Diabetic foot: epidemiological data and current topical treatment options
Authors:
E. Martinka
Authors‘ workplace:
MMM Consulting, Bratislava
; Národný endokrinologický a diabetologický ústav, diabetologické oddelenie, primár doc. MUDr. Emil Martinka, PhD., Ľubochňa
Published in:
Forum Diab 2013; 2(2): 74-83
Category:
Overview
Risk of diabetic foot amputation is 15–40 times higher than in the general population and is linked to diabetic foot syndrome (SDN), a condition defined as infection, ulceration and / or tissue destruction as a result of foot neuropathy and / or ischemia. SDN in the course of the disease may develop in up to 15% of patients with diabetes mellitus. SDN prevalence in developed form (presence of defects / ulceration), according to several authors in the range of 3–10% of all diabetics, the annual incidence is 2–11%. Advanced stages as defects complicated by osteomyelitis or gangrene, develop in about 2.2 to 4% of patients. Amputation power leg is still evaded about 0.25 to 1.8% of patients per year. According to data from NCZI in 2011, when the total number of reported patients with diabetes mellitus was 336,552, foot lesions were observed in 2.3% of patients, what represents just a slight decline in comparison to the previous years. According to the various sources, the risk of amputation could be reduced by up to 40–85%. It requires active search for patients at risk, early detection of defects, good organization of care, establishing podiatric centers, functioning interdisciplinary care (cooperation between diabetologist, surgeon, podiatrist, neurologist, orthoprotetist or dermatologist), well-led treatment and education and cooperation of patients . In addition to traditional pillars of treatment, such as optimization of metabolic control, treatment of blood circulation, treatment of neuropathy, infection or relieving a local treatment with lots of modern dressings materials, has recently appeared several newer methods that are currently now in Slovakia.
Maggot therapy. In the treatment of diabetic wounds larvae successfully used on infected wounds, especially in multi-drug resistant pathogens cultured (for example, Pseudomonas aeruginosa, MRSA, etc). They are used to aseptically reared larvae of Lucilia sericata. They are applied directly to the dregs of the defect. Feed on dead and infected tissue and act as “biological knife” and defect perfectly mechanically cleaned, and do not attack healthy tissue. Debridement is essential for the subsequent start of the process of healing and even accentuate their biologically active substances contained in the saliva of the larvae.
Treatment with controlled vacuum (Vacuum assisted Closure Therapy – VAC). It is used as an effective method for promoting granulation and speed up the natural healing process in larger defects including. When applying negative pressure to the puncture increases capillary blood flow, reduces the interstitial edema and also bacterial colonization defect suction inflammatory debris that contributes to the promotion of granulation base of the defect and fundamental accelerating all phases of healing.
Treatment with live cell lines – Apligraf. It is a method intended primarily for the treatment of chronic, non-healing wounds are long using live cells from human skin (fibroblasts and keratinocytes) technologically processed into double-layer formulation, which in structure resembles the skin. This is not a skin graft. Essence of the method lies in the fact that the cells produce a product delivered to the wound a number of biologically active factors what exactly are growth factors and cytokines that promote the healing process of the wound itself.
Other newer methods include treatment with blood concentrate rich in platelets, special dressings and other materials.
Key words:
diabetic foot – maggot therapy – treatment with controlled vacuum – treatment with live cell lines
Sources
1. Alvarez OM et al. A novel treatment for venous leg ulcers. Wounds 1998; 10(1): 97–104.
2. Argenta LC, Mokykwas MJ. Vacuum assisted closure – new method for wound control and treatment: clinical experience. Ann Plast Surg 1997, 38(6): 563–576.
3. Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg 1998; 51(1): 79.
4. Blume PA, Walters J, Payne W et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers. Diabetes Care 2008; 31(4): 631–636.
5. Burt RK, Testoti A, Oyama Z et al. Autologous peripheral blood CD133+ cell implantation for limb salvage in patients with critical limb ischemia. Bone Marrow Transplantation 2010; 45(1): 111–116.
6. DeCarbo WT. Special Segment: Soft tissue matrices – Apligraf bilayered skin substitute to augment healing of chronic wounds in diabetic patients. Foot and Ankle specialist 2009; 2(6): 299–302.
7. Edmonds M. Apligraf in the treatment of neuropathic diabetic foot ulcers. Int J Low Extrem Wounds 2009; 8(1): 11–18.
8. Eneroth M, van Houtum WH. The values of debridement and vacuum-assisted closure (VAC). Therapy in diabetic foot ulcers. Diabetes Med Res Rev 2008; 24(Suppl 1): S76–80.
9. Etoz A, Kahveci R. Negative Pressure wound therapy on diabetic foot ulcers. Wounds 2007; 19(9): 250–254.
10. Falanga V, Margolis D, Alvarez O (eds) et al (Human Skin Equivalent Investigators Group). Rapid healing of venous ulcers and lack of clinical rejection with an allogenic cultured human skin equivalent. Arch Dermatol 1998, 134(3): 293–300.
11. FleischmannW, Russ M et al. Maggots? Are they really the better surgeons? Chirurg 1999; 70(11): 1340–1346.
12. Gordon PR, Leimig T, Babarin-Dorner A et al. Large – scale isolation of CD 133+ progenitor cells from G-CSF mobilized peripheral blood stem cells. Bone Marow Transplant 2003; 31(1): 17–22.
13. Greene AK, Puder M, Roy R et al. Micro deformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 2006; 56(4): 418–422.
14. Hirsch AT. Critical limb ischemia and stem cell: research anchoring hope with informed adverse event reporting. Circulation 2006; 114(24): 2581–2583.
15. Huang P, Li S, Han M et al. Autologous transplantation of granulocyte colony – stimulating factor-mobilized peripheral blood mononuclear cells improves critical limb ischemia in Diabetes. Diabetes Care 2005; 28(9): 2155–2160.
16. Krahulec B. Diabetická polyneuropatia. In: Mokáň M, Martinka E, Galajda P (eds). Diabetes mellitus a vybrané metabolické ochorenia. Vydavateľstvo P+M: Martin 2008.
17. Kumar N, Verma A, Mishra A et al. Platelet Derived Growth Factor in Healing of Large Diabetic Foot Ulcers in Indian Clinical Set-up: A Protocol-based Approach. WebmedCentral WOUND HEALING 2013;4(2):WMC003985. Dostupné z WWW: <http://www.webmedcentral.com/article_view/3985>.
18. Martinka E. Novšie metódy v konzervatívnej limbe diabetickej nohy. Súč Klin Prax 2010; 7(1): 11–19.
19. Martinka E. Syndróm diabetickej nohy. In: Mokáň M, Martinka E, Galajda P (eds). Diabetes mellitus a vybrané metabolické ochorenia. Vydavateľstvo P+M: Martin 2008.
20. Martinka E. Manažment a liečba chronických komplikácií diabetes mellitus. Metodický list racionálnej farmakoterapie 2007; 11(41): 1–8.
21. Mištuna D. Cievne choroby dolných končatín u diabetikov. In: Mokáň M, Martinka E, Galajda P (eds). Diabetes mellitus a vybrané metabolické ochorenia. Vydavateľstvo P+M: Martin 2008.
22. Mullner T, Mrkonjic L, Kwasny O et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg 1997; 50(3): 194–199.
23. Mumcuoglu KZ, Ingber A, Gilead L et al. Maggot therapy for the treatment of diabetic foot ulcers. Diabetes Care 1998; 21(11): 2030–2031.
24. NCZI. Činnosť diabetologických ambulancií v SR 2011. Dostupné z WWW: <http://www.nczisk.sk>.
25. Organogenesis Inc. Apligraf (graftskin) label. Dostupné z WWW: <http://www.apligraf.com/professional/>.
26. Pavillard ER, Wright EA. An antibiotics from Maggots. Nature 1957; 180(4592): 916–917.
27. Rayman A, Stansfield G Woollard T et al. Use of larve in the treatment of the diabetic necrotic foot. The Diabetic Foot 1998; 1: 7–13.
28. Saxena V, Hwang CW, Huang S et al. Vacuum assisted closure : micro deformations of wound and cell proliferation. Plast Reconst Surg 2004; 114(5): 1086–1096.
29. Sherman RA. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care 2003; 26(2): 446–451.
30. Sherman RA, Wyle FA, Vulpe M. Maggot debridement therapy for treatment of pressure ulcersin spinal cord injury patients. J Spinal Cord Med 1995; 18(2): 71–74.
31. Veves A, Falanga V et al. The Apligraf diabetic foot ulcers study. Graftskin, a human skin equivalent is effective in management of no infected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care 2001; 24(2): 290–295.
32. Vistnes LM, Lee R, Ksander GA. Proteolytic activity of blowfly larvae secretions in experimental burns. Surgery 1981; 90(5): 835–841.
33. Yang X, Wu Y, Wang H et al. Transplantation of mobilized peripheral blood mononuclear cells for peripheral arterial occlusive disease of the lower extremity. J Geriatr Cardiol 2006; 3(3): 181–183.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
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