Diabetic Foot Ulcers Research Articles

Efficacy of Cytoreg in the treatment of diabetic foot disease.

Complications from diabetic foot wounds, including bacterial infection, ulceration and gangrene, are major causes of hospitalisation and are responsible for 85% of amputations in patients with diabetes. Given that orally administered investigational therapeutic Cytoreg (Cytorex de Venezuela SA, Venezuela), a defined aqueous mixture of hydrofluoric, hydrochloric, sulfuric, phosphoric, citric and oxalic acids, has been shown to increase levels of arterial blood oxygen in a Wistar rat model, oral and oral+topical Cytoreg were tested on patients with diabetic foot ulcers (DFUs) under a humanitarian, compassionate-use protocol. All patients received oral Cytoreg (5.0 ml concentrate in fruit juice) for 30 days; half also received weekly wound washing with Cytoreg concentrate in isotonic saline (1:50 volume/volume) (oral+topical group). In addition to standard clinical observations, wounds were monitored against the Saint Elian checklist system for the diabetic foot. A total of 10 patients took part in the study. Complete wound closure was observed in 4/5 patients in the oral+topical group; in the remaining patient, necrotic and fibrin tissues on the wound edges were eliminated. Half (2/4) of the patients receiving oral-only Cytoreg experienced complete wound closure; one patient in this group was removed prematurely because of an unrelated illness and was not replaced. During the study, no significant differences were observed between groups in either the oxygen saturation of the affected tissues or in insulin and glycaemia levels (p<0.05). Significant increases in arterial haemoglobin and arterial oxygen partial pressure (p<0.05) were observed, and significant decreases were measured in the levels of glycosylated haemoglobin, aspartate aminotransferase, glutamic-pyruvic transaminase, creatine and urea (p<0.05). The results of this study justify an expanded clinical study for the treatment of DFUs with Cytoreg.

Predictors of Successful Antibiotic Treatment of Osteomyelitis in Diabetic Forefoot Infection.

Osteomyelitis (OM) associated with diabetic foot ulceration (DFU) is a growing public health challenge worldwide. Since 2012 the number of patients presenting with DFU per year to our centre has doubled. This study aims to evaluate outcomes from outpatient antibiotic therapy (OPAT) in the management of OM in DFU patients. A retrospective analysis was performed of medical notes, radiology, and vascular laboratory reports for all DFU patients with OM treated from April 2016 to April 2020. Variables analyzed included age, gender, site of OM, WIfI Score (Wound Ischaemia and foot Infection Score), probe-to-bone test (PTB), imaging (X-ray/magnetic resonance imaging (MRI), co-morbidities (peripheral arterial disease (PAD), chronic kidney disease (CKD), hypertension (HTN), smoking, ischemic heart disease (IHD), and dyslipidaemia. Outcomes evaluated were healing, recurrent DFU, and freedom from amputation at 12months. 185 patients were admitted with 264 infected digits (Male 223; Female 41). The mean age was 66years. Only 168 (63.6%) were fully healed at 12months. Of the 96 patients who failed to heal, 43 underwent a repeat course of prolonged antibiotics without improvement. Factors associated with treatment failure were PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene. Extended outpatient antibiotic therapy (with an inpatient multidisciplinary approach) is an effective treatment for digital OM in DFU with a success rate of 63%. In recurrence, repeating prolonged antibiotics is unlikely to achieve healing. PAD, poorly controlled HbA1c and Deep or Extensive Ulcer or Gangrene are predictors of treatment failure.

Degree of sulfation of freeze-dried calcium alginate sulfate scaffolds dramatically influence healing rate of full-thickness diabetic wounds.

Diabetic foot ulcer (DFU) is a chronic and non-healing wound in all age categories with a high prevalence and mortality in the world. An ideal wound dressing for DFU should possess the ability of adsorbing high contents of exudate and actively promote wound healing. Here, we introduced the calcium alginate sulfate as a new biomaterial appropriate for use in wound dressing to promote the healing of full-thickness ulcers in a diabetic mouse model. In this regard, alginate sulfate (Alg-S) solutions with different degree of substitution (DS) of 0.2, 0.5, and 0.9 were synthesized, freeze-dried, crosslinked by calcium cations, purified by washing and refreeze-dried. Primary analyses including swelling ratio, porosity content and mechanical properties revealed that all Alg-S scaffolds possess necessities for use as a wound dressing. After confirming the cytocompatibility of both alginate and alginate sulfate-based scaffolds by MTT assay, they were used as wound dressing for healing of full-thickness ulcers in diabetic mice. The results of wound healing process confirmed that calcium alginate sulfate scaffolds can heal the wounds faster than both alginate-treated and non-treated wounds. Furthermore, the histological analyses of healed tissues reveled normal regeneration of the skin tissue layers and collagen deposition similar to the healthy tissue.

Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis.

Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software. Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD=-1.64, 95% CI -2.27 to -1.02 p<0.00001, I2=88%). The ABC group had a significantly decreased number of debridements (SMD=-2.47, 95% CI -4.24 to -0.70, p<0.00001, I2=95%). The pooled data showed no significant difference (RR=0.41, 95% CI 0.12 to 1.39, p=0.84, I2=0%). This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications. PROSPERO CRD42023406017.

Shengji ointment combined with bromelain promotes granulation of exposed tendons in diabetic foot ulcers: A multicenter, randomized, positive-controlled clinical trial

BackgroundExposed, infected and necrotic tendons often occur in the middle and late stages of diabetic foot ulcers (DFUs). The exposed tendon is both a potential source and route of infection, which prolongs the treatment period and affects recovery, leading to amputation and even death. Therefore, management of the exposed tendon in patients with DFU is the key to treatment. This study aimed to evaluate the clinical efficacy of Shengji ointment combined with bromelain in the treatment of DFU with tendon exposure and to provide clinical treatment options and evidence-based medicine. MethodsThis study was a multicenter, nonblinded, randomized, positive controlled clinical trial involving 180 patients with DFU with tendon exposure at four tertiary-grade A-class hospitals. The included patients were randomly assigned 1:1 to an observation group (n = 90) that received Shengji ointment combined with bromelain and a control group (n = 90) that received hydrocolloid dressing, with dressing changes once daily for 4 weeks. Patients in both groups continued with conventional treatments, such as blood glucose and blood pressure medication, lipid regulation, and antiplatelets. The primary outcome measure was wound coverage with granulation tissue. The secondary outcome measures included the wound healing rate, time to granulation, Maryland foot score, time to debridement of necrotic tendon tissue, and granulation tissue score. We performed measurements before enrollment and after the end of treatment for comparison. ResultsThere was no significant difference in the baseline data between the two groups before treatment (P > 0.05). After treatment, the primary outcome indicators of the two groups were compared, and the wound granulation tissue coverage rate of the treatment group was greater than that of the control group (P = 0.003). For the secondary outcome outcomes, the wound healing rate, time to granulation, Maryland foot function score, time to debridement of necrotic tendon tissue, and granulation tissue score in the treatment group were significantly better than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P = 0.444). ConclusionsShengji ointment combined with bromelain effectively promotes the removal of exposed necrotic tendons in patients with DFU, promotes the regeneration of healthy granulation tissue, accelerates wound healing, and protects the limb and its function. It also appears to be safe as an intervention for the treatment of patients with DFU. Trial registrationThe study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR) under the code ChiCTR2000039327 on October 23, 2020. The public title is “Study on evidence-based evaluation and therapeutic mechanism of integrated Chinese and Western medicine for treatment of diabetic foot - An evidence-based evaluation of The combination of Rubber Shengji Paste and compound bromelain to promote the healing of the exposed wound of diabetic foot tendon”.

Education program to prevent diabetic foot ulcer in patient with diabetes: A scoping review

Program-based education has emerged as a crucial strategy in preventing diabetic foot ulcers (DFUs) and related complications. This scoping review aims to assess the program-based education interventions in preventing DFUs in patients with diabetes. A comprehensive search was conducted across major electronic databases, including PubMed, ProQuest, Scopus, and CINAHL. The primary outcome measure was foot self-care behaviors, while secondary outcomes included foot-related knowledge, self-efficacy, and quality of life. The studies encompassed diverse educational programs, such as structured foot care education, and multidisciplinary interventions. In total, 135 articles regarding Program-based education to prevent Diabetic Foot Ulcer on patient with diabetes were found in the literature. However, 18 articles that met the study criteria were reviewed. The results highlight the effectiveness of combining education with follow-up sessions to enhance self-care behavior, self-efficacy, knowledge, self-management, and quality of life in patients with diabetes mellitus (DM).

Evaluating the Role of Hyperbaric Oxygenation Therapy in Improving Diabetic Foot Ulcer Healing: A Systematic Review

Background: Diabetic foot ulcer (DFU) is a frequent complication of poorly controlled diabetes mellitus and can lead to amputation, significantly impacting quality of life. Although DFU is common, its treatment remains complex and could benefit from improvement. Hyperbaric oxygenation therapy (HBOT) is a noninvasive procedure that has recently shown potential as an alternative treatment for DFU. Given the increasing interest in HBOT, with many centers actively researching and developing advancements in this area, this review aims to not only gather and analyze relevant studies but also assess the feasibility of integrating HBOT into clinical practice as a viable, noninvasive alternative for DFU treatment.Methods: This review was conducted following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guideline on studies published on HBOT for DFU. Each included study was critically appraised using the 2020 JBI Checklist for Randomized Controlled Trials.Results: From three databases, eight out of 1,665 records were included for this review. Critical appraisal revealed that of the eight studies, only three fulfilled all criteria outlined in the checklist, as three studies did not indicate blinding, and two studies were open-label. The utilization of HBOT in the treatment of DFU resulted in various changes both in the wound healing process and risk of complications.Conclusion: Based on the majority of the included studies, HBOT revealed a positive impact in aiding the healing of DFUs and in mitigating various risk of complications.

Neutrophil Migration is a Crucial Factor in Wound Healing and the Pathogenesis of Diabetic Foot Ulcers: Insights into Pharmacological Interventions.

Diabetic foot ulcers (DFUs) pose a significant clinical challenge, characterized by impaired wound healing, chronic inflammation, and increased risk of infection. Neutrophils, as critical components of the innate immune response, play a pivotal role in the initial stages of wound healing, particularly during the inflammatory phase. This review explores the intricate relationship between neutrophil migration, inflammation, and the pathogenesis of DFU and drugs that can impact neutrophil production and migration. Neutrophils contribute to infection control through phagocytosis and release pro-inflammatory cytokines and reactive oxygen species, which, when dysregulated, can impede the wound healing process. Furthermore, the chronic hyperglycemic state characteristic of diabetes mellitus has been implicated in impairing neutrophil functions, including chemotaxis and oxidative burst. This compromised neutrophil response prolongs the inflammatory phase and disrupts the delicate balance required for efficient wound healing. Neutrophil extracellular traps (NETs), a unique form of neutrophil defence, have also been implicated in DFU pathogenesis, potentially exacerbating inflammation and tissue damage. Understanding the intricate interplay between neutrophil migration, dysregulated inflammatory responses, and hyperglycemia-driven impairments is essential for developing targeted therapeutic strategies for DFUs. This review sheds light on the critical role of neutrophils in DFU pathogenesis, and innovative and advanced treatment strategies for DFU, highlighting the potential for novel interventions to restore the balance between pro-inflammatory and wound healing processes, ultimately improving clinical outcomes for individuals with DFU.

Clinical efficacy and mechanism of the combination of autologous platelet-rich gel and recombinant human acidic fibroblast growth factor in the management of refractory diabetic foot.

This study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment. Ninety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment. Following treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P< 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P< 0.05). The integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF.

The association of the perioperative neutrophil-to-lymphocyte ratio with wound healing in patients with Wagner grade 3 and 4 diabetic foot ulcers after tibial cortex transverse transport surgery: a prospective observational cohort study.

Diabetic foot ulcers (DFUs) are severe complications of diabetes, involving multiple etiological factors including neuropathy, vascular insufficiency, and impaired wound healing. The global burden of DFUs is substantial, with significant morbidity and high management costs. Recent advancements have introduced the tibial cortex transverse transport (TTT) technique, which has shown promising results in the management of severe DFUs by promoting angiogenesis and immunomodulation. This prospective cohort study enrolled patients with Wagner grade 3 and 4 DFUs, treated using the TTT technique from May 2022 to September 2023 at MianYang Central Hospital. The study assessed the influence of TTT on the perioperative neutrophil-to-lymphocyte ratio (NLR), an established biomarker of systemic inflammation, and its correlation with wound healing outcomes. A total of 82 patients were enrolled, with 66 completing the study. The survival analysis revealed that patients with a lower preoperative NLR experienced significantly faster wound healing compared with a high NLR (log rank test P< 0.05; hazard ratio (HR) = 0.46; 95% CI: 0.26-0.83). The optimal NLR cutoff values (4.25) were established to predict wound healing times for DFUs. The median NLR was significantly different before TTT surgery, 3 days after TTT surgery, and 1 month after TTT surgery (P<0.05). The TTT technique significantly influences the perioperative NLR and is associated with improved wound healing in DFU patients. The perioperative NLR serves as an effective predictive biomarker for wound healing outcomes, highlighting the significance of interventions targeting NLR values in perioperative management strategies and postoperative monitoring protocols for the treatment of diabetic foot ulcers (DFUs) in clinical practice.

Material Technologies for Improved Diabetic Foot Ulcer (DFU) Treatment: A Questionnaire Study of Healthcare Professionals’ Needs

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetic patients, with significant global prevalence and associated health burdens, including high recurrence rates, lower-limb amputations, and substantial associated economic costs. This study aimed to understand the user needs of healthcare professionals treating diabetic foot ulcers for newly developed material technologies. Methods: An open-ended questionnaire was used to identify user needs, identify the limitations of current treatments, and determine the specific requirements for ideal treatment. This information was used to develop a list of key considerations for creating innovative material technologies to improve diabetic wound treatment results. Results: Most respondents indicated that they followed published treatment guidelines for DFUs but noted that treatment often required a case-specific approach. Antibiotics and surgical debridement were commonly used for infection control. The participants showed a strong preference for wound dressings with lasting antibacterial properties. Respondents identified ideal properties for new products, including ease of use, enhanced antibacterial properties, affordability, and targeted biological activity. The respondents also highlighted the importance of a holistic approach to DFU management, integrating product development with comprehensive care strategies and patient education. Conclusions: This study highlights the complexity of DFU care, emphasizing that no single product can address all treatment needs. Future materials could focus on combination therapies and specific use cases. Additionally, understanding global variations in treatment practices and educating users on the proper application of newly developed material technologies is crucial for improving the management of DFUs and patient outcomes.

Modelling the cost-effectiveness of a chloramine gel in treating infected, non-healing diabetic foot ulcers.

Organic chloramines have been developed as a topical wound bed preparation gel. This study aimed to estimate whether the addition of chloramine gel (Chlorasolv, RLS Global AB, Sweden) to standard care compared with standard care alone would afford a cost‑effective technology to the UK's health services for treating infected, non-healing diabetic foot ulcers (DFUs). A Markov model was developed to simulate the management of infected, non-healing DFUs. The model utilised data from a randomised controlled trial and was used to estimate the cost-effectiveness of chloramine plus standard care compared with standard care alone over a period of 24 weeks, expressed as the incremental cost per quality-adjusted life year (QALY) gained at 2021/22 prices. Using adjunctive chloramine to treat infected, non-healing DFUs was found to shorten the time to healing by 36% (from a mean of 17.1 weeks per ulcer to a mean of 11.0 weeks per ulcer). This translated into a 6% improvement in the probability of being healed by 24 weeks and a corresponding 3% improvement in health-related quality of life (HRQoL). Also, use of adjunctive chloramine was found to reduce the total cost of ulcer management by 13%. Sensitivity analysis found that adjunctive chloramine remained a cost-effective treatment, even when the value of the model inputs was varied by ±20%. Within the limitations of the study, treatment with adjunctive chloramine instead of standard care alone could potentially afford the UK's health services a cost-effective debridement strategy for infected, non-healing DFUs, due to its ability to accelerate the time to healing.

Efficacy of Autologous Platelet Rich Plasma For Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer (DFU) is a common complication of long standing uncontrolled diabetes mellitus. There are different types of treatment commonly practiced among the clinicians to treat DFU. Among them, autologous platelet rich plasma (PRP) application is getting popularity day by day throughout the western world. Methodology: It was a prospective, randomized, controlled study that was carried out among 40 DFU patients in the Department of Surgery, Dhaka Medical College Hospital. Among them, 20 patients were treated by autologous PRP and another 20 patients were treated by conventional method. They were followed up for 12 weeks period. Data collected from the participants were analyzed to compare the healing rate among two groups. Result: In PRP treated ulcers, healing rate was significantly faster and better in comparison to conventionally treated ulcers. After 10th weeks follow up, in PRP group 14 ulcers were completely healed whereas in control group,4 ulcers were completely healed. On the contrary, 3 ulcers in control group showed further deterioration. At the end of 12th weeks follow up, 19 ulcers in PRP group were completely healed whereas 13 ulcers in control group were completely healed. In PRP group no patient showed any complication during treatment, whereas in control group 7 patients experienced local complications. Conclusion: Treatment of diabetic foot ulcer with autologous platelet rich plasma results in faster and better ulcer healing in comparison to conventional treatment. PRP accelerates the healing rate and keep the ulcer area safe from external pathogens. Hence, autologous PRP is a better selection for DFU treatment. J Dhaka Med Coll. 2023; 32(1) : 38-42

Identifying Predictors and Its Relationship with Developing of Diabetic Foot Ulcer (DFU)

Diabetic foot Ulcer is one of the severe complication of diabetes mellitus that leading to increasing serious problem. Early detection was an appropriate effort to prevent deteriorate condition. The aims of this study was to Identifying predictors of diabetic foot ulcer among type 2 diabetic patients through a scoping review. This study design is a scoping review using journal database with entering keyword predictors, diabetic foot ulcer, diabetic patient. Articles selected were met its inclusion criteria. The result showed that 17 articles included from 170 articles, from which 8 articles are cross-sectional studies, 7 articles are retro-spective studies, as well as 2 articles are systematic review. The incidence of diabetic foot ulcer reached more than 11,6%, from which dominated by grade 1 and grade 2 DFU, The significant predictors of diabetic foot ulcer classified into three categories including diabetes complications, demografic characteristic, and self-care behavior. Peripheral arterial disease (PAD) as the dominant predictor of diabetes complication, duration of diabetes &gt;10 years as the dominant predictor of demografic characteristic, and low diabetic foot-care practice as the dominant predictor of self-care behavior. Reducing impact of DFU could be achieved by optimizing self-care behavior through appropriate diabetic-care and foot-care management based on patients characteristic and diabetes complications.

The relationship between dietary phytochemical index and novel anthropometric indices and the severity of diabetic foot ulcers in adults with type 2 diabetes: a cross-sectional study

BackgroundResearch on the relationship between dietary phytochemical intake and the anthropometric indices as well as the diabetic foot ulcers (DFUs) remains inconsistent. We aimed to investigate the associations of dietary phytochemical index (DPI) with the novel anthropometric indices and the severity of DFUs.MethodsThis cross-sectional study was conducted on 339 adults with type 2 diabetes. Dietary intake was assessed using three 24-hour dietary recalls. To quantify the phytochemical content of the diet, the DPI estimation was done through an equation proposed by McCarty. The International Working Group on the Diabetic Foot (IWGDF) criteria and Wagner classification system were applied to assess DFUs. New anthropometric indices including a body shape index (ABSI), body roundness index (BRI) and abdominal volume index (AVI) were calculated based on formulas. We employed analysis of variance (ANOVA), analysis of covariance (ANCOVA) and logistic regression to explore associations between DPI and the anthropometric indices and DFU variables.ResultsOur results revealed no significant association between DPI and the foot ulcer indices, following adjusting for the possible covariates. Furthermore, we also examined the relationship between diabetic neuropathy, as measured by monofilament score, and the DPI. Similarly, we did not find any substantial relationship between the DPI and monofilament score (OR: 1.18; 95% CI: 0.66–2.09; Ptrend = 0.56), as well as biochemical indices. Our analysis did not reveal any significant associations between the DPI and ABSI (OR: 0.70; 95% CI: 0.35–1.38; Ptrend = 0.30), BRI (OR: 0.80; 95% CI: 0.33–1.95; Ptrend = 0.59), and AVI (OR: 1.99; 95% CI: 0.92–4.33; Ptrend = 0.08).ConclusionsOur study revealed no significant links between the DPI and foot ulcer indices, neuropathy measures, and anthropometric indices. These findings imply that factors beyond dietary phytochemical intake may exert greater influence on the development of foot ulcers in diabetes.

Clinical Efficacy of a Contralateral Shoe Lift in Patients with Diabetic Foot Ulcers and Induced Limb-Length Discrepancies: A Randomized Controlled Trial.

Objective: To evaluate the clinical efficacy of combining an offloading device with a contralateral shoe lift to compensate for induced limb-length discrepancies in participants with plantar diabetes-related foot ulcers. Approach: Between March 2021 and December 2023, 42 consecutive patients with active plantar diabetic foot ulcers (DFUs) were randomly assigned (1:1) to the treatment group (limb-length discrepancy compensation with a shoe lift in the therapeutic footwear of the contralateral limb) or a control group that did not receive limb-length discrepancy compensation. Primary outcomes included the 20-week wound-healing rate and wound area reduction. Secondary outcomes included minor amputation, new ulcers in the contralateral limb, perceived comfort, and hip pain. Results: On an intention-to-treat basis, 15 participants in the control and 19 in the treatment group showed ulcer healing (p = 0.0023). In those with >80% adherence to the offloading device, multivariate analysis showed that the shoe lifts improved ulcer healing time. The use of a shoe lift reduced the number of minor amputations and the occurrence of new ulcers in the contralateral limb (p = 0.035; p = 0.033 respectively). Hip pain and perceived comfort improved with the use of shoe lifts (p < 0.001). Innovation: It validates the use of shoe lifts for patients with DFUs, as it is the first largest study of its kind to establish a clear reference standard to guide clinician decision-making. Conclusion: The use of shoe lifts reduced healing time in participants with diabetes and active plantar foot ulcers. Shoe lifts reduce late complications, including new ulcers in the contralateral limb and minor amputations.

Effect of aspirin on platelet-rich plasma of diabetes mellitus with lower extremity atherosclerosis.

Aim: Platelet-rich plasma (PRP), enriched with multiple growth factors, is a promising adjunctive therapy for diabetic foot ulcers (DFUs). As a classic anti-platelet drug for diabetic patients, the effects of aspirin on the content of growth factors in PRP remains unclear.Methods: Our study enrolled diabetic patients who were currently taking or not taking aspirin as the research subjects, with healthy volunteers as the control. PRP from these individuals was activated with glucose calcium and thrombin. Growth factors levels in PRP activated supernatant (PRP-AS) and wound healing ability of platelet gel (PG) in the full-thickness skin defect diabetic mouse model were compared.Results: We found the level of growth factors in PRP-AS derived from two groups of diabetic patients were not statistically different, whereas both lower than that from healthy volunteers. Similarly, we found better wound healing ability of PG from healthy volunteers than those from diabetic patients, but no difference between the two groups of diabetic patients in the mouse model.Discussion: Aspirin does not interfere with autologous PRP therapy when using calcium gluconate and thrombin as agonists. However considering the content of growth factors, PRP from healthy volunteers is a preferable option for promoting DFU repair.

A Comprehensive Approach for Diabetic Foot Ulcer Management

Objectives: This study aims to evaluate the efficacy of a comprehensive management plan in the treatment of diabetic foot ulcers (DFUs). Evaluating the effects of wound debridement on the outcomes of diabetic foot ulcers, advanced dressings, blood sugar control, and offloading strategies are the main objectives. The study also intends to investigate the function of surgery in managing chronic ulcers and preventing recurrences. The goal is to offer advice for managing DFUs optimally and lowering related morbidity based on evidence. Method: The intervention program includes techniques like wound debridement, advanced dressings, unloading modalities, blood sugar level control, and, where necessary, surgical treatments. Growth factors, electrical stimulation, negative pressure wound therapy, bio-engineered skin, and hyperbaric oxygen therapy are among the many treatments that are included. Regression models are among the statistical analyses used to assess the efficacy of the overall management strategy. Results: Significant findings are presented in the results section, which shows how the holistic management strategy improves DFU outcomes. Improved wound healing rates, reduced infection incidents, and enhanced patient-reported outcomes are highlighted. The results underscore the significance of maintaining blood sugar levels, wound debridement, and incorporating various therapeutic modalities in DFU management. Conclusion: This study concludes by recommending a thorough and interdisciplinary approach to DFU management. Maintaining blood sugar levels, debridement of the wound, sophisticated dressings, unloading techniques, and surgical procedures are among the effective strategies that help reduce morbidity and prevent serious complications related to diabetic foot ulcers. Additional investigation is necessary to enhance and broaden these results for ongoing progress in the management of diabetic foot ulcers.

Factors Influencing Outcomes of Diabetic Foot Management: Retrospective Study at Mwananyamala Regional Referral Hospital

Background: Diabetic foot ulcers (DFUs) contribute to significant morbidity and mortality worldwide, with the global prevalence of diabetes expected to rise to 12.2% by 2045, an increasing number of people are at risk for complications like DFUs, which affect 19% to 34% of diabetic patients. People with DFUs carry a 20% lifetime risk of limb amputation and mortality rate of 50% to 70%. In Tanzania DFUs account for 41.9% of major limb amputations and mortality rate of 54%. Methods: A retrospective observational study aimed to investigate the clinical factors, and treatment modalities that influence the management outcomes of diabetic foot among patients attending Mwananyamala Regional Referral Hospital (MRRH). The study reviewed existing patient records. Results: A total of 143 participants were enrolled in the study, of which 94 (65.73%) were female. The participants had a mean age of 57 ± 13.9 years. And approximately half (50.35%) were married. Nearly, all patients, 140 (97.90%), underwent surgical treatment, nearly half (41.96%) had DFU Wagner Class 3 while most of participants (69.93%) had hypertension. The mean hospital stay was 9.2 days. In binary logistic regression model output, marital status, level of education, working diagnosis, surgical management, patient progress and number of readmissions were identified as determinants of the outcome (P-value &lt; 0.05). Conclusion: This study identified key factors influencing diabetic foot outcomes, including gender, marital status, co-morbidities and ulcer grade. These findings underscore the importance of early diagnosis, targeted interventions, and comprehensive management to improve patient outcomes.

Structural analysis and accelerating wound healing function of a novel galactosylated glycosaminoglycan from the snail Helix lucorum

Diabetic foot ulcers (DFUs) as a nonhealing wound remain a clinical challenge, and the development of pro-healing and cost-effective drugs is in urgent need. Herein, we reported a novel galactosylated glycosaminoglycan (GAG) from the snail Helix lucorum, as an effective pro-healing compound. The snail GAG is composed of a heparan sulfate-like main chain and galactose side chains at C-3 of GlcNAc residue. Its main chain has a repeating disaccharide structure of → 4)-α-D-GlcNAc-(1 → 4)-α-L-IdoA2S(1 →. This is the first example of glycosaminoglycan with galactose branches from mollusks. Pharmacological experiments showed that the H. lucorum GAG significantly promoted skin wound healing in both healthy and diabetic mice by accelerating granulation tissue regeneration, angiogenesis, and collagen deposition. The distinctive galactosylated substitution may play an important role on its pro-healing activity. Our discovery enriches the diversity of non-anticoagulant heparan sulfate-like glycosaminoglycans, and provides a potential candidate of pro-healing drug for treating diabetic wound.