Особливості хірурґічної обробки та фіксації шкірного клаптя після малих ампутацій у хворих з синдромом стопи діабетика

35 Years of Advances in Skin & Wound Care: Celebrating the Evolution of the Wound Care Team.

Summary. Aim. The development and implementation into clinical practice methods of local treatment of purulent-necrotic wounds in patients with diabetes, based on the use of modern sorbent drugs.
 Materials and methods. In 2021, 121 patients with various stages of diabetic foot syndrome were treated. The main group included 27 patients in whom Ornidasil sorbent was used for local treatment. The comparison group included 31 patients in whom hypertonic solution and ointment bandages were used for local treatment.
 Research results. The treatment of purulent-necrotic wounds in patients with type II diabetes with diabetic foot syndrome was analyzed.
 Conclusions. Diabetic foot syndrome is a serious complication of diabetes. Application sorbent consisting of ornidazole and nanosilica is an effective tool in the treatment of wounds with diabetic foot syndrome.

Say Goodbye to Wet-to-Dry Wound Care Dressings

The Future of Wound Care.

Synthetic extracellular matrices are artificial polymers that are elongated and deposited as a matrix of nanofibers which mimic the native extracellular matrix. RenovoDerm® Anthem™ Wound Matrix (Columbus, Ohio) is comprised of polyglycolic acid and poly (L-lactide-co-caprolactone) which degrade by hydrolysis into a-hydroxy and fatty acids, lowering the pH and promoting regenerative cellular activity including angiogenesis. Amniotic allografts contain growth factors, cytokines, amino acids, extracellular matrix proteins, and hyaluronic acid which are recognized as intrinsic to the wound healing process. Synthetic extracellular matrices alone or in combination with amnio allografts do not have large bodies of evidence which demonstrate their effectiveness in the treatment of wounds. Presently, no prior studies have been performed to assess what impact these therapies may have on wound healing when used concurrently. The aim of this investigation was to assess whether a synergistic effect is produced with combination therapy using synthetic extracellular matrix and amniotic allografting. In this article, we present four cases of diabetic foot ulcerations treated with combination therapy. An amniotic fluid allograft, and/or membrane amniotic allograft, was implanted with a synthetic extracellular matrix dressing over top of the graft(s) at weekly intervals. All wounds demonstrated a greater than 80% decrease in wound size within four applications and achieved more than 95% wound closure after six applications.

The primary goal of this systematic review article was to provide an outline of the use of diabetic autologous adipose-derived mesenchymal stem cells (DAAD-MSCs) in the treatment of wounds and ulcers in animal models and patients with diabetes mellitus (DM). The secondary goal was to present the outcomes of pretreatment of diabetic adipose-derived mesenchymal stem cells (DAD-MSCs) with probable different agents in the treatment of diabetic foot ulcers (DFUs) and wounds. In view of possible clinical applications of AD-MSC-mediated cell therapy for DFUs, it is essential to evaluate the influence of DM on AD-MSC functions. Nevertheless, there are conflicting results about the effects of DAAD-MSCs on accelerating wound healing in animals and DM patients. Multistep research of the MEDLINE, PubMed, Embase, Clinicaltrials.gov, Scopus database, and Cochrane databases was conducted for abstracts and full-text scientific papers published between 2000 and 2020. Finally, 5 articles confirmed that the usage of allogeneic or autologous AD-MSCs had encouraging outcomes on diabetic wound healing. One study reported that DM changes AD-MSC function and therapeutic potential, and one article recommended that the pretreatment of diabetic allogeneic adipose-derived mesenchymal stem cells (DAlD-MSCs) was more effective in accelerating diabetic wound healing. Recently, much work has concentrated on evolving innovative healing tactics for hastening the repair of DFUs. While DM alters the intrinsic properties of AD-MSCs and impairs their function, one animal study showed that the pretreatment of DAlD-MSCs in vitro significantly increased the function of DAlD-MSCs compared with DAlD-MSCs without any treatment. Preconditioning diabetic AD-MSCs with pretreatment agents like photobiomodulation (PBM) significantly hastened healing in delayed-healing wounds. It is suggested that further animal and human studies be conducted in order to provide more documentation. Hopefully, these outcomes will help the use of DAAD-MSCs plus PBM as a routine treatment protocol for healing severe DFUs in DM patients.

Background: A diabetic foot ulcer is a complication that often occurs in patients with diabetes mellitus. The healing process of a chronic wound is more complicated and requires more complex treatment. There is an increase in IL-1, IL6, and TNF-α pro-inflammatory cytokines in a chronic wound. Hyaluronic acid (HA) is a component that has been used for a long time and is known to help the wound healing process. This study was at a time to determine the effectiveness of hyaluronic acid on the reduction of interleukin-6 in accelerating the healing of Wagner II-III diabetic foot ulcers. Methods: This study is an experimental, randomized study of pre and post-test design on diabetic foot ulcer patients with the Wagner II-III classification who were controlled at the thoracic, cardiac, and vascular surgery polyclinic at Dr. Soetomo Hospital Surabaya. Data were analyzed using SPSS version 20 for Windows. Result: About 39 samples are willing to participate in the study, divided into 20 samples in the treatment group and 19 in the control group. The mean concentrations of IL-6 in the treatment group before and after the intervention were 280.70±155.50 ng/ml and 126.60±145.60 ng/ml. There was a significant decrease in IL-6 levels (p<0.05) before and after the intervention. The mean concentrations of IL-6 in the control group pre and post were 315.20±127.40 ng/ml and 136.30±134.60 (p<0.05). The decrease in the control and treatment groups was no statistically significant difference (p>0.05). There was no significant difference in the PUSH Score (p>0.05) in the two groups before intervention/treatment. The decrease of wound area in the control and treatment groups were -4.80 ((-0.40)-(-24.50)) and -4.8 ((-0.70)-(-30.90)) (p>0.05). Conclusion: Topical hyaluronic acid and wound care using 0.9% NaCl reduced interleukin-6 levels, PUSH scores, and wound area in Wagner II-III diabetic foot ulcers.

Journal of Wound CareVol. 27, No. 5 EditorialFree AccessFuture technologies versus basic guidelinesRachel WebbRachel WebbSearch for more papers by this authorRachel WebbPublished Online:8 May 2018https://doi.org/10.12968/jowc.2018.27.5.257AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Welcome to the May issue of the Journal of Wound Care (JWC). This month's issue contains quite a mix of papers and subject areas all aimed at improving wound healing.I would like to draw your attention to a couple of articles. The first in this month's line-up investigates the use of 3D-printing to create a collagen scaffold to facilitate healing in four pressure ulcers and one diabetic foot ulcer. In my editorial in September 2016,1 ‘The 3D future of wound healing’ I wrote about the potential of this technology to aid wound healing, so it is quite satisfying to publish the first JWC paper on the use of the technology. It is a small case series that demonstrates the potential of the printed collagen scaffold to aid wound healing (page 262).Another paper I would like to draw you attention to, by Van Acker et al. (page 310), examines the awareness and perception of general practitioners (GPs) of diabetic foot ulcers (DFU). Often, the first health professional to see a DFU would be a GP and it is critical that these are assessed and treated accordingly to get rapid healing and prevent amputation. The authors report on the responses they received from 600 questionnaires sent to GPs in the UK, France, Germany and Spain. There are a number of differences observed between these four European countries, which raises the question of what differences would be seen when looking at other countries and, indeed, continents. Perhaps one of the most concerning findings was that 30% of GPs in France and Germany thought that DFU treatment was not well established and lacking in guidelines. We know many of these guidelines exist but could it be that they are not accessed beyond the wound care world and, thus, helping those who need specific guidance on what to do when confronted with a DFU. Perhaps that is one of the biggest challenges wound care specialists face in getting the information out to other health professionals. For pressure ulcer prevention, there have been huge improvements, in part due to initiates such as ‘Stop the Pressure’. However, it seems, based on the data from the Acker et al study, that in terms of DFU treatment, the lack of knowledge and understanding about DFU diagnosis, treatment and management needs to be addressed.The final paper I wanted to mention is a management article, ‘Wound centres—how do we obtain high quality? The EWMA wound centre endorsement project’ (page 288). As the title suggests this article looks at the EWMA project that aims to describe the minimum requirements for a wound management centre, and describes the experience of a set of pilot projects.This is, of course, our EWMA issue of JWC, so if you are at the meeting I hope you have also picked up a copy of the EWMA Daily Newspaper which, along with session coverage, EWMA and society updates, contains details of the day's events, and a games section and a little more time tourist pages, for those with some time to spare. If you want to share your views on the conference or on wound care, you can do this through the Vox Pops section—just find our roving reporter and photographer, or tell us what you're up to by tweeting us @EWMADaily, using the hashtag #EWMA2018. I hope you enjoy this issue of JWC and if you are at EWMA pop by the JWC stand and say hello. References 1 Webb RJ. The 3D future of wound healing. J Wound Care 2016; 25(10):559–559. https://doi.org/https://doi.org/10.12968/jowc.2016.25.10.559 Link, Google Scholar FiguresReferencesRelatedDetails 2 May 2018Volume 27Issue 5ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics Downloaded 42 times History Published online 8 May 2018 Published in print 2 May 2018 Information© MA Healthcare LimitedPDF download

Telemedicine in wound care is an evolving method of information technology and telecommunication designed to provide health care at a distance. Given the visual nature of wound care, telemedicine has many potential applications within this field. The authors will review the current status of wound care and telemedicine. A comprehensive literature review of articles published on telemedicine in wound care was performed. Articles were selected for their relevance to wound healing and then reviewed for their discussion on the potential applications, benefits, and limitations to telemedicine in wound care. The CICAT network data were reviewed including 5,794 patients between January 2005 and October 2015. Clinical efficacy and medicoeconomic results were analyzed. Current literature suggests a myriad of potential benefits of telemedicine in wound care, often citing increased access to professional expertise in remote and rural settings, as well as cost savings. The CICAT wound network in France analyzed wounds, which were principally pressure ulcers (44%), leg ulcers (24%), and diabetic foot ulcers (8%). Results demonstrated 75% of wounds improved or healed, a 72% reduction in the number of hospitalizations, and 56% reduction in ambulance transfers to wound healing centers. There is an increasing demand for assistance from professionals not specialized in wound healing, facing complex wounds. The goal is to enable the spread of expertise beyond major medical centers. Several limitations and barriers to the application of telemedicine in all settings are evident, including over diagnosis, dependence on a functional telecommunication system, and various legal aspects. The CICAT network in France provides an example of a how telemedicine may be of benefit in wound care, although it is important to note that in other countries, such as the United States, legal constraints and credentialing concerns may make telemedicine extremely complicated.

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Objective To explore clinical effects about surgical operation treatment and non-surgical operation treatment methods for acute infectious diabetic foot moist gangrene wounds, and to provide guidance for treatment of acute infectious diabetic foot moist gangrene wounds. Methods To retrospectively analyze 63 cases of acute infectious diabetic foot moist gangrene patients treated by the Department of Burns, Guangzhou First People′s Hospital from January 2014 to March 2017. According to the clinical situation of acute infectious diabetic foot moist gangrene wounds, the surgical treatment[including debridement surgery and debridement surgery plus negative pressure wound therapy (NPWT)] and non-surgical treatment (including ultrasonic debridement and routine dressing) was performed respectively. The 63 cases were divided into surgical treatment group(44 cases) and non-surgical treatment group(19 cases) on the basis of the differences of treatments. By analyzing the changes of blood glucose before and after wound treatment, the inflammation around the wound, the growth of granulation tissue and the total amputation rate, the clinical effect of different clinical treatment on diabetic foot moist gangrene wound was evaluated. The data were compared by t test, Radit analytical method and chi-square test. Results Both the surgical treatment group and the non-surgical treatment group had obvious blood glucose reduction before and after operation, the difference were statistically significant (with P values below 0.05). In the field of inflammatory reaction and granulation tissue formation, the surgical treatment group had 95%CI in the control of inflammatory reaction (0.808-1.149), and in granulation generation, the following 95%CI was 0.792-1.133, obviously better than non-surgical treatment group, the difference was statistically significant. At the same time, Radit analysis was performed on the debridement surgery and debridement plus NPWT in the surgical treatment group. The results suggested that there was no significant difference in granulation between the two treatment methods. The 95%CI was 0.2466-0.6466. The amputation rate was 9% in the surgical treatment group, and 37% in the non-surgical treatment group, it was suggesting that surgical treatment can significantly reduce the amputation rate, the difference was statistically significant (χ2=5.30, P<0.05). Conclusions For acute infectious diabetic foot moist gangrene wounds, debridement surgery or plus NPWT should be actively performed to remove necrotic tissue as much as possible, actively control infection, and promote granulation growth. That is of great significance for limb salvage treatment of diabetic foot moist gangrene. Key words: Diabetic foot; Gangrene; Negative-pressure wound therapy; Wound treatment; Acute infectivity

Introduction. Due to the acquisition of resistance to antibiotics by pyogenic microbiota, the problem of local (medicinal) treatment of wounds has become more acute. Aim. Evaluation of the medicinal properties of Bioseptin ointment in vivo on a model of a purulent incised skin wound of research animals. Materials and object of the research. Bioseptin ointment was developed by LLC “Research Center”. The active principle of the ointment is a microbial association: bacteria Baсillus subtilis strain VKPМ B-7048 and Bacillus licheniformis strain VKPМ B-7038, which has high antagonistic activity against a wide range of pathogenic and opportunistic microorganisms. As an auxiliary component of the ointment, a dense nutrient medium is taken, used for growing cultures of B. subtilis and B. licheniformis in the process of obtaining a specific batch of ointment. The ointment is a combination preparation for topical use. The wound-healing effectiveness of the ointment was assessed in two groups (20 mice each) of healthy non-inbred mice with a body weight of 16 and 20 g of ICR colony of both sexes from the nursery State Scientific Center for Virology and Biotechnology “Vector” of Russian Federal State Agency for Health and Consumer Rights. The control group was a group of mice treated with the reference ointment Iruksol (20 mice per group). A model of a purulent wound in animals of these three groups was obtained by infecting incised skin wounds with a mixture of bacterial cells P. aeruginosa and S. Aureus. Treatment of mice was continued until their incised skin wounds healed. Every day, mice in all groups were assessed for wound area, percentage reduction in wound area (WAR) according to L.N. Popova’s method, rate of wound contraction, motor activity, appetite, dynamics and nature of wound healing. Every 3 days, changes in body weight were assessed, laboratory blood tests and histomorphological examination of the incised skin wound were performed. To obtain tissue samples, animals, according to the observation period were removed from the experiment by euthanasia using the method of cervical dislocation. Tissue samples excised from the wound and blood samples were examined on days 3, 6, 9, and 12 after skin wound formation. Samples for light microscopy were prepared and stained according to the methods. Viewing of preparations and microphotography was carried out on a Jenaval light microscope (Carl Zeiss, Jena, Germany). All data were processed statistically using Microsoft Excel and STATISTICA. Results and discussion. It was shown that almost until the end of treatment of purulent wounds in all groups of experimental animals with the control ointment Iruksol and Bioseptin ointment, negative dynamics of body weight was observed due to the expressed toxic effect of the purulent wound on the body of the research animals. The results of a blood test for hematological and biochemical parameters in the body of research animals of all three groups revealed changes characteristic of the development of a local infectious process and intoxication. Evidence was established of faster healing of purulent wounds in animals of groups 1 and 2 treated with Bioseptin and Iruksol ointments, respectively, compared to animals of group 3 (with a severe superinfected purulent wound). Moreover, complete visually observed wound healing in group 2 occurred in less than 9 days, in control group 1 and experimental group 3 on the 12th day of observation. Histomorphological study demonstrated the restoration of the structure of the skin in the wound as an organ with all its derivatives already on the 9th day in groups 1-2; in group 3 with a burdened purulent wound, complete restoration of the epidermal defect was not noted. Conclusion. Bioseptin ointment is promising as a drug for effective topical use in the treatment of infected wounds; the ointment has a significant antimicrobial effect. The microbial association (Bacillus subtilis strain ВКПМ B-7048 and Bacillus licheniformis strain ВКПМ B-7038) which is part of the Bioseptin ointment, promotes the cleansing of wounds, their granulation and faster healing compared to the control ointment Iruksol. The use of Bioseptin ointment for the treatment of complicated purulent wounds has been shown to be promising.

The goal of this study was to review clinical experience in treating diabetic and venous stasis wounds with Apligraf or PriMatrix. A total of 40 diabetic foot ulcers and 28 venous stasis ulcers were treated with either PriMatrix or Apligraf for number of days open and for number of days for complete healing between the 2 treatments. Although both treatments were highly effective, the study results of 68 ulcers in 48 patients demonstrated that patients treated with PriMatrix healed faster than patients treated with Apligraf despite larger wound sizes.

Introduction: Diabetes mellitus is considered a metabolic syndrome of multifactorial origin characterized by hyperglycemia and disorders in the metabolism of carbohydrates, proteins and fats that occurs when there is no insulin or when insulin does not perform its function properly. Diabetic foot injury is one of the most frequent implications of diabetes mellitus. It is associated with many factors, such as peripheral vascular disease and peripheral neuropathy, which in many cases may compromise the entire limb. In this context, the systematization of nursing care starts as a systematic method that makes it possible to identify and understand the needs of the patient. The application of the Systematization of Nursing Assistance brings benefits to the client, the institution, professionals and to nursing as a whole. Objectives: To verify the inference of the nursing diagnosis “Impaired skin integrity” and the use of the other steps of Nursing Care Systematization in the treatment of diabetic foot wound. Methods: This is an exploratory clinical study of the case-study type, carried out during the period of clinical nursing internship in a public hospital in the city of Recife-PE, from September 17 to October 11, 2018 Results: A 77-year-old male patient with diabetes mellitus, with MIE lesion and hallux amputation, fourth and fifth finger. During the aforementioned period, the data was collected through anamnesis, physical examination, records in the medical record and analysis of laboratory tests. In this way, it was possible to plan the Nursing Care Systematization and to apply the interventions for the diagnosis “Impaired skin integrity”, being: daily skin examination with image records and monitoring of wound healing, daily dressing with use of serum saline at 0.9%, Essential Fatty Acids (AGE) and Hydrogel in the necessary places, orientation on how to change the decubitus periodically and use of cushions in the regions, aiming to decrease the pressure. During the 14 days of activities implemented in the patient, the clinical progress of the patient was observed, with evolution of the wound, being observed the decrease of exudate, modification of necrotic tissue by shedding and increase of granulation tissue. Conclusion: In view of the above, it was possible to obtain satisfactory results, which emphasizes the importance of the implementation of the Nursing Assistance Systematization and nurses’ work in the treatment of wounds, requiring greater investments in this scope, regarding training, acquisition of coverages, standardization in the accomplishment, daily evaluation and respect the aseptic techniques.

Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general. To assess the clinical- and cost-effectiveness of (1) prevention and treatment strategies for diabetic foot ulcers and (2) systemic and topical antimicrobial agents in the prevention and healing of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases were searched, including MEDLINE, CINAHL, Embase and the Cochrane Library. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was consulted. Randomised and non-randomised trials with a concurrent control group, which evaluated any intervention for the prevention or treatment of diabetic foot ulcers, or systemic or topical antimicrobials for chronic wounds (diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds) and used objective measures of outcome such as: (1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses. Studies reporting solely microbiological outcomes were excluded. Decisions on the inclusion of primary studies were made independently by two reviewers. Disagreements were resolved through discussion. Data were extracted by one reviewer into structured summary tables. Data extraction was checked independently by a second reviewer and discrepancies resolved by discussion. All included studies were assessed against a comprehensive checklist for methodological quality. INCLUDED STUDIES - DIABETIC FOOT ULCERS: Thirty-nine trials which evaluated various prevention and treatment modalities for diabetic foot ulcers: footwear (2), hosiery (1), education (5), screening and foot protection programme (1); podiatry (1) for the prevention of diabetic foot ulcers; and footwear (1), skin replacement (2), hyperbaric oxygen (2), ketanserin (3), prostaglandins (3), growth factors (5), dressings and topical applications (9), debridement (2) and antibiotics (2) for the treatment of diabetic foot ulcers. INCLUDED STUDIES - ANTIMICROBIALS: Thirty studies were included, 25 with a randomised design. There were nine evaluations of systemic antimicrobials and 21 of topical agents. The methodological and reporting quality was generally poor. Commonly encountered problems of reporting included lack of clarity about randomisation and outcome measurement procedures, and lack of baseline descriptive data. Common methodological weaknesses included: lack of blinded outcome assessment and lack of adjustment for baseline differences in important variables such as wound size; large loss to follow-up; and no intention-to-treat analysis. RESULTS - PREVENTION OF DIABETIC FOOT ULCERS: There is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations. The evidence for special footwear (2 small trials) and educational programmes (5 trials) is equivocal. A single trial of podiatric care reported a significantly greater reduction in callus in patients receiving podiatric care. RESULTS - TREATMENT OF DIABETIC FOOT ULCERS: Total contact casting healed significantly more ulcers than did standard treatment in one study. There is evidence from 5 trials of topical growth factors to suggest that these, particularly platelet-derived growth factor, may increase the healing rate of diabetic foot ulcers. Although these studies were of relatively good quality, the sample sizes were far too small to make any definitive conclusions, and growth factors should be compared with current standard treatments in large, multicentre studies. Topical ketanserin increased ulcer healing rate in 2 studies, while systemic hyperbaric oxygen therapy reduced the rate of major amputations in 1 study. Preliminary research into the effects of iloprost and prostaglandin E1 (PGE1) on diabetic foot ulcer healing suggests possible benefits. However, good quality, large-scale confirmatory research is needed. (ABSTRACT TRUNCATED)