Acellular fish skin grafts in diabetic foot ulcer care:Advances and clinical insights

Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.

Global trends in publications regarding macrophages-related diabetic foot ulcers in the last two decades

BACKGROUND Diabetic foot ulcers(DFUs)are one of the most severe and popular complications of diabetes.The persistent non-healing of DFUs is the leading cause of amputation,which causes significant mental and financial stress to patients and their families.Macrophages are critical cells in wound healing and perform essential roles in all phases of wound healing.However,no studies have been carried out to systematically illustrate this area from a scientometric point of view.Although there have been some bibliometric studies on diabetes,reports focusing on the investigation of macrophages in DFUs are lacking.AIM To perform a bibliometric analysis to systematically assess the current state of research on macrophage-related DFUs.METHODS The publications of macrophage-related DFUs from January 1,2004,to December 31,2023,were retrieved from the Web of Science Core Collection on January 9,2024.Four different analytical tools:VOSviewer(v1.6.19),CiteSpace(v6.2.R4),HistCite(v12.03.07),and Excel 2021 were used for the scientometric research.RESULTS A total of 330 articles on macrophage-related DFUs were retrieved.The most published countries,institutions,journals,and authors in this field were China,Shanghai Jiao Tong University of China,Wound Repair and Regeneration,and Aristidis Veves.Through the analysis of keyword co-occurrence networks,historical direct citation networks,thematic maps,and trend topics maps,we synthesized the prevailing research hotspots and emerging trends in this field.CONCLUSION Our bibliometric analysis provides a comprehensive overview of macrophage-related DFUs research and insights into promising upcoming research.

Therapeutic Effectiveness of Leukocyte-and Platelet-rich Fibrin for Diabetic Foot Ulcers:A Retrospective Study

Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.Methods Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were enrolled.The clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was evaluated.Results Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)days.The severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–4.The initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)cm3.The median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh week.The overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining weeks.Concurrent treatment did not change the percentage of complete epithelialization or healing rate.Conclusion Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for DFU treatment under different clinical conditions.

Impact of tibial transverse transport in tissue regeneration and wound healing with perspective on diabetic foot ulcers

In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.

Delayed treatment of diabetic foot ulcer in patients with type 2 diabetes and its prediction model

BACKGROUND Diabetic foot(DF)is a serious complication of type 2 diabetes.This study aimed to investigate the factors associated with DF occurrence and the role of delayed medical care in a cohort of patients with type 2 diabetes.AIM To reveal the impact of delayed medical treatment on the development of DF in patients with type 2 diabetes and to establish a predictive model for DF.METHODS In this retrospective cohort study,292 patients with type 2 diabetes who underwent examination at our hospital from January 2023 to December 2023 were selected and divided into the DF group(n=82,DF)and nondiabetic foot group(n=210,NDF).Differential and correlation analyses of demographic indicators,laboratory parameters,and delayed medical treatment were conducted for the two groups.Logistic regression was applied to determine influencing factors.Receiver operating characteristic(ROC)analysis was performed,and indicators with good predictive value were selected to establish a combined predictive model.RESULTS The DF group had significantly higher body mass index(BMI)(P<0.001),disease duration(P=0.012),plasma glucose levels(P<0.001),and HbA1c(P<0.001)than the NDF group.The NDF group had significantly higher Acute Thrombosis and Myocardial Infarction Health Service System(ATMHSS)scores(P<0.001)and a significantly lower delayed medical treatment rate(72.38%vs 13.41%,P<0.001).BMI,duration of diabetes,plasma glucose levels,HbA1c,diabetic peripheral neuropathy,and nephropathy were all positively correlated with DF occurrence.ATMHSS scores were negatively correlated with delayed time to seek medical treatment.The logistic regression model revealed that BMI,duration of diabetes,plasma glucose levels,HbA1c,presence of diabetic peripheral neuropathy and nephropathy,ATMHSS scores,and delayed time to seek medical treatment were influencing factors for DF.ROC analysis indicated that plasma glucose levels,HbA1c,and delayed medical treatment had good predictive value with an area under the curve of 0.933 for the combined predictive model.CONCLUSION Delayed medical treatment significantly affects the probability of DF occurrence in patients with diabetes.Plasma glucose levels,HbA1c levels,and the combined predictive model of delayed medical treatment demonstrate good predictive value.

Home-based Detection and Prediction of Diabetic Foot Ulcers at Early Stage Using Sensor Technology and Supervised Learning

For years,foot ulcers linked with diabetes mellitus and neuropathy have significantly impacted diabetic patients’ health-related quality of life(HRQoL). Diabetes foot ulcers impact15% of all diabetic patients at some point in their lives. The facilities and resources used for DFU detection and treatment are only available at hospitals and clinics,which results in the unavailability of feasible and timely detection at an early stage. This necessitates the development of an at-home DFU detection system that enables timely predictions and seamless communication with users,thereby preventing amputations due to neglect and severity. This paper proposes a feasible system consisting of three major modules:an IoT device that works to sense foot nodes to send vibrations onto a foot sole,a machine learning model based on supervised learning which predicts the level of severity of the DFU using four different classification techniques including XGBoost,K-SVM,Random Forest,and Decision tree,and a mobile application that acts as an interface between the sensors and the patient. Based on the severity levels,necessary steps for prevention,treatment,and medications are recommended via the application.

Relevance of macrophages in the wound healing process among individuals afflicted with diabetic foot ulcers

In this paper,we provide a commentary on an article focusing on diabetic foot ulcer(DFU)as a dreadful complication of diabetes mellitus.The development of this condition is influenced by factors such as diabetic peripheral neuropathy,lower extremity artery disease,and infection.However,the underlying mecha-nism remains elusive.Macrophages play a critical role in wound healing proce-sses,suggesting that therapies targeting these cells could potentially improve the management of DFU.A comprehensive understanding of developmental trends of macrophages within the field of DFU may facilitate research advancements and the development of novel treatment strategies.

Portraying Diabetic Foot Ulcers: Comparative Evaluation of Diabetic Foot Infections versus Diabetic Foot Ulcers

Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers;no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.

Intact fish skin graft a new hope for the treatment of diabetic foot ulcers:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are a real public health problem which carry a high risk of amputation.The treatment of DFUs is based on general management such as the treatment of infection,arterial disease,and offloading,but recent studies have shown that the quality of the local covering can impact the healing rate.CASE SUMMARY We report the case of a 39-year-old man,living with diabetes since the age of 15,who developed DFU on the dorsum of his left foot,with muscle and tendon in-volvement.Conventional management with intensive diabetes control,surgery,treatment of infection and negative pressure therapy gave only limited results.The patient benefited from the application of an intact fish skin graft with com-plete epithelialisation of the ulcer after 10 weeks of treatment.CONCLUSION The use of intact fish skin graft appears to be a promising option for deep DFUs.

Efficacy of Huangma Ding or autologous platelet-rich gel for the diabetic lower extremity arterial disease patients with foot ulcers

BACKGROUND Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability,traditional treatment has poor efficacy and there is an urgent need to develop a practical treatment method.AIM To investigate whether Huangma Ding or autologous platelet-rich gel(APG)treatment would benefit diabetic lower extremity arterial disease(LEAD)patients with foot ulcers.METHODS A total of 155 diabetic LEAD patients with foot ulcers were enrolled and divided into three groups:Group A(62 patients;basal treatment),Group B(38 patients;basal treatment and APG),and Group C(55 patients;basal treatment and Huangma Ding).All patients underwent routine follow-up visits for six months.After follow-up,we calculated the changes in all variables from baseline and determined the differences between groups and the relationships between parameters.RESULTS The infection status of the three groups before treatment was the same.Procalcitonin(PCT)improved after APG and Huangma Ding treatment more than after traditional treatment and was significantly greater in Group C than in Group B.Logistic regression analysis revealed that PCT was positively correlated with total amputation,primary amputation,and minor amputation rates.The ankle-brachial pressure and the transcutaneous oxygen pressure in Groups B and C were greater than those in Group A.The major amputation rate,minor amputation rate,and total amputation times in Groups B and C were lower than those in Group A.CONCLUSION Our research indicated that diabetic foot ulcers(DFUs)lead to major amputation,minor amputation,and total amputation through local infection and poor microcirculation and macrocirculation.Huangma Ding and APG were effective attreating DFUs.The clinical efficacy of Huangma Ding was better than that of autologous platelet gel,which may be related to the better control of local infection by Huangma Ding.This finding suggested that in patients with DFUs combined with coinfection,controlling infection is as important as improving circulation.

Clinical comprehensive treatment protocol for managing diabetic foot ulcers:A retrospective cohort study

BACKGROUND Diabetic foot ulcers(DFUs)are a common complication of diabetes,often leading to severe infections,amputations,and reduced quality of life.The current standard treatment protocols for DFUs have limitations in promoting efficient wound healing and preventing complications.A comprehensive treatment approach targeting multiple aspects of wound care may offer improved outcomes for patients with DFUs.The hypothesis of this study is that a comprehensive treatment protocol for DFUs will result in faster wound healing,reduced amputation rates,and improved overall patient outcomes compared to standard treatment protocols.AIM To compare the efficacy and safety of a comprehensive treatment protocol for DFUs with those of the standard treatment protocol.METHODS This retrospective study included 62 patients with DFUs,enrolled between January 2022 and January 2024,randomly assigned to the experimental(n=32)or control(n=30)group.The experimental group received a comprehensive treatment comprising blood circulation improvement,debridement,vacuum sealing drainage,recombinant human epidermal growth factor and anti-inflammatory dressing,and skin grafting.The control group received standard treatment,which included wound cleaning and dressing,antibiotics administration,and surgical debridement or amputation,if necessary.Time taken to reduce the white blood cell count,number of dressing changes,wound healing rate and time,and amputation rate were assessed.RESULTS The experimental group exhibited significantly better outcomes than those of the control group in terms of the wound healing rate,wound healing time,and amputation rate.Additionally,the comprehensive treatment protocol was safe and well tolerated by the patients.CONCLUSION Comprehensive treatment for DFUs is more effective than standard treatment,promoting granulation tissue growth,shortening hospitalization time,reducing pain and amputation rate,improving wound healing,and enhancing quality of life.

Research Progress on Healing Mechanism of Diabetic Foot Ulcer

Diabetic foot ulcers are a prevalent complication that can significantly impact quality of life and necessitate high-level amputations. Hence, early diagnosis and treatment, elucidation of pathogenesis, and targeted countermeasures assume paramount importance. Wound healing entails a complex process wherein various components such as inflammatory cells, extracellular matrix, and immune cells intricately interact with each other. Due to the vulnerability of the skin to damage, inadequate or impaired wound healing has emerged as an urgent clinical challenge requiring resolution. This paper provides a comprehensive overview of the pathogenesis, diagnosis, and treatment of diabetic foot ulcers in order to offer theoretical guidance for specific interventions.

Self-management in patients with diabetic foot ulcer:a concept analysis

Objective:This paper presents an analysis of the concept of patient outcomes.Methods:The present study conducted searches on various databases,including Wanfang,Sinomed,CNKI,Pub Med,Cochrane Library,Embase,Web of Science,and Ovid.The paper followed the Walker and Avant concept-analysis approach.Results:Initially,899 pieces of literature were identified through the search process,and after screening,41 of them were ultimately included in the analysis.The identified attributes of the concept included(1)capability,(2)decision making,and(3)action.These antecedents were shaped by factors such as illness perception,self-efficacy,and family and social.The consequences included(1)physiological effects,(2)psychological effects,and(3)social influence.Conclusions:The concept analysis of self-management in patients with diabetic foot ulcers(DFUs)not only aids in clinical practice and suppor ts interventions,but also contributes to the development of self-management theory.The common goal of clinical medical staff is to assist DFU patients in improving cognitive ability,making correct self-management decisions,and enhancing self-management behavior.

Adipose-derived stem cells in diabetic foot care:Bridging clinical trials and practical application

Diabetic foot ulcers(DFUs)pose a critical medical challenge,significantly impairing the quality of life of patients.Adipose-derived stem cells(ADSCs)have been identified as a promising therapeutic approach for improving wound healing in DFUs.Despite extensive exploration of the mechanical aspects of ADSC therapy against DFU,its clinical applications remain elusive.In this review,we aimed to bridge this gap by evaluating the use and advancements of ADSCs in the clinical management of DFUs.The review begins with a discussion of the classification and clinical management of diabetic foot conditions.It then discusses the current landscape of clinical trials,focusing on their geographic distribution,reported efficacy,safety profiles,treatment timing,administration techniques,and dosing considerations.Finally,the review discusses the preclinical strategies to enhance ADSC efficacy.This review shows that many trials exhibit biases in study design,unclear inclusion criteria,and intervention protocols.In conclusion,this review underscores the potential of ADSCs in DFU treatment and emphasizes the critical need for further research and refinement of therapeutic approaches,with a focus on improving the quality of future clinical trials to enhance treatment outcomes and advance the field of diabetic wound care.

Quality Assessment of Online Patient Education Materials for Diabetic Foot

Background: The quality of online Arabic educational materials for diabetic foot syndrome (DFS) is unknown. This study evaluated Arabic websites as patients’ sources of information for DFS. Methods: The study assessed patient-related websites about DFS using a modified Ensuring Quality of Information for Patients (EQIP) tool (score 0 - 35). Specific terms were searched in Google to identify DFS websites;eligibility criteria were applied to 20 pages of search results to select the included websites. Data on country of origin, source types and subtypes, and website traffic were extracted. Additional therapeutic information regarding prevention and conservative, pharmacological, and surgical treatments was also recorded and analyzed. Results: Among 559 websites, 157 were eligible for inclusion. The median EQIP score was 16 out of 35, indicating poor quality in one of three domains (content, identification, or structure). Most sources originated from Arab countries (75.8%) were non-governmental (94.9%), and were medical information websites (46.5%). High-scoring websites were significantly more likely than low-scoring websites to describe information on prevention (30.9% vs. 2.9%, p = 0.001), conservative treatment (34.1% vs. 13%, p = 0.002), or pharmacological treatment (32.5% vs. 16.8%, p = 0.024). There were increased odds of scoring high if a website provided information on prevention (OR = 12.9, 95% CI [1.68 - 98.57], p = 0.014). Conclusion: Most Arabic online patient information on DFS is of poor quality. Quality control measures are needed to ensure accurate health information for the public.

Use of Topical Complementary and Alternative Medicines (CAM) in Diabetic Septic Foot Disease in Makkah Region, Western of Saudi Arabia, an Exploratory Study

Diabetes is a chronic condition that is significantly impacted daily by environment. At least one in five Saudis, suffer from diabetes. “Diabetes is a pandemic of unprecedented magnitude spiraling out of control” (Boulton). Saudi Arabia ranks the second highest in the Middle East, and is the seventh in the world for the prevalence of diabetes (WHO). Diabetes mellitus (DM) has been found to be related to high mortality, morbidity accompanied by poor general health and lower quality of life. Current Saudi diabetes patients’ behaviors, practices, and beliefs regarding foot health problems such as ulcers, are not well investigated. Diabetic patients frequently utilize natural remedies and Herbs for self-medication as a part of complementary and alternative Medicine. Aim of study: To explore the widespread use of the alternative remedies in the local communities of the Western Saudi Arabia, the drives behind using and to focus on the potential adverse effects following their usage. Method: A descriptive, cross-sectional study of 386 diabetic patients with feet problems in Makkah Region, West of Saudi Arabia during the period April - June 2023. Results: Out of the 531 participants, only 386 participants reported diabetic foot disorder (DFD). Most of the participant were above 65 years of age group (24.61 %). Male (52.08%) more than female (47.92%) in the research group. All of the participants had diabetic foot disorders at least once. The prevalence of complementary and alternative medicines (CAM) use among them was 67.88%, as solitary or in combination with hospital medicines. Honey headed the list followed by myrrh and black seeds. Acquaintances advice (59.54%) was the most reason for using the alternative medicine. 60.30% of Diabetic foot patient complained of adverse effects during CAM remedies use. Conclusion: Consumption of CAM remedies among diabetic patients for Diabetic Foot Disorder (DFD) is common. Honey headed the list followed by myrrh and black seeds. Additional wide-scale research is required to establish their actual efficacy, safety and potential adverse out-comes and to generalize the outcomes.

Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

Electrospun nanofibers as a wound dressing for treating diabetic foot ulcer

Diabetes is one of the most prevalent diseases in the world with high-mortality and complex complications including diabetic foot ulcer(DFU). It has been reported that the difficulties in repairing the wound related to DFU has much relationship with the wound infection,change of inflammatory responses, lack of extracellular matrix(ECM), and the failure of angiogenesis. Following the development of medical materials and pharmaceutical technology, nanofibers has been developed by electrospinning with huge porosity, excellent humidity absorption, a better oxygen exchange rate, and some antibacterial activities. That is to say, as a potential material, nanofibers must be a wonderful candidate for the DFU treatment with so many benefits. Careful selection of polymers from natural resource and synthetic resource can widen the nanofibrous application. Popular methods applied for the nanofibrous fabrication consist of uniaxial electrospinning and coaxial electrospinning. Furthermore, nanofibers loading chemical, biochemical active pharmaceutical ingredient(API)or even stem cells can be wonderful dosage forms for the treatment of DFU. This review summarizes the present techniques applied in the fabrication of nanofibrous dressing(ND)that utilizes a variety of materials and active agents to offer a better health care for the patients suffering from DFU.

Topical application of platelet-rich plasma for diabetic foot ulcers: a systematic review

AIM To determine if topical application of platelet-rich plasma(PRP) to diabetic foot ulcers(DFUs) results in superior healing rates. METHODS A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Level Ⅰ-Ⅳ investigations of topical PRP application in DFUs were sought in multiple databases including: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The search terms used were "platelet rich plasma", "diabetes", "ulcers", and "wound". The Modified Coleman Methodology Score(MCMS) was used to analyze study methodological quality. Study heterogeneity and a mostly non-comparative nature of evidence precluded meta-analysis. Only the outcome measurements used by more than 50% of the studies were included in the data synthesis to increase power of the measurement over that of individual studies. A weighted mean of healing rate per week between PRP group vs controls were compared using two-sample z-tests using P-value of less than 0.05 for significance.RESULTS One thousand two hundred and seventeen articles were screened. Eleven articles(322 PRP subjects, 126 controls, PRP subject mean age 58.4 ± 7.2 years, control mean age 58.7 ± 5.9 years) were analyzed. Six articles were level Ⅱ evidence, four were level Ⅲ, and one article was level Ⅳ. The mean MCMS was 61.8 ± 7.3. Healing rate was significantly faster with PRP application compared to controls(0.68 ± 0.56 cm2/wk vs 0.39 ± 0.09 cm2/wk; P < 0.001). Mean heal time to > 90% of the original ulcer area was 7.8 ± 2.7 wk and 8.3 ± 3.7 wk for patients in the PRP group and control groups, respectively(P = 0.115). There were significantly lower adverse effects reported with PRP application compared to controls(7 wound infections, 1 contact dermatitis vs 14 wound infections, 1 maceration; P < 0.001).CONCLUSION The topical application of PRP for DFUs results in statistically superior healing rates and lower complication rates compared to controls.

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients(one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.