Based on the formulation composition [ 5 ], HLB values were found for several different combinations of lipids and surfactants. Because capric acid does not repel water very well, stable formulations that contain it need poloxamer 407 and other surfactants with high HLB values.…”

“…For the ultrasonic treatment of a pre-emulsion of clove oil (CO.) and water for five minutes with a probe (Sonics and Materials Inc., Sonics, India), the sonication process was carried out at a frequency of 20 kHz and 500 watts for 5 min at an intensity of 50% power, with a pulse cycle of 5 s on and 10 s off to ensure proper emulsification. At last, the hot dispersion was refrigerated at 4 °C and kept for further study [ 5 ].…”

“…Active inflammatory cells produce high levels of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6. Cytokines accumulate and remain at the wound site, causing significant damage [ 5 ]. Diabetic oral mucosal wounds heal slowly due to oxidative stress.…”

Augmented Marshmallow Extract Lipid Nanoparticles with Clove Oil Embedded in Collagen Sponge for Ultimate Antimicrobial Healing of Diabetic Mouth Ulcer

“…Surfactant type also played an important role, with poloxamer 407-based formulations achieving the highest EE%, most likely due to its stabilizing effect on the lipid core, which prevents drug leakage, as shown in Figure 3 d. The HLB value is essential for emulsification and nanoparticle stability as it influences the self-assembly and dispersion of lipid-based systems. Based on the formulation composition [ 5 ], HLB values were found for several different combinations of lipids and surfactants. Because capric acid does not repel water very well, stable formulations that contain it need poloxamer 407 and other surfactants with high HLB values.…”

“…For the ultrasonic treatment of a pre-emulsion of clove oil (CO.) and water for five minutes with a probe (Sonics and Materials Inc., Sonics, India), the sonication process was carried out at a frequency of 20 kHz and 500 watts for 5 min at an intensity of 50% power, with a pulse cycle of 5 s on and 10 s off to ensure proper emulsification. At last, the hot dispersion was refrigerated at 4 °C and kept for further study [ 5 ].…”

“…Active inflammatory cells produce high levels of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6. Cytokines accumulate and remain at the wound site, causing significant damage [ 5 ]. Diabetic oral mucosal wounds heal slowly due to oxidative stress.…”

Dual-domain engineered exosome-based self-powered microneedle delivery platform for the treatment of infected wounds

“…Infected wounds are a common but challenging clinical condition, particularly in cases such as chronic diabetic ulcers, burns, and postoperative infections [ [1] , [2] , [3] , [4] ]. Their healing is hindered by a complex pathological microenvironment involving bacterial colonization, biofilm formation, persistent inflammation, and impaired tissue repair [ [5] , [6] , [7] , [8] , [9] ].…”

Postoperative Complications and Risk Factors in Skin Tumor Excision With Simple Suturing Under Local Anesthesia: A Multicenter Retrospective Study in Japan

“…These complications not only affect the quality of life (QOL) of patients but may also lead to increased medical resources owing to the need for re‐examination and additional treatment [ 4 ]. In addition, patients with underlying conditions such as diabetes may be at even greater risk of complications due to impaired wound healing and delayed immune response [ 5 ].…”

Augmented Marshmallow Extract Lipid Nanoparticles with Clove Oil Embedded in Collagen Sponge for Ultimate Antimicrobial Healing of Diabetic Mouth Ulcer

“…Surfactant type also played an important role, with poloxamer 407-based formulations achieving the highest EE%, most likely due to its stabilizing effect on the lipid core, which prevents drug leakage, as shown in Figure 3 d. The HLB value is essential for emulsification and nanoparticle stability as it influences the self-assembly and dispersion of lipid-based systems. Based on the formulation composition [ 5 ], HLB values were found for several different combinations of lipids and surfactants. Because capric acid does not repel water very well, stable formulations that contain it need poloxamer 407 and other surfactants with high HLB values.…”

“…For the ultrasonic treatment of a pre-emulsion of clove oil (CO.) and water for five minutes with a probe (Sonics and Materials Inc., Sonics, India), the sonication process was carried out at a frequency of 20 kHz and 500 watts for 5 min at an intensity of 50% power, with a pulse cycle of 5 s on and 10 s off to ensure proper emulsification. At last, the hot dispersion was refrigerated at 4 °C and kept for further study [ 5 ].…”

“…Active inflammatory cells produce high levels of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6. Cytokines accumulate and remain at the wound site, causing significant damage [ 5 ]. Diabetic oral mucosal wounds heal slowly due to oxidative stress.…”

Dual-domain engineered exosome-based self-powered microneedle delivery platform for the treatment of infected wounds

“…Infected wounds are a common but challenging clinical condition, particularly in cases such as chronic diabetic ulcers, burns, and postoperative infections [ [1] , [2] , [3] , [4] ]. Their healing is hindered by a complex pathological microenvironment involving bacterial colonization, biofilm formation, persistent inflammation, and impaired tissue repair [ [5] , [6] , [7] , [8] , [9] ].…”

Postoperative Complications and Risk Factors in Skin Tumor Excision With Simple Suturing Under Local Anesthesia: A Multicenter Retrospective Study in Japan

“…These complications not only affect the quality of life (QOL) of patients but may also lead to increased medical resources owing to the need for re‐examination and additional treatment [ 4 ]. In addition, patients with underlying conditions such as diabetes may be at even greater risk of complications due to impaired wound healing and delayed immune response [ 5 ].…”

Augmented Marshmallow Extract Lipid Nanoparticles with Clove Oil Embedded in Collagen Sponge for Ultimate Antimicrobial Healing of Diabetic Mouth Ulcer

“…Surfactant type also played an important role, with poloxamer 407-based formulations achieving the highest EE%, most likely due to its stabilizing effect on the lipid core, which prevents drug leakage, as shown in Figure 3 d. The HLB value is essential for emulsification and nanoparticle stability as it influences the self-assembly and dispersion of lipid-based systems. Based on the formulation composition [ 5 ], HLB values were found for several different combinations of lipids and surfactants. Because capric acid does not repel water very well, stable formulations that contain it need poloxamer 407 and other surfactants with high HLB values.…”

“…For the ultrasonic treatment of a pre-emulsion of clove oil (CO.) and water for five minutes with a probe (Sonics and Materials Inc., Sonics, India), the sonication process was carried out at a frequency of 20 kHz and 500 watts for 5 min at an intensity of 50% power, with a pulse cycle of 5 s on and 10 s off to ensure proper emulsification. At last, the hot dispersion was refrigerated at 4 °C and kept for further study [ 5 ].…”

“…Active inflammatory cells produce high levels of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6. Cytokines accumulate and remain at the wound site, causing significant damage [ 5 ]. Diabetic oral mucosal wounds heal slowly due to oxidative stress.…”

Dual-domain engineered exosome-based self-powered microneedle delivery platform for the treatment of infected wounds

“…Infected wounds are a common but challenging clinical condition, particularly in cases such as chronic diabetic ulcers, burns, and postoperative infections [ [1] , [2] , [3] , [4] ]. Their healing is hindered by a complex pathological microenvironment involving bacterial colonization, biofilm formation, persistent inflammation, and impaired tissue repair [ [5] , [6] , [7] , [8] , [9] ].…”

Postoperative Complications and Risk Factors in Skin Tumor Excision With Simple Suturing Under Local Anesthesia: A Multicenter Retrospective Study in Japan

“…These complications not only affect the quality of life (QOL) of patients but may also lead to increased medical resources owing to the need for re‐examination and additional treatment [ 4 ]. In addition, patients with underlying conditions such as diabetes may be at even greater risk of complications due to impaired wound healing and delayed immune response [ 5 ].…”