Effectiveness of topical oxygen therapy in wound healing for patients with diabetic foot ulcer

Objectives:Non-healing wounds have been one of the major challenges in health care because of increased morbidity,especially for those who have diabetes mellitus.Numerous regimens are being innovated to produce an evidence-based practice that would minimize complications and promote healing.Topical oxygen therapy is an innovation in wound care that has been considered influential in the wound healing process.This intervention aims to increase the oxygen concentration in the affected limb to promote wound healing.Methods:This research applied an experimental design that targeted a total of 60 adult patients aged 45–64 years with diabetic foot ulcers.A randomized systematic sampling technique was used to allow equal chances and prevent bias.In total,30 patients in the control group received usual care for diabetic foot ulcers,and the remaining 30 patients in the experimental group received topical oxygen therapy together with standard care for diabetic foot ulcers.Subjects were assessed using the Wagner-Meggitt Wound Classification System.Results:The result proved that there was a significant difference in the wound grade of patients in the experimental group after the application of the usual wound care plus the topical oxygen therapy using Friedman's test.The control and experimental groups were compared using Mann–Whitney statistical analyses,and the results showed that there was a significant difference between the control and experimental groups after the application of topical oxygen therapy.Conclusions:Topical oxygen therapy was demonstrated to be effective to aid in the wound healing process of patients with diabetic foot ulcers.Fur ther research was recommended to improve the application of topical oxygen therapy to patients with chronic wounds and promote the wound healing process.

Diabetic foot ulcer:A comprehensive review of pathophysiology and management modalities

Diabetic foot ulcer (DFU) is a debilitating and severe manifestation ofuncontrolled and prolonged diabetes that presents as ulceration, usually locatedon the plantar aspect of the foot. Approximately 15% of individuals with diabeteswill eventually develop DFU, and 14%-24% of them will require amputation ofthe ulcerated foot due to bone infection or other ulcer-related complications. Thepathologic mechanisms underlying DFU are comprise a triad: Neuropathy,vascular insufficiency, and secondary infection due to trauma of the foot.Standard local and invasive care along with novel approaches like stem celltherapy pave the way to reduce morbidity, decrease amputations, and preventmortality from DFU. In this manuscript, we review the current literature withfocus on the pathophysiology, preventive options, and definitive management ofDFU.

Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Diabetic foot(DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients. In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations. Significant improvements have been reached in the treatment of diabetic foot ulcers(DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy. Among these, negative pressure wound therapy(NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery. NPWT has shown remarkable results although its mechanisms of action are not completely understood. In this paper, we offer a complete overview of this medication and its implication in the clinical setting. We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs. Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs.

Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers?

One of the most common and serious complications of diabetes mellitus is ulceration of the foot. Among persons with diabetes, 12%-25% will present to a healthcare institution for a foot disorder during their lifespan. Despite currently available medical and surgical treatments, these are still the most common diabetes-related cause of hospitalization and of lower extremity amputations. Thus, many adjunctive and complementary treatments have been developed in an attempt to improve outcomes. We herein review the available literature on the effectiveness of several treatments, including superficial and deep heaters, electro-therapy procedures, prophylactic methods, exercise and shoe modifications, on diabetic foot wounds. Overall, although physical therapy modalities seem to be useful in the treatment of diabetic foot wounds, further randomized clinical studies are required.

Treatment of diabetic foot ulcer with medicinal leech therapy and honey curcumin dressing: a case report

Background:Diabetic foot ulcers(DFUs)are common in patients with diabetes.The mortality rate of DFUs is ranked the highest after cancer.With advancements in modern medicine,leech therapy,a traditional treatment method for chronic wounds in Iranian medicine,has proven effective in relieving venous congestion.Herein,we aimed to observe the curative effects of leech therapy in combination with honey and curcumin dressing in a 77-year-old patient with a diabetic foot ulcer(UFC).Methods:Two medium-sized medicinal leeches were placed surrounding a grade 2 wound,based on Wagner’s classification system,located on the right first toe.The patient reported a visual analogue scale(VAS)score of 8.After leech therapy,the wound was covered with honey and curcumin,followed by oral administration of ciprofloxacin for 10 days.Results:Pain increased immediately after leech therapy(VAS:9-10)but decreased significantly(VAS:6)2 days after the therapy.At the end of the 2nd day,pain completely disappeared.After 3 weeks,there was no wound on the toe.After 12 weeks,there were no traces of the wound.Conclusion:Leech therapy in combination with honey and curcumin dressing is effective against disease progression in patients with DFUs.

Effect of Carbon Dioxide Therapy on Diabetic Foot Ulcer

Ulceration of diabetic foot represents one of the most concerning complications associated with uncontrolled blood sugar in diabetes mellitus. The aim of this study is to evaluate the condition of twenty-two diabetic patients with different degrees of ulceration in their feet after daily secessions of carbon dioxide therapy. Blood flow to the affected foot was measured by Doppler;also the size, color, degree of ulceration and sensation of the ulcerative area were all evaluated. Results showed improvement of blood flow to the affected foot as well as improvement in the sensation and color of the ulcerative area. It was concluded that carbon dioxide therapy of diabetic foot was promising and needed thorough investigation to be brought widely into application.

Experimental study of red light therapy instrument combined with insulin on type 2 diabetic foot model rats

Objective: To investigate the therapeutic effect and clinical value of red light therapy combined with insulin therapy on wound in type 2 diabetic foot (DF) rats. Methords: Wistar rats were injected intraperitoneally with medium-dose high-fat and high-fat streptozotocin and carefully controlled at room temperature. The type 2 diabetes mellitus Wistar rats were reproved with high glucose and high fat streptozotocin (STZ) Foot involvement in the establishment of type 2 diabetic foot rat model. The rats were randomly divided into three groups: metformin 0.140 g/kg group, red light therapy group combined with insulin treatment group, model group, blank control group (30 d after intragastric administration of rats), further observation of each group of rat wounds Healing rate, insulin, blood glucose and blood lipid and vascular endothelial activity factors such as laboratory changes. Results: The observation of red light therapy combined with insulin treatment group was the most obvious, the difference was statistically significant, significantly promoted wound healing in DF rats, increased healing rate, increased insulin sensitivity (NO) and nitric oxide synthase (NOS) were increased in the serum of rats. The insulin resistance and platelet aggregation rate of the DF model rats were significantly higher than those of the control group, and the insulin sensitivity index (ISI) , Blood glucose, blood lipid, blood viscosity and endothelin (ET) and other active factors were significantly reduced. Conclusion: (1) treatment of red light therapy can improve blood rheology, improve glucose and lipid metabolism, improve insulin sensitivity, Vascular endothelial cell activation and so on to improve the wound healing rate of DF wound in rats. (2) The treatment of red light therapy is effective, safe and high in clinical application.

Osteomyelitis in diabetic foot:A comprehensive overview

Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 10%-15% of moderate and in 50% of severe infectious process. An early and accurate diagnosis is required to ensure a targeted treatment and reduce the risk of major amputation. The aim of this review is to report a complete overview about the management of diabetic foot osteomyelitis. Epidemiology, clinical aspects, diagnosis and treatment are widely described according to scientific reccomendations and our experience.

Nutritional supplementation on wound healing in diabetic foot:What is known and what is new?

Non-healing diabetic foot ulcers(DFU)are the most notable and striking complications of diabetes mellitus.More than 25% of nonhealing DFU can ultimately lead to amputation of the lower extremity within 6-18 mo after the first manifestation of the wound.Although wound healing is complex,nutritional status is crucial in soft tissue repair.Malnutrition is highly prevalent and overlooked in patients with diabetes and chronic wounds.Moreover,to date,we do not have clear recommendations or evidence about the use of nutritional supplements for improving wound healing in patients with DFU.In this article the authors briefly analyzed the current evidence on the use of nutritional supplements of proteins or amino acids,fatty acids,probiotics,vitamins,and trace elements in the wound healing process in patients with DFU.

Hyperbaric oxygen therapy and chemokine administration - a combination with potential therapeutic value for treating diabetic wounds

Non-healing wounds impart serious medical problems to people with diabetes.Amongst 15%of diabetic patients,the incidence of foot ulcer is the most prevailing,which confers a significant risk of limb amputation,mainly due to hypoxia and impairment in cell signaling.Alteration in the expression of chemokines and the related factors in diabetic conditions delays the recruitment of different cell types,including fibroblasts,keratinocytes,and immune cells such as macrophages to the site of injury,further impairing neovasculogenesis,reepithelialization,and extracellular matrix formation.Thus,proper activation of effector cells through an accurate signal pathway is necessary for better therapeutic application.Hyperbaric oxygen therapy(HBOT)is the current treatment prescribed by medical practitioners,shown to have increased the wound healing rate by reducing the need for significant amputation among the diabetic population.However,the risk of morbidity associated with HBOT needs complete attention through rigorous research to avoid adverse outcomes.Altering the level of pro-angiogenic chemokines may regulate the inflammatory response,further promote vascularization,and enhance the complete healing of wounds in diabetic patients.Thus,a combination of better therapeutic approaches could pave the way for developing a successful treatment for diabetic foot and wound healing.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

Twenty-eight Cases of Diabetic Foot Ulcer and Gangrene Treated with the Chinese Herbal Medicine Combined with Injection of Ahylsantinfarctase

Since 1995, the Chinese herbal medicine for supplementing qi and activating blood circulation combined with injection of ahylsantinfarctase into the femoral artery has been used in 28 cases of diabetes complicated with gangrene and ulcer of the foot, with quite good therapeutic effects as reported in the following.……

Research progress in the treatment of diabetic foot with traditional Chinese medicine

Diabetic foot is one of the chronic complications of diabetes,which is serious and expensive to treat.As an effective method for treating diabetic foot,Chinese medicine plays an important role in improving the clinical symptoms and reducing the suffering of diabetic foot patients.The methods of traditional Chinese medicine to treat diabetic foot include internal treatment method,external treatment method and comprehensive therapy.This article reviews the research results of traditional Chinese medicine treatment of diabetic foot in order to provide reference for the treatment of diabetic foot.

糖尿病足坏疽患者一例的居家安宁疗护实践

本文总结1例糖尿病足坏疽患者进行中医药特色的居家安宁疗护实践体会,护理要点包括入户指导家属对患者进行糖尿病足照护、帮助患者建立预立医疗计划、为患者及家属提供家庭尊严疗法、灵性照护、哀伤抚慰等,使患者有尊严、无遗憾、安详地离世;同时,减轻家属照护压力,缩短其哀伤过程。

中药足浴联合西药降糖治疗糖尿病周围神经病变临床观察

目的观察中药足浴联合西药降糖治疗糖尿病周围神经病变的临床效果。方法回顾性选取2021年9月—2023年5月江西省宜丰县人民医院收治的糖尿病周围神经病变患者62例,分为西医降糖药常规治疗联合中药足浴治疗组(联合治疗组)、西医降糖药常规治疗组(常规治疗组)两组,各31例。比较两组中医证候积分,凉温感觉阈值,血糖、血脂水平,震动感觉阈值(VPT),疼痛觉阈值,间歇性跛行距离分级。结果联合治疗组患者的疼痛感、麻木感、烧灼感、异样感积分及中医证候总积分,凉感觉阈值、温感觉阈值,空腹血糖、餐后2 h血糖、胆固醇、三酰甘油水平,足背VPT、第一足趾VPT、疼痛觉阈值均低于常规治疗组(P<0.05)。联合治疗组患者的间歇性跛行距离分级1级比率高于常规治疗组,2级、3级、4级比率均低于常规治疗组(P<0.05)。联合治疗组患者的总缓解率96.77%(30/31)高于常规治疗组的70.97%(22/31)(P<0.05)。结论糖尿病周围神经病变应用西医降糖药常规治疗联合中药足浴治疗的临床效果较西医降糖药常规治疗好。

中医传统特色外治疗法在糖尿病周围神经病变患者中的应用进展研究

糖尿病周围神经病变(Diabetic Peripheral Neuropathy, DPN)广泛存在于糖尿病患者群体中,患者通常存在下肢麻木疼痛等感觉异常。DPN患者临床症状诸多,严重影响生活质量。临床针对DPN患者治疗方式多采用口服药物治疗为主,其临床应用效果具有一定局限性。中医传统特色外治法的出现为DPN治疗领域工作开展提供新思路,诸多特色外治疗法应用方式及功效均存在差异。该文主要从DPN发病机制及临床症状、中医对DPN的认识及中医传统特色外治疗法技术优势3个方面探究DPN及外治疗法临床应用意义,并从膏摩疗法、推拿疗法及针刺疗法3个维度探究外治法应用效果。以此为DPN患者治疗提供重要技术参考,满足DPN患者群体个性化治疗需求,凸显传统中医在治疗DPN领域中的价值。

PRP局部注射联合局部氧疗治疗Wagner分级2~4级糖尿病足疗效观察

目的:观察创面富血小板血浆(Platelet rich plasma,PRP)局部注射联合局部氧疗治疗Wagner分级2~4级糖尿病足创面的临床疗效。方法:选择笔者医院2019年1月-2021年12月收治的87例Wagner分级2~4级的糖尿病足患者病例资料进行回顾性研究。将患者按照治疗方法的不同分为对照组(42例)和PRP组(45例)。对照组创面给予常规处理及局部氧疗;PRP组在对照组治疗基础上给予PRP局部注射治疗。统计比较两组炎症指标情况、疼痛评分、创面愈合率及创面愈合时间。结果:治疗3周后,PRP组各炎症指标(白细胞、C反应蛋白、红细胞沉降率、降钙素原)均低于对照组(P<0.05),PRP组疼痛VAS评分低于对照组(P<0.05),PRP组创面愈合率高于对照组(P<0.05);PRP组创面愈合时间短于对照组(P<0.05)。结论:应用创面PRP局部注射联合局部氧疗能有效控制糖尿病足创面感染,加快糖尿病足创面的愈合速度,提高创面的愈合率,缩短创面愈合时间。

糖尿病足合并糖尿病肾病多学科联合治疗规范指标及流程的构建

目的构建糖尿病足(DF)合并糖尿病肾病(DN)的多学科联合治疗规范指标及流程。方法通过文献检索及小组讨论等方法,撰写DF合并DN多学科联合治疗规范指标及流程的初稿并形成专家函询问卷。利用德尔菲法进行3轮专家函询,确立DF合并DN多学科联合治疗规范指标,通过专家论证会最终确定DF合并DN多学科联合治疗流程。结果3轮专家函询问卷有效回收率均>90%,专家权威系数均>0.70;第三轮函询后一级、二级指标的肯德尔协调系数分别为0.268、0.314,变异系数分别为0.084~0.151、0.093~0.189。最终形成的DF合并DN多学科联合治疗规范指标及流程包括9个一级指标、61个二级指标,并在专家论证会讨论基础上形成流程图。结论本研究构建的DF合并DN多学科联合治疗规范指标及流程具有一定的科学性、可靠性和适用性,可为DF合并DN患者的综合管理提供框架。

中医导引术联合中西医结合疗法对2型糖尿病足溃疡康复的影响

目的评估中医导引术联合中西医结合治疗对2型糖尿病足溃疡康复的疗效。方法回顾性分析2017年1月至2021年4月在首都医科大学附属北京中医医院接受治疗的71例2型糖尿病足溃疡患者资料。患者按治疗方法分导引组(36例)和对照组(35例),其中导引组接受导引术结合中西医结合疗法,对照组仅接受中西医结合疗法,比较两组患者的疗效和相关临床指标。结果对照组治疗后心功能分级、降钙素原(procalcitonin,PCT)和C反应蛋白(C-reactive protein,CRP)指标和治疗前的差异有统计学意义(P<0.05),而导引组的踝肱指数(ankle brachial index,ABI)、经皮氧分压(transcutanous oxygen pressure,TcPO2)、疼痛评分、跛行距离、心功能分级、PCT和CRP等指标和治疗前比较差异有统计学意义(P<0.05)。两组患者治疗后ABI、TcPO2、疼痛评分、跛行距离、心功能分级和CRP指标的差异有统计学意义(P<0.05)。导引组患者出现不良事件25次,发生率1.15%,无跌倒损伤、骨折及膝、踝关节损伤等情况出现。结论导引术结合中西医结合疗法对2型糖尿病足溃疡康复具有积极的影响,在促进创面愈合、改善疼痛、缓解炎症、改善心脏功能方面显出益处。

中西医诊治糖尿病足的进展与思考

糖尿病足是糖尿病严重并发症,具有高截肢率、高致残率和高致死率,其高昂的治疗费用及治疗后的护理费用会造成社会和家庭的沉重负担。由于糖尿病足发病机制的复杂性和临床表现的多变性,在疾病初期不易被察觉,给临床诊断与及时治疗带来难度。糖尿病足的西医治疗与中医治疗都有各自的优势与弊端,随着对糖尿病足研究的逐步深入,中西医对于糖尿病足的治疗方法也在不断发展创新,中西医联合治疗糖尿病足具有较好的临床效果。本文对糖尿病足的发病机制、疾病分类及中西医治疗方法进行综述,分析中西医联合治疗糖尿病足的进展,并提出运动疗法与中医导引术作为具有潜力的治疗方法有待于更充分地利用与更系统化地深入研究。