Management Of Diabetic Foot Ulcers Research Articles

Systematic review of cellular, acellular and matrix-like products (CAMPs) and indirect treatment comparison between cellular/acellular and amniotic/non-amniotic grafts in the management of diabetic foot ulcers.

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on the efficacy of cellular, acellular and matrix-like products (CAMPs) in the management of diabetic foot ulcers based on published randomized control trials (RCTs). While CAMPs have been incorporated into the clinical algorithm for chronic wounds, evidence is lacking to comparatively evaluate the efficacy of these products. Level 1 RCT studies are the gold standard to evaluate efficacy of different treatment approaches, however, due to differences in surgical techniques, patient demographics and compliance, standard of care outcomes in the wound care space can vary significantly between different randomized controlled trials, making it difficult to compare them against each other. To mitigate variability between different RCTs, wound closure outcomes can be reported as risk ratios. This review of all currently published RCTs (with similar trial design) in diabetic foot ulcer (DFU) patients and risk ratios, confirms that CAMPs adjunct to standard of care result in statistically superior wound closure outcome in diabetic foot ulcers, when compared to standard of care alone, with a Risk Ratio (RR) of 1.72 [1.56, 1.90], p< 0.00001. Enough evidence is still lacking to determine a statistical difference between broad categories of cellular/acellular and amniotic/non-amniotic CAMPs; and hence decision makers should consider published head-head comparative studies, real-world evidence and cost-effectiveness evidence between individual CAMPs to decide on which to use in practice.

SOCIOECONOMIC FACTORS AND HEALTHCARE ACCESS: THEIR ROLE IN THE MANAGEMENT AND OUTCOMES OF DIABETIC FOOT ULCERS

Objective: Diabetic foot ulcers (DFUs) are a significant complication of diabetes mellitus, affecting millions globally and presenting considerable challenges to healthcare systems. While clinical aspects of DFUs are well-documented, socioeconomic factors and healthcare access play crucial roles in their management and outcomes. This study investigates how socioeconomic status (SES), healthcare accessibility, and patient education influence DFU prevention, treatment, and prognosis. Methods: A prospective, cross-sectional observational study was conducted over 13 mo at the Department of General Surgery, Command Hospital (Western Command), Chandimandir. Fifty patients with DFUs were enrolled based on specific inclusion and exclusion criteria. Data were collected on demographic details, lifestyle habits, comorbidities, and specifics of diabetes and DFU. Ulcer characteristics, wound cultures, and outcomes were analyzed using SPSS version 21.0. Results: The study population had a mean age of 60.10 y, with a predominance of males (78%). Smoking and obesity emerged as significant risk factors, with smoking more prevalent among males and obesity more common in females. The distribution of ulcer locations and the microbial profile, dominated by Staphylococcus aureus, underline the complexity of DFU management. These findings highlight the influence of socioeconomic factors and healthcare access on DFU outcomes. Conclusion: Effective DFU management requires a holistic approach that extends beyond clinical treatment to address socioeconomic factors and healthcare access. Tailored interventions that consider these broader determinants of health are essential for improving DFU outcomes and patient quality of life. Addressing healthcare disparities can significantly reduce the burden of DFUs, creating a more equitable and effective framework for diabetes care.

Tibial Cortex Transverse Transport Facilitates Severe Diabetic Foot Wound Healing via HIF-1α-Induced Angiogenesis.

Management of severe diabetic foot ulcers (DFUs) remains challenging. Tibial cortex transverse transport (TTT) facilitates healing and limb salvage in patients with recalcitrant DFUs. However, the underlying mechanism is largely unknown, necessitating the establishment of an animal model and mechanism exploration. Severe DFUs were induced in rats, then assigned to TTT, sham, or control groups (n=16/group). The TTT group underwent a tibial corticotomy, with 6 days each of medial and lateral transport; the sham group had a corticotomy without transport. Ulcer healing was assessed through Laser Doppler, CT angiography, histology, and immunohistochemistry. Serum HIF-1α, PDGF-BB, SDF-1, and VEGF levels were measured by ELISA. The TTT group showed lower percentages of wound area, higher dermis thickness (all p < 0.001 expect for p = 0.001 for TTT vs Sham at day 6) and percentage of collagen content (all p < 0.001) than the other two groups. The TTT group had higher perfusion and vessel volume in the hindlimb (all p < 0.001). The number of CD31+ cells (all p < 0.001) and VEGFR2+ cells (at day 6, TTT vs Control, p = 0.001, TTT vs Sham, p = 0.006; at day 12, TTT vs Control, p = 0.003, TTT vs Sham, p = 0.01) were higher in the TTT group. The activity of HIF-1α, PDGF-BB, and SDF-1 was increased in the TTT group (all p < 0.001 except for SDF-1 at day 12, TTT vs Sham, p = 0.005). The TTT group had higher levels of HIF-1α, PDGF-BB, SDF-1, and VEGF in serum than the other groups (all p < 0.001). TTT enhanced neovascularization and perfusion at the hindlimb and accelerated healing of the severe DFUs. The underlying mechanism is related to HIF-1α-induced angiogenesis.

Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review.

Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates. A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada

BackgroundPrimary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model.MethodsA one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement.ResultsExperts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken.ConclusionsThis study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Mesenchymal stem cell therapy in diabetic foot ulcer: An updated comprehensive review.

Diabetes has evolved into a worldwide public health issue. One of the most serious complications of diabetes is diabetic foot ulcer (DFU), which frequently creates a significant financial strain on patients and lowers their quality of life. Up until now, there has been no curative therapy for DFU, only symptomatic relief or an interruption in the disease's progression. Recent studies have focused attention on mesenchymal stem cells (MSCs), which provide innovative and potential treatment candidates for several illnesses as they can differentiate into various cell types. They are mostly extracted from the placenta, adipose tissue, umbilical cord (UC), and bone marrow (BM). Regardless of their origin, they show comparable features and small deviations. Our goal is to investigate MSCs' therapeutic effects, application obstacles, and patient benefit strategies for DFU therapy. A comprehensive search was conducted using specific keywords relating to DFU, MSCs, and connected topics in the databases of Medline, Scopus, Web of Science, and PubMed. The main focus of the selection criteria was on English-language literature that explored the relationship between DFU, MSCs, and related factors. Numerous studies are being conducted and have demonstrated that MSCs can induce re-epithelialization and angiogenesis, decrease inflammation, contribute to immunological modulation, and subsequently promote DFU healing, making them a promising approach to treating DFU. This review article provides a general snapshot of DFU (including clinical presentation, risk factors and etiopathogenesis, and conventional treatment) and discusses the clinical progress of MSCs in the management of DFU, taking into consideration the side effects and challenges during the application of MSCs and how to overcome these challenges to achieve maximum benefits. The incorporation of MSCs in the management of DFU highlights their potential as a feasible therapeutic strategy. Establishing a comprehensive understanding of the complex relationship between DFU pathophysiology, MSC therapies, and related obstacles is essential for optimizing therapy outcomes and maximizing patient benefits.

The Effectiveness of Wound Dressing with Virana Sanjeevi Thailam (VST) in the Management of Madhumegha Viranam – A Case Report

Diabetic foot ulcer (DFU) is one of the most prevalent consequences for those with uncontrolled diabetes mellitus (DM). The annual incidence of DFU worldwide is between 9.1 to 26.1 million, the mortality and morbidity are the common reasons for hospitalisation of diabetes patients. The available treatment modalities are expensive and unsatisfactory in the clinical management of DFU. In Siddha system of medicine Diabetic ulcers are referred to as Madhumegha Viranam (MV). Various thailam (medicated oil) are used in the management of ulcers. Virana Sanjeevi thailam (VST) is one of the classical Siddha topical formulations indicated for the management of chronic ulcers. As this thailam is not been subjected to clinical evaluation yet, this case study is to report the effectiveness of wound dressing with VST along with adjuvant Siddha medications in 60 years old, post-menopausal, house wife who reported with complaints of ulcer in the plantar aspect of right foot for a period of 6 months, along with a past history of diabetes and systemic hypertension undergoing modern treatment for the past 10 years. The patient was diagnosed to have MV and the ulcer had features of Grade 2 in Maggit Wagner system of classification of diabetic ulcers, wound area was 12cm2, with pale granulation tissues and purulent discharges. Following treatment, ulcer healed completely in a span of 86 days and Leg Ulcer Measurement Tool score improved from 41/68 to 3/68. This may encourage the use of Siddha medicines in management of DFUs.

Diabetic Foot Ulcer Detection: Combining Deep Learning Models for Improved Localization

AbstractDiabetes mellitus (DM) can cause chronic foot issues and severe infections, including Diabetic Foot Ulcers (DFUs) that heal slowly due to insufficient blood flow. A recurrence of these ulcers can lead to 84% of lower limb amputations and even cause death. High-risk diabetes patients require expensive medications, regular check-ups, and proper personal hygiene to prevent DFUs, which affect 15–25% of diabetics. Accurate diagnosis, appropriate care, and prompt response can prevent amputations and fatalities through early and reliable DFU detection from image analysis. We propose a comprehensive deep learning-based system for detecting DFUs from patients’ feet images by reliably localizing ulcer points. Our method utilizes innovative model ensemble techniques—non-maximum suppression (NMS), Soft-NMS, and weighted bounding box fusion (WBF)—to combine predictions from state-of-the-art object detection models. The performances of diverse cutting-edge model architectures used in this study complement each other, leading to more generalized and improved results when combined in an ensemble. Our WBF-based approach combining YOLOv8m and FRCNN-ResNet101 achieves a mean average precision (mAP) score of 86.4% at the IoU threshold of 0.5 on the DFUC2020 dataset, significantly outperforming the former benchmark by 12.4%. We also perform external validation on the IEEE DataPort Diabetic Foot dataset which has demonstrated robust and reliable model performance on the qualitative analysis. In conclusion, our study effectively developed an innovative diabetic foot ulcer (DFU) detection system using an ensemble model of deep neural networks (DNNs). This AI-driven tool serves as an initial screening aid for medical professionals, augmenting the diagnostic process by enhancing sensitivity to potential DFU cases. While recognizing the presence of false positives, our research contributes to improving patient care through the integration of human medical expertise with AI-based solutions in DFU management.

Analysing patient factors and treatment impact on diabetic foot ulcers in South Africa

In the South African public healthcare sector, 28% of diabetic patients present to primary healthcare clinics with diabetic foot ulcers (DFUs), often presenting in advanced stages of ulcer severity. In this study, we aimed to categorise factors predisposing individuals to developing a DFU and to identify the potential shortcomings in existing treatment plans in the South African healthcare system. In addition, the use of preventative measures in the management of DFUs was examined as well as the influence of past treatment practices. A total minimum sample size of 50 DFUs was required for this study. Participants who were selected for this study had their past records reviewed in order to determine the likelihood of previous DFU infections, as well as to determine the occurrence of co-morbidities. The treatment protocol implemented was recorded. Twelve-month patient records were used to identify the infection frequency and past treatment protocols. A total of 48.9% of patients reported that they did not make use of any preventative measures. The most frequent concurrent medical conditions were hypertension, dyslipidaemia, and peripheral neuropathy. Polypharmacy was prevalent, with 55% of the population prescribed five or more medications. Potential medication interactions were examined and a total of 210 interactions were documented. An analysis of past and current treatment practices revealed that 52.1% of the treatment protocols did not comply with local treatment guidelines. This study highlights the urgent need for updated DFU treatment protocols in relation to the overall management of DFUs, taking into account existing international guidelines.

Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Evaluating a promising methylcellulose hydrogel for enhanced diabetic foot ulcer therapy through comprehensive preclinical studies

The present research focuses on formulating and evaluating hydrogels modified with crosslinking agents using methylcellulose to treat diabetic foot ulcers (DFU). Methylcellulose hydrogels are prepared and characterized for their crosslinking capacity through FTIR and degradation studies. The optimized hydrogel is further assessed for viscosity, gel strength, contact angle, in-vitro biodegradation, water-vapor transmission rate, anti-bacterial activity, and in-vivo efficacy. The results demonstrate that the developed hydrogel exhibits promising properties for DFU treatment, including increased wound healing percentage, improved ulcer morphology, reduced levels of proinflammatory cytokines, and enhanced tissue characteristics. These findings suggest that the novel hydrogel composition could serve as a viable alternative to existing dressings for DFU management.

Tibial cortex transverse transport promotes ischemic diabetic foot ulcer healing via enhanced angiogenesis and inflammation modulation in a novel rat model

BackgroundTibial Cortex Transverse Transport (TTT) represents an innovative surgical method for treating lower extremity diabetic foot ulcers (DFUs), yet its underlying mechanisms remain elusive. Establishing an animal model that closely mirrors clinical scenarios is both critical and novel for elucidating the mechanisms of TTT.MethodsWe established a diabetic rat model with induced hindlimb ischemia to mimic the clinical manifestation of DFUs. TTT was applied using an external fixator for regulated bone movement. Treatment efficacy was evaluated through wound healing assessments, histological analyses, and immunohistochemical techniques to elucidate biological processes.ResultsThe TTT group demonstrated expedited wound healing, improved skin tissue regeneration, and diminished inflammation relative to controls. Marked neovascularization and upregulation of angiogenic factors were observed, with the HIF-1α/SDF-1/CXCR4 pathway and an increase in EPCs being pivotal in these processes. A transition toward anti-inflammatory M2 macrophages indicated TTT's immunomodulatory capacity.ConclusionOur innovative rat model effectively demonstrates the therapeutic potential of TTT in treating DFUs. We identified TTT's roles in promoting angiogenesis and modulating the immune system. This paves the way for further in-depth research and potential clinical applications to improve DFU management strategies.

Prediction model for lower limb amputation in hospitalized diabetic foot patients using classification and regression trees

BackgroundThe decision to perform amputation of a limb in a patient with diabetic foot ulcer (DFU) is not an easy task. Prediction models aim to help the surgeon in decision making scenarios. Currently there are no prediction model to determine lower limb amputation during the first 30 days of hospitalization for patients with DFU. MethodsClassification And Regression Tree analysis was applied on data from a retrospective cohort of patients hospitalized for the management of diabetic foot ulcer, using an existing database from two Orthopaedics and Traumatology departments. The secondary analysis identified independent variables that can predict lower limb amputation (mayor or minor) during the first 30 days of hospitalization. ResultsOf the 573 patients in the database, 290 feet underwent a lower limb amputation during the first 30 days of hospitalization. Six different models were developed using a loss matrix to evaluate the error of not detecting false negatives. The selected tree produced 13 terminal nodes and after the pruning process, only one division remained in the optimal tree (Sensitivity: 69%, Specificity: 75%, Area Under the Curve: 0.76, Complexity Parameter: 0.01, Error: 0.85). Among the studied variables, the Wagner classification with a cut-off grade of 3 exceeded others in its predicting capacity. ConclusionsWagner classification was the variable with the best capacity for predicting amputation within 30 days. Infectious state and vascular occlusion described indirectly by this classification reflects the importance of taking quick decisions in those patients with a higher compromise of these two conditions. Finally, an external validation of the model is still required. Level of evidenceIII

Dermal Regeneration Template in the Management and Reconstruction of Burn Injuries and Complex Wounds: A Review.

Dermal scaffolds have created a paradigm shift for burn and wound management by providing improved healing and less scarring, while improving cosmesis and functionality. Dermal regeneration template (DRT) is a bilayer membrane for dermal regeneration developed by Yannas and Burke in the 1980s. The aim of this review is to summarize clinical evidence for dermal scaffolds focusing on DRT for the management and reconstruction of burn injuries and complex wounds. A comprehensive search of PubMed was performed from the start of indexing through November 2022. Articles reporting on DRT use in patients with burns, limb salvage, and wound reconstruction were included with focus on high-level clinical evidence. DRT has become an established alternative option for the treatment of full-thickness and deep partial-thickness burns, with improved outcomes in areas where cosmesis and functionality are important. In the management of diabetic foot ulcers, use of DRT is associated with high rates of complete wound healing with a low risk of adverse outcomes. DRT has been successfully used in traumatic and surgical wounds, showing particular benefit in deep wounds and in the reconstruction of numerous anatomical sites. Considerable clinical experience has accrued with the use of DRT beyond its original application for thermal injury. A growing body of evidence from clinical studies reports the successful use of DRT to improve clinical outcomes and quality of life across clinical indications at a number of anatomical sites.

Cost effectiveness analysis for commonly used human cell and tissue products in the management of diabetic foot ulcers

AbstractBackground and AimsThis study considers the cost‐effectiveness of commonly used cellular, acellular, and matrix‑like products (CAMPs) of human origin also known as human cell and tissue products (HCT/Ps) in the management of diabetic foot ulcers.MethodsWe developed a 1‐year economic model assessing six CAMPs [cryopreserved placental membrane with viable cells (vCPM), bioengineered bilayered living cellular construct (BLCC), human fibroblast dermal substitute (hFDS), dehydrated human amnion chorion membrane (dHACM), hypothermically stored amniotic membrane (HSAM) and human amnion membrane allograft (HAMA) which had randomized controlled trial evidence compared with standard of care (SoC). CAMPs were compared indirectly and ranked in order of cost‐effectiveness using SoC as the baseline, from a CMS/Medicare's perspective.ResultsThe mean cost, healed wounds (hw) and QALYs per patient for vCPM is $10,907 (0.914 hw, 0.783 QALYs), for HAMA $11,470 (0.903 hw, 0.780 QALYs), for dHACM $15,862 (0.828 hw, 0.764 QALYs), for BLCC $18,430 (0.816 hw, 0.763 QALYs), for hFDS $19,498 (0.775 hw, 0.757 QALYs), for SoC $19,862 (0.601 hw, 0.732 QALYs) and $24, 214 (0.829, 0.763 QALYs) for HSAM respectively. Over 1 year, vCPM results in cheaper costs overall and better clinical outcomes compared to other CAMPs. Following probabilistic sensitivity analysis, vCPM has a 60%, HAMA 40% probability of being cost‐effective then dHACM, hFDS, BLCC, and lastly HSAM using a $100,000/healed wound or QALY threshold.ConclusionsAll CAMPs were shown to be cost‐effective when compared to SoC in managing DFUs. However, vCPM appears to be the most cost‐effective CAMP over the modelled 52 weeks followed by HAMA, dHACM, hFDS, BLCC, and HSAM. We urge caution in interpreting the results because we currently lack head‐to‐head evidence comparing all these CAMPs and therefore suggest that this analysis be updated when more direct evidence of CAMPs becomes available.

Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents.

One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common. The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly. The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system. Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments. The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.

A REVIEW OF MAGGOT DEBRIDEMENT THERAPY IN DIABETIC FOOT ULCER

the protocol for treating diabetic foot ulcers which occur in at least 15% of patients with diabetes and precede 84% of leg amputations. Debridement may be surgical or non-surgical. Surgical debridement is carried out using sharp instruments. It has some complications like perioperative bleeding and general complications of anaesthesia. It demands skilled surgeon. Non-surgical debridement includes autolytic, enzymatic, mechanical and biological debridement. All the methods have their own advantages and disadvantages. Biological debridement is a technique based on the use of maggots to remove necrotic tissues from chronic wound. Maggots or larvae of flies are applied on the infected wound. Maggots excrete the enzyme which degrade and liquefy necrotic tissue and later on ingest this from the wound. It is relatively painless procedure as compared to the surgical debridement. This technique has been granted FDA approval in US since 2004. All classical and contemporary literature especially PubMed database regarding maggot debridement therapy and diabetic foot ulcer is scrutinised for the review. It was found that Maggot debridement therapy (MDT) is the better technique as compared to other non-surgical debridement methods for management of diabetic foot ulcer. Sushruta the father of surgery was the first to introduce the maggot therapy in context to kaphaja arbuda (a type of tumour). It is the need of time to conserve this basic principle as a non-surgical method for debridement.

Primary Care Physicians' Knowledge, Attitude, and Practice towards Diabetic Foot Ulcer at Primary Healthcare Corporation, Qatar: A Cross-Sectional Survey

Primary Care Physicians' Knowledge, Attitude, and Practice towards Diabetic Foot Ulcer at Primary Healthcare Corporation, Qatar: A Cross-Sectional Survey

Use of Serum Protein Measurements as Biomarkers that Can Predict the Outcome of Diabetic Foot Ulceration.

Objectives: To identify proteins that are prognostic for diabetic foot ulcer (DFU) healing and may serve as biomarkers for its management, serum samples were analyzed from diabetic mellitus (DM) patients. Approach: The serum specimens that were evaluated in this study were obtained from DM patients with DFU who participated in a prospective study and were seen biweekly until they healed their ulcer or the exit visit at 12 weeks. The group was divided into Healers (who healed their DFU during the study) and Non-Healers. Results: Interleukin (IL)-10, IL-4, IL-5, IL-6, and IL-13 and interferon-gamma were higher in the Healers while Fractalkine, IL-8, and TNFα were higher in the Non-Healers. The trajectory of IL-10 levels remained stable over time within and across groups, resulting in a strong prognostic ability for the prospective DFU healing course. Classification and Regression Tree analysis created an 11-node decision tree with healing status as the categorical response. Innovation: Consecutive measurements of proteins associated with wound healing can identify biomarkers that can predict DFU healing over a 12-week period. IL-10 was the strongest candidate for prediction. Conclusion: Measurement of serum proteins can serve as a successful strategy in guiding clinical management of DFU. The data also indicate likely superior performance of building a multiprotein biomarker score instead of relying on single biomarkers.

Comparative study of tissue culture and sensitivity versus swab culture and sensitivity of microorganisms in the healing of diabetic foot ulcers

This prospective observational study, conducted at the Department of General Surgery, SRM Medical College and Hospital, aimed to assess the effectiveness of tissue culture and sensitivity compared to swab culture and sensitivity in the healing of diabetic foot ulcers through antibiotic sensitivity of microorganisms. Between May 2016 and August 2017, 160 subjects with diabetic foot ulcers were randomly assigned treatment based on either swab or tissue culture findings. Patients were followed at 15-day intervals for up to 60 days. Results showed positive swab cultures in 76.88% and positive tissue cultures in 92.50% of the study population. The most prevalent organism in swab cultures was Proteus (14.38%), while Pseudomonas (16.88%) dominated in tissue cultures. The cumulative proportion of subjects developing granulation tissue was faster in the tissue culture group, reaching 57.50% at 15 to 30 days and 99% at 31 to 45 days. The swab culture group exhibited proportions of 48.80%, 75%, and 93.80% at the same intervals. In conclusion, diabetic foot ulcer treatment based on tissue culture showed slightly faster healing rates compared to swab culture. However, both groups achieved good ulcer healing within the 60-day follow-up period. These findings emphasize the importance of choosing an appropriate culture method for effective management of diabetic foot ulcers.