Wound treatment diabetic ulcer

Edmonds M, Bates M, Doxford M, Gough A, Foster A. New treatments in ulcer healing and wound infection. Diabetes Metab Res Rev 2000 16(Suppl. 1) S51-S54. 

Complications secondary to diabetes, such as diabetic foot ulcers continue to be a major worldwide health problem [4], At the same time, health care systems are changing rapidly, causing concern about the quality of patient care. While the ultimate effect of current changes on health care professionals and patient outcomes remain uncertain, measures commonly used to reduce costs, e.g., disease and multi-disciplinary management strategies have been shown to help prevent the occurrence of diabetic ulcers. In addition, utilizing a multi-disciplinary approach, the principles of off-loading and optimal wound care, and the vast majority of diabetic foot ulcers can be expected to heal within 12 weeks of treatment. Education of primary care providers and patients is paramount. 

The demand in bum wound treatment, skin and muscle loss in tiafiic and work accidents, diabetic ulcers, cardiovascular diseases, radiation induced ulcers... is currently popular. The most difftcult problem for the treatment of massive full-thickness wounds is the lack of skin for autograft. Thus, a large number of various methods have been developed such as CEA (Cultured Epidermal Autograft) (Aiiane et al., 2006). Its advantages have been determined by the use of a small intact skin area (2-3 cm ), we could initiate the culture in order to obtain a big number of keratinocytes which were ready to use for autograft (James et al., 2009). 

The pathogenesis of diabetic foot infection stems from three key factors neuropathy, angiopathy, and immunopathy. Aerobic gram-positive cocci, such as S. aureus and P-hemolytic streptococci, are the predominant pathogens in acutely infected diabetic foot ulcers. However, chronically infected wounds are subject to polymicrobial infection and require treatment with broad-spectrum antibiotics. 

The nonpharmacologic treatment of diabetic foot ulcers may include off-loading, chemical or surgical debridement of necrotic tissue, wound dressings, hyperbaric oxygen, vascular or orthopedic surgery, and the use of human skin equivalents.30... 

Presentation 1 HPI BK is a 72-year-old 60-kg man who is admitted to the hospital for treatment of sepsis. He has a long history of diabetes mellitus for which he has been receiving glipizide. He has a leg wound that is erythematous and tender. Blood cultures and a needle aspirate of the leg ulcer were taken and sent to the laboratory for culture and sensitivity. 

The key treatment for diabetic foot wounds is often debridement in its many guises. Despite the plethora of treatment available their success can be limited if the wound is not sufficiently prepared. The process of debridement removes non-viable tissue and the products remaining from an abnormal, sustained inflammatory response. Increased protease levels and an imbalance of matrix metal-loproteinases and their tissue inhibitors [10] maintain the chronic wound state and their removal with associated hyperaemia will encourage an influx of the biological components of healing. The level of debridement used will depend on the aetiopathogenesis and the morphology of the ulcer. 

A 68-year-old male patient with a diabetic foot ulcer was treated with a combination of Vivamel alginate dressings and medical honey from the tube. Prior to Vivamel treatment the patient was dealing with the unhealed wound after amputation for more than... 

Zerm, R., 2013. Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency and diabetes topical honey for diabetic foot ulcers. Deutsches Arzteblatt International 110 (21), 373. 

L.I.F. Moura, A.M.A. Dias, E. Carvalhoa, H.C. de Sousa, Recent advances on the development of wound dressings for diabetic foot ulcer treatment—a review, Biomaterialia 9 (2013) 7093-7114. 

Figure 4. Healing of a chronic ulcer in the foot of a 71 years old diabetic patient. The wound did not close even 4ien treated for 9 months by conventional treatment (oral antibiotics, Acticoat Absorbent, Allevyn, Apligraf and sharp debridement).

Over five million people each year in the UK suffer from various kinds of wounds that require treatment. As the age profile of the population increases, chronic or hard to heal wounds resulting fi-om diabetes, pressure induced wounds, cancer and leg ulcers are becoming by far the most dominant and potentially most expensive types of wounds to treat. The cost to the NHS of caring for patients wiffi a chronic wound is conservatively estimated at per year (at 2005-2006 costsf. UK... 

Venous insufficiency is the most common cause of leg ulcers. Venous insufficiency is often caused by deep thrombosis or weakness of the valve system of the lower leg superficial veins, but the wound may also be caused due to, for example, arterial circulatory disorders, vasculitis or diabetes. The first sign of venous insufficiency is lower leg swelling but also eczema around the ankle, caused by venous stasis, can be an early marker (Mayrovitz and Larsen, 1997). The most important treatment is to counteract the oedema condition, which can be done by keeping the leg in a raised position or by applying a compression bandage to the leg (Reichenberg and Davis, 2005 Rajendran et al., 2007). 

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