Diabetic Foot Ulcers

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Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic lower-limb amputations in the US. Although already high, the rate of amputation is increasing.

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By Temple University School of Podiatric Medicine Journal Review Club

A diabetic foot ulcer (DFU) is a wound that has a higher risk of becoming chronic, leading to amputation and, in some cases, even death. Currently, the Wagner and Texas classification are used worldwide to assess the extent of diabetic foot lesion. The authors of this article believe that there is a lack of wound treatment principles based on both classification systems. In the article, they have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification system. The STAGE principle refers to surgical intervention during wound treatment of a DFU. With a focus on the anatomical layers of the wound, the management of blood supply, layer by layer incision to the infected area, maintenance of adequate wound drainage, and step by step treatment of the wound. STAGE is the management of an ulcer through its anatomical layers. Skeleton, Tendon, Angiogenesis, Granulation, and Epithelialization.

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Chronic wounds of the lower extremities impose an increasing burden on health care providers and systems, and they can have a devastating impact on patients and their families. These wounds include diabetic ulcers, venous ulcers, arterial ulcers, and pressure injuries. The estimated socioeconomic cost of chronic wounds is 2% to 4% of the health budget in Western countries. Moreover, patient mortality in individuals with chronic wounds has been estimated at 28% over a two-year period, significantly higher than the 4% mortality rate reported for 75 to 79 year-olds without chronic wounds.

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Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that recurrence rates are high; nearly 40% of patients with an ulcer will develop a recurrence within one year of healing. This percentage is 60% at three years after healing and 65% at the five-year mark.

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By Temple University School of Podiatric Medicine Journal Review Club

Hard-to-heal wounds, such as diabetic foot ulcers, pressure injuries, and venous leg ulcers, comprise a significant portion of health care visits, and these wounds place a physical and economic burden on many patients. These hard-to-heal wounds are defined as wounds with stagnant or delayed stages of healing that fail to resolve within eight weeks. Finding ways to accelerate this healing process is of great importance because it can reduce the physical and economic burden on patients, as well as decreasing costs for health care facilities. Matrix metalloproteinases (MMPs) are endopeptidases, which are involved in many healing processes, including the cell signaling processes, migration processes, angiogenesis, and the degradation of extracellular proteins. These mechanisms are necessary for the wound healing process by breaking down damaged tissue. In the late stages of healing, when breaking down of tissue is no longer necessary, tissue inhibitors of metalloproteinases down-regulate MMPs. In hard-to-heal wounds, this process is thrown off balance, with delays in the subsequent stages of healing. In an attempt to restore this balance, MMPs have been investigated for their role in wound healing through MMP-inhibiting wound dressings. There have been a number of consequential reviews done using current market wound dressings, such as oxidized regenerated cellulose/collagen and Technology Lipido-Colloid with nano-oligosaccharide factor (TLC-NOSF).

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By Alton Johnson Jr., DPM, CWSP

Since my last blog post, I was fortunate enough to turn 32 years old. To many of us, turning 32 years old does not seem like much of a big deal, but as an African American man, it is, because the average life expectancy of a Black man in America is 75 years, which is the lowest life expectancy of all ethnicities in America. Essentially, in five years, I will be statistically at my midlife. It is with that mind that I work tirelessly for all patients, but I try to emphasize to African American patients the importance of wound healing, diabetes management, and overall healthy well-being.

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By Temple University School of Podiatric Medicine Journal Review Club

Chronic wounds require an increased amount of oxygen to help with cellular function and growth. They often manifest with biofilm, slough, and necrotic tissue, all of which deprive cells of the oxygen they need to perform vital functions. Various forms of debridement are commonly employed to rid wounds of pathological tissues that negatively affect cellular communication and growth. Sharp surgical debridement is most frequently performed by physicians. Continuous diffusion of oxygen (CDO) involves the use of humidified, purified air at 3mL/hour in conjunction with moist wound therapy (MWT) dressing. A previous paper by Niederauer et al. published in 2018 in the Journal of Wound Care, described using CDO for healing DFUs. This study showed that CDO improved the healing rate of DFUs in terms of time, chronicity, and weight-bearing ability when compared to a placebo. Additionally, the previous paper described wound size, chronicity, and adverse events.

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Holly Hovan MSN, RN-BC, APRN, CWOCN-AP

Diabetes is extremely prevalent in the United States. The Centers for Disease Control and Prevention (CDC) report that over 10% of the US population has this chronic disease, and 26.8% of older adults (65 and over) are impacted by diabetes, both diagnosed and undiagnosed.

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Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

Chronic diabetic foot ulcers affect approximately 13% of the United States population. Chronic diabetic foot ulcers, or DFU, are defined by the authors as, “nonhealing ulcers of the foot lasting more than 3 months’ duration in patients with diabetes”. It is critical to treat DFUs effectively and timely, as ulcers may progress to the point of requiring an amputation. Patients suffering from a DFU may have an amputation rate of 21.5% to 28.4%.

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By the WoundSource Editors

Collateral circulation: A collateral blood vessel circuit that may be adapted or remodeled to minimize the use of occluded arteries. Collateralization may offset some of the physiological signs of peripheral artery disease, such as maintaining a normal capillary refill.

Critical limb ischemia: A severe form of peripheral arterial disease in which a severe blockage of the arteries of the lower extremities reduces blood flow. It is a chronic condition that is often characterized by wounds of the lower extremity.

Dependent rubor: A light red to dusky-red coloration that is visible when the leg is in a dependent position (such as hanging off the edge of a table) but not when it is elevated above the heart. The presence of dependent rubor is often an indicator of underlying peripheral arterial disease. When the leg is raised above the level of the heart, its color will normalize.