Ulcer Complications Research Articles

Interventions for stoma care for children with a tracheostomy to prevent and reduce wound complications: A systematic review

Introduction: In the pediatric population pressure-and friction related wounds secondary to the tracheostomy related tubes and ties are frequently encountered and require special attention. Tragic complications of tracheostomy related pressure ulcers resulted in additional infections, poor quality of life and prolonged hospitalization of children. Taking an evidence –based approach to this current problem, a concrete question was formed for PICO, “Interventions for stoma care for children with tracheostomy to prevent& reduce wound complications”. Objective: The objective of this systematic review is mainly to synthesize reports of articles on interventions of stoma care for children with tracheostomy to prevent and reduce wound complications. Methods: Based on eligibility criteria, the search was limited to research articles published between 2000-2018 in English language. Data base searched were CINAHL (identified 3 articles); PUBMED (3 articles) COCHRANE (No articles relevant to tracheostomy care for children).Additional records identified 32 articles and 144 further articles were identified that met the inclusion criteria through citation tracking and reference list checking of included articles. Of these 128 articles included after duplicates removal. Of these records screened 48 articles and 29 excluded because they didn’t meet the selection criteria from full text. The full text of 19 articles was reviewed. Results: A total of 10 studies were identified for inclusion in the review. The descriptive synthesis of the data was done after quality appraisal and risk of bias and ten studies included for qualitative synthesis. The studies reviewed were heterogeneous in nature. Conclusions: All papers included in the study were low- moderate quality. High quality evidence from Randomized controlled trials and well -designed systematic reviews were lacking. Evidence based protocols were recommended for stoma care and policies need to be formulated for individualized patient care.

EFFECT OF SCLEROTHERAPY ON VARICOSE ULCERS AND OTHER SKIN COMPLICATIONS OF VARICOSE VEINS-A PROSPECTIVE COHORT STUDY.

BACKGROUND: Varicose veins are dilated, tortuous,elongated supercial veins that are usually seen in the legs. Prevalence of Chronic Venous Disease, as reported in studies, ranges from 2%-56% in men and from 1%-60% in women. Various treatment modalities include surgery, sclerotherapy and endo-venous occlusion by lasers or radiofrequency. Varicose veins and its dermatological complications like stasis dermatitis, ulcers, spontaneous bleeding, lipodermatosclerosis are commonly seen. However, there are no specic studies in India which is done to evaluate the role of sclerotherapy in the management of varicose veins and its skin complications. To study the difference in proportion ofOBJECTIVE: improvement in venous ulcer of other dermatological complications associated with varicose vein during 6 months following sclerotherapy when compared to those who underwent surgical treatment. The study was a prospective cohort study conducted in GeneralMETHODOLOGY: Surgery Dept.,Dr.SMCSI Medical College, Karakonam. Patients older than 18 years who have undergone sclerotherapy treatment and surgery for varicose veins with ulceration and with or without skin manifestations from March 2016 to March 2017 were considered eligible to enter the study. Sample size decided was 33 in patients undergoing sclerotherapy and 33 who underwent surgery. The difference in oedema andRESULTS: pigmentation between two groups was statistically not signicant. The difference in pain relief during the initial 4 months were found to be statistically signicant while after 4 months the difference in pain relief were same in both groups. The Trendelenberg surgeryCONCLUSION: plus perforator ligation and foam sclerotherapy showed equivalent efcacy for treating patients with varicose ulcer and other complications of varicose veins.

DISSEMINATED TB IN AN IMMUNOCOMPETENT PATIENT

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Disseminated tuberculosis (TB) is a rare presentation, more common in patients with HIV, chronic liver disease or alcohol abuse and associated with high rates of treatment failure. CASE PRESENTATION: A 28 years-old male, with history of asthma, started complains of cough, sputum production and asthenia . Despite inhaled steroids, he continued to deteriorate. Skin ulcerations on the right wrist, elbow and leg appeared 4 months later. Fourteen months after the first symptoms, there was purulent drainage in the ulcers and a right knee edema which prevented the patient from walking. The patient presented to the hospital with extreme weight loss (20Kg). HIV screening was negative. CT scan with peri broncho-vascular opacities, tree-in-bud, cavitary lesions and pneumomediastinum. PCR for Mycobacterium tuberculosis was positive on sputum and knee pus. The patient started antibiotics (Clindamycin) and anti-TB drugs. A drain was placed on the right knee. Bone MRI revealed osteomyelitis in the knee, femur and cervical-dorsal spine, with need for surgical cleaning. DISCUSSION: A long evolution of symptoms was probably responsible for the exuberant presentation in this case of disseminated TB. The antibiotics and surgical strategies to treat the skin lesions were very challenging due to different microbiologic isolates and recurrence after drainage. The extension of lesions to the bone led to leg and arm movement impairment. Due to this, a multidisciplinary evaluation and decision to perform surgery were essential to prevent permanent disability. CONCLUSIONS: This case highlights the challenges in the management of thoracic complications of cavitary lesions, cutaneous ulceration and osteomyelitis due to TB. DISCLOSURE: Nothing to declare. KEYWORD: disseminated tuberculosis

Update on Treatment of Infantile Hemangiomas: What's New in the Last Five Years?

Among benign vascular tumors of infancy, hemangiomas are the commonest, affecting approximately 5–10% of one-year-old children. They are derived from a benign proliferation of vascular endothelial cells (VECs) in the mesoderm and may arise anywhere on the body around 1–2 weeks after birth. Infantile hemangiomas (IHs) are characterized by an early proliferative phase in the first year followed by a spontaneous progressive regression within the following 5 years or longer. IH prevalence is estimated to be 5%–10% in one-year-old children and commonly affects female, Caucasian and low-birth weight infants. Although most of them spontaneously regress, approximately 10% requires treatment to prevent complications due to the site of occurrence such as bleeding, ulceration, cosmetically disfigurement, functional impairment, or life-threatening complications. For over 30 years, steroids have represented the first-line treatment for IHs, but recently topical or systemic β-blockers are increasingly being used and recognized as effective and safe. A search for “Cutaneous infantile hemangioma” [All Fields] AND “Treatment” [All Fields] was performed by using PubMed and EMBASE databases. Treatment of IHs with labeled drugs, such as oral propranolol, but also with off-label drugs, such as topical β-blockers, including topical timolol and carteolol, steroids, itraconazole or sirolimus, with a focus on formulations types and adverse events were described in our review. We also discussed the benefits of pulsed dye laser and the treatment of IHs with involvement of central nervous system, namely the PHACE and LUMBAR syndrome.

Wearable medical apparatus to monitor temperature and pulsatile-blood-flow signal on forefoot to predict diabetic foot ulcers

PurposeThe purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.Design/methodology/approachThe prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.FindingsThe height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.Originality/valueThe proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.

MO767: Severe Bleeding and Infectious Complications Associated with Dialysis Access—an 11 Year Experience in Treating and Salvaging Problematic Accesses

Abstract BACKGROUND AND AIMS Penetrating ulcers and cellulitis of autogenous fistulae have become significant and common complications of haemodialysis access. Their presentation can be associated with exsanguinating haemorrhage or a severe septic picture—both endangering the access and the very life of the patient. Over a 12-year period, we have seen and treated over 70 patients requiring treatment of these types of difficult complications. METHOD There were 762 autogenous fistulae and 26 prosthetic grafts performed in the 11-year period for dialysis access. In this collection of patients, there were 76 patients who presented with severe complications of infection, bleeding ulcers, exsanguinating haemorrhage, exposed graft, or massive aneurysms. In order to apply some order to these diverse complications—they were divided into five groups. There were 12 patients and 16 procedures treated with interventional techniques of covered stent placement. There were 30 patients with 34 procedures who presented with bleeding, massive, or intermittent and were treated operatively urgently or emergently depending on their stability. A total of 23 patients were presented with ulcers on their autogenous fistula or aneurysmal dilatation of the autogenous fistula. There were 11 patients who presented with obvious and significant infection in autogenous or prosthetic grafts. There were 10 patients who presented with a prosthetic graft with persistent bleeding, an ulcer with penetration to the graft, or an exposed graft. RESULTS No patient was exsanguinated from these complications at the time of operative intervention. In reviewing the 12 patients treated with stents and interventional radiology, the range of time from the repair until death or occlusion of the graft ranged from 1–89 months and an average of 15 months. In the 30 patients who presented with bleeding—the individual patients who could be primarily repaired (20) had the best results. This entailed wide excision of the ulcer/bleeding site, repair of the vein, and a two-layer closure over the repaired vein. These patients were able to resume dialysis in 24-h through their repaired fistula. In reviewing the patients who presented with large ulcers on the fistula or aneurysm with no history of bleeding—these numbered 23 patients requiring 29 procedures. There were 13 patients who had a primary repair and excision of the ulcer and these had the best results. There were two patients with large aneurysmal Cimino fistulae who had a conversion to a mid-forearm fistula, excluding the massive aneurysm. A total of 11 patients presented with severe infection and cellulitis involving the dialysis access unresponsive to antibiotics. There were 4 patients with postoperative infections from autogenous fistula construction, and these were all treated with debridement and secondary closure. There were 10 patients with a prosthetic graft who presented with an ulcer, exposed graft, or a severe infection involving the dialysis graft. These were treated with secondary closure and irrigation. As to be expected the majority (60%) were functional for only 1–2 months. CONCLUSION The results of our study continue to affirm the use of autogenous fistula in the construction of dialysis access for those patients requiring long-term haemodialysis. In each of the five groups the best results, unequivocally, were found in those patients with an autogenous fistula repaired with autogenous tissue. The fact that these autogenous fistulae were in place for several years before requiring repair allowed their walls to become thickened and have a larger diameter. It is these two characteristics, which allowed the excision of the ulcerated/bleeding area to be excised and repaired. The size of the functioning fistula allowed the closure of the defect with no compromise of the lumen and the thickened vein walls allowed a good haemostatic closure. This study emphasizes the need for autogenous tissue for both construction and repair of haemodialysis access—whether it is for ulcers on the fistula, ulcers actively haemorrhaging, or infected fistula.

Comparative Evaluation of the Results of Surgical Treatment of Complicated Giant Pyloroduodenal Ulcers

Comparative Evaluation of the Results of Surgical Treatment of Complicated Giant Pyloroduodenal Ulcers

Video- and Robotic-Assisted Thoracoscopic Truncal Vagotomy.

A subset of patients with marginal ulcers after Roux-en-Y gastric bypass (RNYGB) is refractory to medical management. Here we report a retrospective review of a single institution cohort (N = 10) of video- or robotic-assisted thoracoscopic (VATS or RATS) truncal vagotomies performed between 2013 and 2018. All patients had recurrent marginal ulcers following RNYGB complicated by bleeding or perforation, refractory to medical management for a median of 3.5months prior to undergoing truncal vagotomy. With a median of 23months' follow-up, only three patients had continued symptoms (70% symptom resolution) post-operatively. Only one patient who had repeat endoscopy after the procedure had documented endoscopic evidence of recurrent marginal ulcer (83% endoscopic resolution). VATS or RATS truncal vagotomy is a safe and effective method to treat complicated marginal ulceration after RNYGB. After an average duration of unsuccessful medical treatment lasting three months, vagotomy led to successful resolution in 70-83% of patients.

Morphological features of complicated gastroduodenal ulcers

The objective of the study was to evaluate structural changes in the margin of gastroduodenal ulcers complicated by perforation, bleeding or penetration in terms of the features of ulcer healing.Methods and materials. Histological and IHC studies were performed on 25 patients of the main group with perforated gastroduodenal ulcers and 23 patients of the control group with chronic recurrent ulcers complicated by bleeding and penetration. Histological sections were stained with hematoxylin and eosin, and Van Gieson's picrofuchsin. Immunohistochemical reactions were performed with antibodies to Ki-67, CD68, CD138, and CD34.Results. On macroscopic evaluation, a clear even margin of the perforation was noted. Histological examination with the background of acute dyscirculatory changes clearly shows a zone of necrosis and a weakly expressed layer of granulation tissue, which in majority of the cases was practically absent. The margin of a perforated ulcer consists of a minimally presented, clearly delimited zone of tissue detritus and a practically unchanged muscle layer. Plasma cells dominated in the cell infiltrate, and the index of proliferative activity in the epithelium of the ulcer margins was about 45 %, distributed fairly evenly.Conclusions. Perforated ulcers can be considered as a special group of ulcers with the most pronounced changes of infiltration by plasmatic cells and eosinophils, edema and acute dyscirculatory changes, uniform and fairly high proliferative activity of the epithelium. Changes in the margins of the perforated ulcer allow for complete regeneration without excessive scarring with precise suturing of the perforation.

Identifying Risk Factors for Complicated Duodenal Ulcer in Children

In recent years, there has been an increase in the incidence of duodenal ulcer and an increase in the number of complicated forms. Bleeding from duodenal ulcers is the most formidable complication and occupies one of the first places in the structure of mortality from duodenal ulcer. The anamnestic, clinical features and pH values ​​in children with duodenal ulcer were studied. The study allows us to consider sex, age, heredity, erosive nature of gastroduodenitis, multiple ulcers, high bacterial contamination, low pH in the antroduodenal zone as factors for the complicated course of duodenal ulcer.

Identifying Risk Factors for Complicated Duodenal Ulcer in Children

Identifying Risk Factors for Complicated Duodenal Ulcer in Children

DETERMINATION OF SALICYLIC ACID RESIDUE IN ACETYLSALICYLIC ACID TABLETS

The pharmacological indications for acetyl salicylic acid have been on the increase over the years. It was initially indicated for the management of inflammation but its use as a cardioprotective agent is now more prominent. However, one of the major drawbacks of this drug is gastric irritation and bleeding which could lead to ulcer, anemia and several medical complications. These drawbacks are attributable to salicylic acid residue in acetyl salicylic acid. The determination of salicylic acid residue in acetylsalicylic acid (ASA) tablets was carried out using a spectrophotometric method.
 Twenty one formulations of acetylsalicylic acid (ASA) tablets were assayed. From the results, 71.43% of the formulations failed to meet up the British pharmacopoeia standard of 0.75% limit of free salicylic acid in acetylsalicylic acid tablets. This work highlights the need for regulatory agencies to routinely determine the level of free salicylic acid in acetylsalicylic acid formulations to ensure that they conform to pharmacopoeia standard

Assessment the Role of Phagocytic Neutrophil Cells among Different Wagner’s Grades of Diabetic Foot Ulcers Infection

Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems. This study aimed to assessment the role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection in diabetic patients. A case-control analytical study was conducted on 60 DM, DFU patients and healthy control group. Blood samples were collected for phagocytic activity testing and swabs samples of DFU were collected and processed for culture and antibiotics susceptibility testing after the ulcers classified according to Wagner’s grades system. Findings revealed that Gram-positive bacteria were the most prevalent in the DFU 57.1% with statistically significant relationship between the bacterial species and grades of Wagner’s classification. Wagner’s ulcers grade I and II were the most prevalence in DFU patients 30% for both. There was a weak negative correlation between phagocytic activity and grade ulcers classified. Amikacin and ciprofloxacin were the most effective antibiotics against bacterial isolates, whereas ampicillin, cefepime and cefadroxil were the most common resistance antibiotics of bacterial isolates. In conclusion, this is the first study carried out in Hadhramout, Yemen to assessment the phagocytic neutrophil cells and its role to fight the bacterial infection of diabetic foot ulcers. When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalence of Gram-negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

Topical Administration of Lactiplantibacillus plantarum Accelerates the Healing of Chronic Diabetic Foot Ulcers through Modifications of Infection, Angiogenesis, Macrophage Phenotype and Neutrophil Response.

This work aimed to evaluate the adjuvant treatment to surgical debridement using topical applications of Lactiplantibacillus plantarum ATCC 10241 cultures in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical wound debridement. A randomised controlled trial was performed involving 22 outpatients with complicated diabetic foot ulcers that either received surgical debridement (SuDe, n = 12) or surgical debridement plus topical applications of L. plantarum cultures (SuDe + Lp, n = 10) every week during a 12 week treatment period. Compared to patients receiving SuDe, patients treated with SuDe + Lp exhibited significantly increased fibroplasia and angiogenesis, as determined by Masson’s trichrome staining and the study of CD34 cells, α-smooth muscle actin to semi-quantify vascular area, number of vessels and endothelial cells. In addition, a promotion of the polarisation of macrophages from M1 (CD68) to M2 (CD163) phenotype was observed in SuDe + Lp patients with remarkable differences in the tissue localisation. Bacterial counts were significantly diminished in the SuDe + Lp group compared to the SuDe group. Ex vivo assays, using polymorphonuclears isolated from peripheral blood of patients with diabetes and healthy individuals and challenged with Staphylococcus aureus demonstrated that the addition of L. plantarum supernatants significantly improved the phagocytosis of these cells. L. plantarum-secreted components increased the neutrophils bactericidal activity and regulated the netosis induced by S. aureus. At day 49, the average wound area reduction with SuDe + Lp was 73.5% compared with 45.8% for SuDe (p < 0.05). More patients progressed to closure with SuDe + Lp compared with SuDe treatment, indicating the ability of L. plantarum to accelerate the healing. At day 60, 60% of patients treated with SuDe + Lp achieved 100% of wound area reduction compared with 40% for SuDe. We propose that SuDe + Lp could be an effective adjuvant to surgical debridement when SuDe is not satisfactory for patients with complicated diabetic foot ulcers. The treatment is cheap and easy to apply and the product is easy to obtain.

Stress Ulcer Prophylaxis for Critical Asthma.

Children hospitalized for critical asthma (CA) in the pediatric ICU (PICU) are commonly prescribed stress ulcer prophylaxis (SUP) to mitigate risk of gastrointestinal (GI) bleeding. We sought to describe trends for SUP prescribing and explore for differences in rates of GI bleeding, gastritis, and SUP-related complications for those with and without SUP exposure. We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System registry among 42 children's hospitals from 2010 to 2019 including children 3 to 17 years of age admitted to the PICU for CA. Primary outcomes were chronologic and regional variation in SUP prescribing assessed by Joinpoint regression and Pearson's correlation. Rates of GI bleeding, gastritis, enteric ulceration, and SUP-related complications (C. difficile colitis, necrotizing enterocolitis, and thrombocytopenia) were compared for those with and without SUP exposure. Of 30 177 children studied, 10 387 (34.4%) received SUP. No episodes of GI bleeding were recorded. One subject developed gastric ulceration and 32 (0.1%) gastritis. Linear trends for SUP were observed with rates increasing from 25.5% in 2010 to 42.1% in 2019 (+1.9% annually). Prescribing varied by institution (range: 5.5% to 97.2%) without correlation to admission volumes. Extremely rare rates of SUP-related complications were noted. Although children hospitalized for CA routinely receive SUP, no episodes of GI bleeding were noted over a 10-year period. SUP solely for corticosteroid exposure may be unwarranted. We advocate for a targeted approach to SUP considering alternative risk factors for GI bleeding.

Evaluation of a Multifunctional Polyvinylpyrrolidone/Hyaluronic Acid-Based Bilayer Film Patch with Anti-Inflammatory Properties as an Enhancer of the Wound Healing Process.

The management of acute and chronic wounds is still a socioeconomic burden for society due to the lack of suitable tools capable of supporting all the healing phases. The exponential spread of diabetes worldwide and the consequent increase of complicated diabetic ulcers require further efforts to develop scalable, low-cost, and easy-to-use treatments for tackling this emergency. Recently, we explored the fabrication of a polyvinylpyrrolidone/hyaluronic acid-based bilayer wound dressing, characterizing its physicochemical features and detailing its excellent antimicrobial activity. Here, we further demonstrate its biocompatibility on fibroblasts, keratinocytes, and red blood cells. The bilayer shows anti-inflammatory properties, statistically reducing the level of IL-6, IL-1β, and TNF-α, and a capacity to accelerate wound healing in vitro and in healthy and diabetic mice models compared to untreated mice. The outcomes suggest that this bilayer material can be an effective tool for managing different skin injuries.

Physiologic Insulin Resensitization as a Treatment Modality for Insulin Resistance Pathophysiology.

Prevalence of type 2 diabetes increased from 2.5% of the US population in 1990 to 10.5% in 2018. This creates a major public health problem, due to increases in long-term complications of diabetes, including neuropathy, retinopathy, nephropathy, skin ulcers, amputations, and atherosclerotic cardiovascular disease. In this review, we evaluated the scientific basis that supports the use of physiologic insulin resensitization. Insulin resistance is the primary cause of type 2 diabetes. Insulin resistance leads to increasing insulin secretion, leading to beta-cell exhaustion or burnout. This triggers a cascade leading to islet cell destruction and the long-term complications of type 2 diabetes. Concurrent with insulin resistance, the regular bursts of insulin from the pancreas become irregular. This has been treated by the precise administration of insulin more physiologically. There is consistent evidence that this treatment modality can reverse the diabetes-associated complications of neuropathy, diabetic ulcers, nephropathy, and retinopathy, and that it lowers HbA1c. In conclusion, physiologic insulin resensitization has a persuasive scientific basis, significant treatment potential, and likely cost benefits.

Профілактика і лікування пролежнів у відділенні інтенсивної терапії (огляд літератури)

У статті з позиції Міжнародної національної нарадо-рекомендаційної ради з пролежнів, Європейської рекомендаційної ради з пролежнів, Всесвітнього альянсу з проблем пролежнів наведено питання термінології, статистики, факторів ризику розвитку, міжнародної класифікації, основних напрямків профілактики, диференціальної діагностики, інспекції шкірних покривів і документування; наведено шкали для прогнозування ризику розвитку пролежнів (PUSH Toll, 2008); викладені вузлові питання інтенсивної терапії залежно від результатів категорії пролежнів; надано правило SPECIAL; рекомендації робочої групи ICSI. Наведено практичні рекомендації Американської колегії фізіотерапевтів. Особливу увагу приділено принципам нутритивної терапії за наявності пролежнів.

Encounter complications during treatment for radiation-ulcer: Five years inexperience.

Complications of radiation-induced ulcers are one of the most challenging situations a reconstructive surgeon can encounter. In that case, finding an optimal solution to cover the defect is not easy. In this paper, we presented our experience in dealing with such drastic ulcers, dividing them into 4 groups.+ Group A: Exposed carotid artery.+ Group B: Exposed axillary artery.+ Group C: Exposed pleura and pericardium. + Group D: Exposed tracheal stenosis.All patients underwent appropriate reconstructive surgery methods and recovered well with acceptable functional and cosmetic outcomes.

Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital.

ObjectivesThe study aims to scale patients with diabetic foot ulcers according to Wagner’s classification, measure the various risk factors, study various outcomes and improve the treatment measures.MethodologyThe article presents materials on a prospective observational study of 50 diabetic foot patients with different presentations who underwent stage-specific intervention.ResultsPoor glycemic control, lifestyle factors, and smoking showed increased risks for foot ulcer complications. Diabetic neuropathy and vasculopathy have been significant outcome predictors. As a result, advanced Wagner’s grades showed increased amputation risks and multimodal management.ConclusionsStratification of diabetic foot patients and appropriate management based on their Wagner’s grade helps reduce amputation rates and mortality. In addition, multimodal management and exceptional attention to diabetes and lifestyle control improve long-term outcomes.