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This is a prospective case series study aimed to preliminarily assess the efficacy and safety of a skin substitute (Apligraf) application to heal chronic diabetic foot ulcers (DFUs) in a group of diabetic patients who were treated in the diabetic foot clinic of King Abdulaziz University, Jeddah, Saudi Arabia. Five consecutive patients who presented with large, hard to heal neuropathic ulcer for an average duration of 162.2 weeks were treated with multiple applications of Apligraf and followed up for 40 weeks. Three out of the five ulcers (60%) ended up with complete wound closure. One plantar ulcer healed partially and another plantar ulcer healed after 14 weeks but recurred after 10 weeks of wound closure due to infection. This small case series study indicates the importance of careful patient selection in healing chronic (DFUs) when using a skin substitute like Apligraf. Long standing large plantar ulcer in a non-complaint diabetic patient is the most difficult to heal and this should be kept in mind when using this relatively high cost modality of treatment.
Objective: To review all the studies on diabetic
foot disorders (DFDs) that were published on the PubMed? site aiming
to identify the contributions of the different Arabs’ countries in the world scientific
literature on this topic. Methods: The PubMed? site was searched using different
key words for searching all the abstracts on Diabetes mellitus (DM) and DFDs published
from Arabs’ League countries (n = 22). For this review, the 22 countries were classified
into 3 groups: Group 1 (G1): Gulf Council Countries (GCC) countries (n = 6), Group
2 (G2): African Arabs’ countries (n = 10), Group 3 (G3): Asian and/or Eastern Mediterranean
Arabs’ countries (n = 6). All the abstracts on DM coming from all of the 22 Arabs’
countries were initially reviewed to locate the ones related to DFDs’ management.
All of the articles related to DFDs were reviewed by the senior author. A publication
index was created to allow a comparison between the productivity of various countries
and correlate that to the population number. Results: By April 2012, a total of 906 articles were published
on DM, out of them 115 (11.6%) were related to DFDs. The largest number of DM/DFDs
research came from G1 countries (n = 437/51) followed by G2 (n = 307/38) and finally
G3 (n = 162/26). The percentages of the studies related to DFDs were therefore:
11.6%, 12.3% and 20.6% respectively. Saudi Arabia was the top on the list
of all studied countries with 31 studies related to DFDs out of the 187 on DM (16.5%). Conclusion: More research on DFDs is needed in most of the Arabs’ countries particularly
those in the GCC region which reported very high prevalence rates and are expected
to hold these rates for the coming decades. Also, special attention is needed for
those low-income Arabs’ countries that had no contributions in DFDs’ research.