Healing Of Diabetic Foot Ulcers Research Articles

Effect of Diluted Dakin's Solution Versus Standard Care on Diabetic Foot Ulcer Management: A Randomized Controlled Trial.

Diabetic foot ulcers (DFUs) are the main cause of hospitalizations and amputations in diabetic patients. Failure of standard foot care is the most important cause of impaired DFU healing. Dakin's solution (DS) is a promising broad-spectrum bactericidal antiseptic for management of DFUs. Studies investigating the efficacy of using DS on the healing process of DFUs are scarce. Accordingly, this is the first evidence-based, randomized, controlled trial conducted to evaluate the effect of using diluted DS compared with the standard care in the management of infected DFUs. A randomized controlled trial was conducted to assess the efficacy of DS in the management of infected DFUs. Patients were distributed randomly to the control group (DFUs irrigated with normal saline) or the intervention group (DFUs irrigated with 0.1% DS). Patients were followed for at least 24 weeks for healing, reinfection, or amputations. In vitro antimicrobial testing on DS was performed, including determination of its minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration, minimum biofilm eradication concentration, and suspension test. Replacing normal saline irrigation in DFU standard care with 0.1% DS followed by soaking the ulcer with commercial sodium hypochlorite (0.08%) after patient discharge significantly improved ulcer healing (P < .001) and decreased the number of amputations and hospitalizations (P < .001). The endpoint of death from any cause (risk ratio, 0.13; P = .029) and the amputation rate (risk ratio, 0.27; P < .001) were also significantly reduced. The effect on ulcer closure (OR, 11.9; P < .001) was significantly enhanced in comparison with the control group. Moreover, DS irrigation for inpatients significantly decreased bacterial load (P < .001). The highest values for the in-vitro analysis of DS were as follows: minimum inhibitory concentration (MIC), 1.44%; minimum bactericidal concentration (MBC), 1.44%; minimum biofilm inhibitory concentration (MBIC), 2.16%; and minimum biofilm eradication concentration (MBEC), 2.87%. Compared with standard care, diluted DS (0.1%) was more effective in the management of infected DFUs. Dakin's solution (0.1%) irrigation with debridement followed by standard care is a promising method in the management of infected DFUs.

Neuropeptides, Inflammation, Biofilms, and diabetic Foot Ulcers.

A diabetic foot ulcer (DFU) is a serious complication in patients with diabetes mellitus (DM). A DFU is the most common cause of non-traumatic limb amputation, and patients with DFUs have increased mortality rates within 5 years after amputation. DFUs also increase the risk of cardiovascular and cerebrovascular diseases; therefore, with the increasing incidence and prevalence of diabetic foot wounds, DFUs are gradually becoming a major public health problem. The pathophysiology of DFUs is complicated and remains unclear. In recent years, many studies have demonstrated that the pathophysiology of DFUs is especially associated with neuropeptides, inflammation, and biofilms. Neuropeptides, especially substance P (SP) and calcitonin gene-related peptide (CGRP), play an important role in wound healing. SP and CGRP accelerate the healing of cutaneous wounds by promoting neovascularization, inhibiting the release of certain proinflammatory chemokines, regulating macrophage polarization, and so on. However, the expression of SP and CGRP was downregulated in DM and DFUs. DFUs are characterized by a sustained inflammatory phase. Immune cells such as neutrophils and macrophages are involved in the sustained inflammatory phase in DFUs by extracellular traps (NETs) and dysregulated macrophage polarization, which delays wound healing. Furthermore, DFUs are at increased risk of biofilm formation. Biofilms disturb wound healing by inducing a chronic inflammatory response, inhibiting macrophage phagocytosis and keratinocyte proliferation migration, and transferring antimicrobial resistance genes. To understand the relationships among neuropeptides, inflammation, biofilms, and DFUs, this review highlights the recent scientific advances that provide possible pathophysiological insights into the delayed healing of DFUs.

Diabetic foot ulcer, the effect of resource-poor environments on healing time and direct cost: A cohort study during Syrian crisis.

Diabetic foot ulcer (DFU) is one of the slowest healing wounds that hurt the human body. Many studies from developed countries are concerned about materials, procedures, and equipment that accelerate the healing time. In Sweden, the diabetic foot management costs around 24965$/patient. In this review, we would evaluate the healing time of DFUs during what is considered one of the worst humanitarian crisis of the 21st century. 1747 DFUs were studied from the main diabetic foot clinic in Damascus (2014‐2019). We predicted many variables that could prolong the healing time. The cost according to these variables was also reported. The SINBAD Classification was performed to grade the severity of ulcers. We noticed that the median healing time for DFUs was 8 weeks. Almost half of these ulcers healed between 3 and 12 weeks. The time of healing for men was significantly longer than that for women. While the presence of infection doubled the median time of healing, the presence of peripheral artery disease doubled the mean of the direct health care cost. The location of the ulcer acted as another independent risk factor. In conclusion, DFUs face many barriers to heal during a crisis.The environment with resource‐poor settings should be added to the traditional risk factors that delay the healing of DFUs for months or even years. More studies from disaster are as are needed to evaluate low‐cost materials that could be cost effective in applying standard care of the diabetic foot.

Materials and Cytokines in the Healing of Diabetic Foot Ulcers

AbstractDiabetes affects an increasing number of patients, and is associated with sustained and chronic inflammation. Complications arising from diabetes, including hypoxia, neuropathy, hyperglycemia, and ischemia that contribute to a delayed and reduced healing response result in chronic slow healing wounds. Here, key differences in native versus diabetic wound healing during each phase of healing are discussed, and the roles of cells and their secreted cytokines which regulate this process are outlined. Monocyte chemoattractant protein‐1 (MCP‐1) is a pro‐inflammatory mediator which plays a key role in modulating angiogenesis. Its importance in diabetic wound healing as well as recent work using MCP‐1 and similar chemokines to reduce inflammation and improve healing are reviewed. The delayed healing response observed in diabetic patients often results in the formation of slow healing wounds, commonly presenting in the lower extremities as diabetic foot ulcers (DFUs); classification systems and current treatment options for DFUs, including debridement, off‐loading, and amputation are outlined. Common dressing strategies are highlighted, and recent work developing biocompatible and bioactive hydrogels to address and hasten chronic wound healing is focused on.

Beta-Catenin Signaling Pathway: Perhaps We Should Start Exploring it for Diabetic Foot Ulcer Healing?

Diabetic foot ulcers (DFUs) remain a common debilitating and costly complication of diabetes mellitus. Indeed, despite all efforts and emerging technologies, many DFUs are difficult to heal and frequently recur. Thus, novel therapeutic approaches are urgently needed. Specific targeting of different molecular and cellular pathways implicated in wound healing emerges as an attractive therapeutic modality to improve outcomes. One of the novel pathways that carry this potential is the wingless-type mouse mammary tumor virus integration site family/beta-catenin signaling pathway (WβcSP). It plays an important role in different stages of wound healing, including inflammation, proliferation, and remodeling. Potential therapeutic implications of WβcSP activation include producing agonists and/or blocking its endogenous inhibitors. Thus, we should perhaps start exploring potential ways of its therapeutic implication to improve DFU healing.

Biomarker Prediction of Postoperative Healing of Diabetic Foot Ulcers

The purpose of this study was to investigate the relationship and to determine potential usefulness of serum albumin as a biomarker for predicting postoperative diabetic foot ulcer (DFU) healing. A retrospective study. The sample comprised 266 inpatients with type 2 diabetes receiving care in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Among them, 174 had DFUs and underwent surgery for foot DFUs including amputation, skin grafting, and flap procedures. A comparison group consisted of 92 inpatients without a DFU or surgery. The association between healing and preoperative albumin levels was analyzed via a logistic regression model and receiver operating characteristic (ROC) curve. The albumin value of patients with DFU grade 3 or more (3.23 ± 0.58 g/dL) was lower than that of patients with DFU grade 1-2 (3.58 ± 0.5 g/dL), and both were lower than that of the comparison group (3.89 ± 0.3 g/dL). Patients with a DFU with hypoalbuminemia (<3.5 g/dL) had a 2.5-fold higher risk of nonhealing at postoperative 28 days than patients with normal levels (odds ratio = 3.51; 95% confidence interval, 1.75-7.06; P < .001). For patients with a DFU overall, the ROC curve showed a preoperative albumin cutoff of 3.44 g/dL for DFU wound healing. For patients with a DFU undergoing surgery, preoperative serum albumin may be used as a biomarker for predicting postoperative healing.

INSTRUCTIONS: Biomarker Prediction of Postoperative Healing of Diabetic Foot Ulcers: A Retrospective Observational Study of Serum Albumin

Journal of Wound, Ostomy and Continence Nursing: July/August 2021 - Volume 48 - Issue 4 - p E7 doi: 10.1097/WON.0000000000000791

Prospective Comparative Observational Study of Safety and Efficacy of Topical Ozone Gas Therapy in Healing of Diabetic Foot Ulcers versus Only Conventional Wound Management.

The prevalence of diabetic foot ulcers (DFUs) in India is 11.6%. DFU accounts for major cost expenditure, morbidity, and mortality. 1 Ozone gas has antimicrobial and antioxidant properties. We studied efficacy of topical ozone gas therapy in promoting healing of DFU. This is an observational comparative cohort study, n = 160, There were two groups of patients namely: those who received Conventional wound management alone C and those who received topical ozone therapy in addition to conventional wound management O + C therapy groups (81 each). Study group, i.e., O + C received five alternate day sessions of ozone therapy by bagging method for 30 minutes each session. Both groups were observed for 30 days for wound healing parameters like reduction of wound surface area, wound diameter, presence and character of discharge, granulation tissue, healing wound edges, microbial negativity, and requirement of revision (re-debridement and/or amputation) surgery. Mean baseline ulcer surface area is 17.43 ± 8.6 cm 2 for C and 17.87 ± 9.2 cm 2 (range 1–50 cm 2 ) in O + C group. Percentage change in ulcer surface after 21 days in O + C group is 32.37% compared with 17.15% in C group, which is statistically significant ( p = 0.01). Rates of microbial negativity and ulcer healing were significantly faster in ozone group. There was a statistically significant decrease in hospital stay, number of revision surgeries required, and mortality in ozone group. Topical ozone gas was well tolerated. Our study supports the efficacy of ozone therapy in DFU healing and reduction in the chances of infection and revision (re-debridement and/or amputation) surgery. More research is needed for dose, duration, and exposure time standardization.

Wound Healing by Semelil: A Structured Review With a Focus on Diabetic Foot Ulcers

Diabetic Foot Ulcer (DFU) is a common complication of diabetes mellitus. Among the various non-invasive treatment modalities used for the improvement of DFUs healing, topical herbal therapies are regaining an increasing body of interest. In this report, the authors review the literature and discuss wound healing with a focus on DFUs with Semelil. In this Structured review, we searched for articles published between 2008 and 2021, in the international and national databases with keywords “Melilotus officinalis”, “Semelil”, “Angipars”, and “diabetic foot ulcer”, “wound management”. Eligible articles (n=26) were identified according to inclusion and exclusion criteria. This review showed no complications with the application of Semelil and consensus on the positive effects of the found medication. In summary, our review showed that Semelil may be a valuable non-invasive treatment for wound healing in DFUs patients and reduces the wound size for four weeks without major adverse side effects.

Circ_PRKDC knockdown promotes skin wound healing by enhancing keratinocyte migration via miR-31/FBN1 axis.

Circular RNA protein kinase, DNA-activated, catalytic subunit (circ_PRKDC) has been found to impede wound healing in diabetic foot ulcers via regulating keratinocyte proliferation and migration. However, the mechanisms underlying circ_PRKDC in skin wound healing remain unclear. The expression of circ_PRKDC, microRNA (miR)-31 and fibrillin 1 (FBN1) was detected using quantitative reverse transcription-polymerase chain reaction and Western blot assays. The migration ability and the changes of matrix metallopeptidase 9 (MMP-9) and MMP2 levels were determined using wound healing, transwell and Western blot assays. The interaction between miR-31 and circ_PRKDC or FBN1 was verified by dual-luciferase reporter assay. The expression of circ_PRKDC was gradually down-regulated in wound edge at 1 and 7 days after injury relative to the unwounded skin. In human epidermal keratinocytes (HEKa), knockdown of circ_PRKDC promoted cell migration partly through up-regulating MMP-2 and MMP9, while circ_PRKDC overexpression showed opposite effects. In a mechanical study, we confirmed that miR-31 was a target of circ_PRKDC, and inhibition of miR-31 reversed the promotive effect of circ_PRKDC knockdown on HEKa migration. Besides that, miR-31 was verified to target FBN1, and ectopic overexpression of miR-31 accelerated HEKa migration via FBN1. Importantly, we also demonstrated that FBN1 overexpression attenuated the effects of circ_PRKDC knockdown on HEKa migration. In all, circ_PRKDC knockdown promoted HEKa migration during wound healing through miR-31/FBN1 axis, suggesting the therapeutic potential for circ_PRKDC on skin wound healing.

Advance-Platelet Rich Fibrin and Hyaluronic Acid Combination Improves Interleukin-6 and Granulation Index in Diabetic Foot Ulcer Patients

BACKGROUND: Diabetic foot ulcer (DFU) is the most common and threatening complication of Diabetes Mellitus (DM). Ideal wound dressing for DFU management should relieve symptoms, provide wound protection, and encourage healing. Advanced-Platelet Rich Fibrin (A-PRF) and Hyaluronic Acid (HA) have been proven to improve wound healing process. This study was aimed to demonstrate the ability of combination of A-PRF and HA in reducing inflammation and improving DFU tissue healing.METHODS: Twenty DFU subjects were involved in this study, and divided into two groups based on the topical fibrin gel treatment: A-PRF + HA group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. A-PRF + HA was prepared by homogening A-PRF and AH with a ratio of 1:0.6. Interleukin-6 (IL-6) level, granulation index (GI), numeric pain score (NPS), and inflammation clinical symptoms (ICS) were assessed on day-0, 3, 7 and 14.RESULTS: Wound swabs’ IL-6 level on day-7 was found to be significantly lower in A-PRF + HA compared to A-PRF alone (p=0.041). The IL-6 level reduction also found to be significant higher either in wound swabs (day 0-7, p=0.015) or fibrin gel (day 0-3, p=0.049; day 0-7, p=0.034). A-PRF + HA treatment significantly increased the GI even since day-3 (p=0.043), with lower NPS (p&lt;0.001), and ICS score.CONCLUSION: The combination of A-PRF and HA increases the GI in DFU healing by reducing the inflammation state which will induce the angiogenesis process, as well as reducing pain in DFU subjects better than A-PRF alone.KEYWORDS: inflammation, interleukin-6, wound healing, angiogenesis, proliferation

Novel Diabetic Foot Wound Dressing Based on Multifunctional Hydrogels with Extensive Temperature-Tolerant, Durable, Adhesive, and Intrinsic Antibacterial Properties.

Diabetic foot ulcers (DFUs) are hard-healing chronic wounds and susceptible to bacterial infection. Conventional hydrogel dressings easily lose water at high temperature or freeze at low temperature, making them unsuitable for long-term use or in extreme environments. Herein, a temperature-tolerant (-20 to 60 °C) antibacterial hydrogel dressing is fabricated by the assembly of polyacrylamide, gelatin, and ε-polylysine. Owing to the water/glycerin (Gly) binary solvent system, the resultant hydrogel (G-PAGL) displayed good heat resistance and antifreezing properties. Within the wide temperature range (-20 to 60 °C), all the desirable features of the hydrogel, including superstretchability (>1400%), enduring water retention, adhesiveness, and persistent antibacterial property, are quite stable. Remarkably, the hydrogel wound dressing displayed lasting and broad antibacterial activity against Gram-positive and Gram-negative bacteria. Satisfactorily, the double-network (DN) G-PAGL hydrogel dressing could effectively promote the healing of DFUs by accelerating collagen deposition, promoting angiogenesis, and inhibiting bacterial breed. As far as we know, this is the first time that the extensive temperature-tolerant DN hydrogel with antibacterial ability is developed to use as DFU wound dressing. The G-PAGL hydrogel provides more choices for DFU wound dressings that could be used in extreme environments.

20-LB: A M1/M2-Macrophages Regulating New Drug in an International Phase 3 Study

The healing of diabetic foot ulcers (DFUs) stalled in inflammation stage due to overabundance of inflammatory macrophages and the dysregulated M1/M2 macrophages in the lesion. Restoring the balance of M1/M2 macrophages plays a critical role in orchestrating the healing process of DFUs. By recognizing the therapeutic potential in M1/M2-macrophage-regulation for DFUs, we aim to evaluate the efficacy and safety of ON101, a topical new drug with M1/M2-macrophage-regulating mechanism versus a hydrocolloid dressing in an international, multicenter, randomized, controlled, evaluator-blind phase 3 study in 21 clinical/medical centers across the US, China, and Taiwan by following Guidance for Industry Chronic Cutaneous Ulcer and Burn Wounds — Developing Products for Treatment. 236 eligible patients with post-debrided DFU(s) between 1 - 25 cm2, present for ≥4 weeks and Wagner Grade 1 or 2, were randomized 1:1 to receive ON101 or comparator for up to 16 weeks followed by a 12-week follow-up. Baseline demography and medical history between the two groups were well balanced. The incidence of complete healing as the primary endpoint in full analysis set was 60.7% by ON101 and 35.1% by the comparator during the treatment period (p=0.0001). Time to complete ulcer healing as the secondary endpoint was noted faster in the ON101 group (p=0.002). No significant changes or differences between the two treatment groups in hematology, biochemistry (including HbA1c and fasting glucose), or vital signs. Related treatment of emergent adverse events was reported in 7 patients (5.7%) in the ON101 group and 5 (4.4%) from the comparator group. None of the serious adverse events was related to ON101 while there was a case of osteomyelitis reported to be related to the comparator. ON101, recently approved by Taiwan Food and Drug Administration, was shown with clinically significant efficacy and well-tolerated safety profile in DFUs which provides not only a new prospect in DFU management but a differentiated approach towards active-healing. Disclosure M. Kuo: Employee; Self; Oneness Biotech Co., Ltd.

267-OR: Assessing Patient Knowledge about Diabetic Foot Ulcer Offloading

Introduction: Standard of care for diabetic foot ulcers (DFU) includes wound debridement, dressing changes, diabetes control, and offloading. Despite this, half of all patients fail to heal when standard of care is met. Offloading DFU is critical to promote wound healing, yet patient adherence is undesirably low and contributes to failed wound healing. We evaluated patient knowledge of DFU offloading through a voluntary telephone survey. Methods: Participants were recruited from a tertiary care center podiatry department and completed a 21-item telephone survey. All subjects had a history of diabetes and were included regardless of DFU history. Descriptive statistics and chi square were calculated to evaluate survey responses. Results: Currently 92 of 167 subjects (55.1%) completed the telephone survey. All subjects regardless of DFU history correctly identified DFU increases risk of amputation (DFU95.7%; n=88/92). All subjects regardless of DFU history identified “offloading” and “pressure relief” as important factors to improve DFU healing (97.8%; n=90/92; 98.9%; n=91/92, respectively). Only a minority (43.5%; n=40/92) of participants were able to correctly identify the best offloading strategy, regardless of DFU history (DFU history 48.5%; n=16/33 vs. No DFU history 40.7%; n=24/59; p=0.5155). Discussion: We hypothesized people with a history of a DFU would understand the concept of offloading better, but yet patients who had a history of a DFU were as likely to misunderstand the term “offloading” compared to patients who have no history of a previous DFU. Our findings importantly identify a gap in patient education surrounding an essential component of DFU standard of care. Disclosure R. A. Burmeister: None. C. Holmes: None. C. Jarocki: None. T. Strom: None. G. M. Torrence: Research Support; Self; Kent Imaging. B. M. Schmidt: None.

The effectiveness of Diabetic Foot Clinic in prevention and healing of diabetic foot ulcers

ObjectiveTo assess the effects of the primary prevention and the healing of diabetic foot ulcers at Diabetic Foot Clinic at a university hospital in Thailand. Study designProspective descriptive study. MethodsDiabetic patients with diabetic foot ulcers or pre-ulcerative lesions who regularly were followed at the outpatient Diabetic Foot Clinic, were recruited. The data were collected prospectively. Prevention and healing of diabetic foot ulcers were assessed and measured. ResultsThirty-five diabetic patients with diabetic foot ulcers (n=21) and pre-ulcerative lesions (n=28) were recruited. Weekly wound radius reduction was 1.1±1.1 (mean±SD) mm/week. Fifty-seven percent of the ulcers achieved the surrogate 50% area reduction within 4 weeks. The percentage of healed ulcers at 12 and 16 weeks were 38.1%, and 47.6%, respectively. The percentage of improvement of the pre-ulcerative lesion was 78.6%. The most common complication was soft tissue infection (19%) which required surgical debridement (14.2%) and minor amputation (4.8%). ConclusionThe effectiveness of the Diabetic Foot Clinic was assessed by the reduction of the ulcer radius, ability to reach the surrogate 50% area reduction, and the improvement of the pre-ulcerative lesion. The weekly reduction of the ulcer radius was 1.1±1.1mm/week. The percentage of reaching the surrogate 50% area reduction within 4 weeks was 57%. The percentage of improvement of the pre-ulcerative lesion was 78.6%.

The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery.

The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.

The effects of dietary/herbal supplements and the serum levels of micronutrients on the healing of diabetic foot ulcers in animal and human models: a systematic review.

Diabetic Foot Ulcer (DFU) is one of the common and serious complications in patients with Diabetes Mellitus (DM) worldwide. Given the considerable tendency of patients suffering from DFU to use the complementary therapies, the objectives of this study were to: (i) summarize the effects of dietary and herbal supplements on DFU characteristics and metabolic parameters in both animal models and clinical trials, and (ii) evaluate any links between the serum levels of micronutrients and DFU in observational studies. A systematic search in five electronic databases including PubMed/Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted to find relevant English language published from 1990 until 31 December 2018. Of a total of 8603 studies, 30 eligible papers including animal studies (n = 15), clinical trials (n = 7), and observational works (n = 8) were included in the systematic review. We found that some dietary/herbal supplements and micronutrients had positive effects on the wound healing. However, limited evidence is existed. Also, lower serum levels of vitamin D, C, vitamin E, and selenium in patients with DFU were likely to increase the risk of DFU, leading to impaired wound healing. Findings suggested that some dietary and herbal supplements such as Vitamin D, Magnesium, Vitamin E, Probiotic, Zinc, and Pycnogenol would be effective on wound healing of DFUs. However, further high-quality randomized controlled clinical trials and prospective cohort studies are needed to clarify the roles of micronutrients and other dietary and herbal supplements on the progress and treatment of DFU.

Effect of topical phenytoin with normal saline dressing in patients of diabetic foot ulcers

Background: The management of wound and wound dressing is an important aspect of chronic ulcer management. Choosing an appropriate dressing can be a complex process. Topical phenytoin helps in faster wound remodelling. The objective of the study was to assess the effect of topical phenytoin dressing with normal saline dressing in healing of diabetic foot ulcer in terms of mean decrease in size of the ulcer.Methods: The present study was conducted on 60 patients with diabetic foot ulcer. The patients were divided into two different groups (group 1 topical phenytoin and group 2 normal saline dressing). Wound measurement was taken on day one and end of every week for four weeks. Mean reduction in ulcer area at the end of four weeks was calculated.Results: There was no statistical difference in the baseline characteristics like age, sex and initial wound area of the ulcer between the two groups. The mean reduction in wound area was 1856.9±724.9 mm2 in patients treated with topical phenytoin dressings and 1066.8±565.3 mm2 in patients treated with normal saline dressings, which is statically significant (p&lt;0.001).Conclusions: The study concluded that the topical phenytoin dressing can be used for the healing of diabetic foot ulcer.

Plant Leaves Extract Irrigation on Wound Healing in Diabetic Foot Ulcers.

Purpose We aimed to evaluate and compare the efficacy of neem leaves extract with normal saline irrigation practice in wound dressing on healing outcome and clinic-physiological parameters among individuals with diabetic foot ulcer (DFU). Methods A quasiexperimental with repeated measures design was used on two study groups. One group received neem leaf extract wound irrigation and another group received normal saline wound irrigation. Study participants were randomly assigned to each group from 100 DFU individuals. Demographic and clinical data sheets were used to collect baseline information. Random blood sugar and HbA1C measurement was performed on the initial day of visit for all participants. We used the PUSH tool for wound assessment (wound surface area, exudate amount, and tissue type), and clinic physiological parameters (temperature, pulse rate, respiration, blood pressure, wound pain, wound infection, and local warmth) assessment was performed at baseline and then at the end of each week till four weeks were completed. Participants attended a foot clinic every 3rd or 4th day for wound care. Results Reduction of wound healing score (PUSH score) and other wound variables improved significantly in the neem leaves extract group (p < 0.001). There were no significant changes in the clinic-physiological parameters. Conclusion Neem leaves extract irrigation for foot ulcers is considered to be very safe as it did not cause any complication systematically during the study. Neem leaf extract solution can be used as an alternative solution for normal saline. Managing DFU requires continuous foot care and early risk identification of ulcer.

Ready-to-Use Micronized Human Acellular Dermal Matrix to Accelerate Wound Healing in Diabetic Foot Ulcers: A Prospective Randomized Pilot Study.

To examine and report clinical outcomes of a ready-to-use micronized dermal matrix for diabetic foot ulcers (DFUs) and compare it to treatment with conventional negative-pressure wound therapy (NPWT) only. The researchers randomly allocated 30 DFUs Wagner grade 2 or higher from 30 adult patients into two groups. The control group (n = 15) was treated with conventional NPWT, and the experimental group (n = 15) was treated with micronized dermal matrix and NPWT. The researchers evaluated the following outcomes: granulation tissue formation, proportion of patients with closed or granulated wounds at 42 and 120 days, achievement of complete wound healing in the 6 months of follow-up, and intervals from enrollment to final surgical procedures. All 15 wounds treated with the micronized matrix showed healthy granulation tissue without noticeable complications during follow-up. At 42 days, 46.7% of wounds in the experimental group had closed compared with 28.6% in the conventional NPWT group (P = .007). At 120 days, 86.7% of the experimental group had completely closed wounds, compared with 57.1% in the conventional therapy group (P = .040). During the 6-month follow-up period, 93.3% of the experimental group achieved complete wound healing compared with 85.7% of the conventional therapy group (P = .468). The healing outcomes for DFUs in the experimental group were superior when micronized matrix treatment was combined with NPWT.