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Search Results: 1 - 10 of 2204 matches for " diabetic foot "
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Healing of chronic diabetic foot ulcers with a skin substitute: Patient selection is the key to success  [PDF]
Hasan Alzahrani, Hossam Ammar, Anas Alzahrani, Hossam Shoaib
Open Journal of Regenerative Medicine (OJRM) , 2013, DOI: 10.4236/ojrm.2013.22003

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.

Epidemiological and Clinical Features of Diabetic Foot in Cotonou  [PDF]
Annelie Kerekou Hode, Fran?ois Djrolo, Daniel Amoussou-Guenou
Journal of Diabetes Mellitus (JDM) , 2015, DOI: 10.4236/jdm.2015.53021
Abstract: This was a retrospective and descriptive study conducted from 1 July 2006 to 31 July 2011 and carried on 122 cases of diabetic foot collected a total of 706 diabetic patients hospitalized over a period of 5 years. Objective: To study the characteristics of diabetic feet in Cotonou. Results: The mean age of patients was 58.05 years ± 10.65 years, ranging from 35 years to 70 years. The sex ratio was 1.5. Duration of diabetes before the onset of diabetic foot was 11 years. The overall prevalence of diabetic foot was 21.53%. Of these, 95% had neuropathy, 70.40% had arterial disease and all had a foot infection. The amputation rate was 31.96% and the mortality rate was 17.21%. Conclusion: The occurrence of diabetic foot is earlier than in the West, and hence there is a need for early treatment of diabetes.
Effect of Vascular Occlusion on Amputation Level in Diabetic Foot
Murat BüLBüL,Semih AYANO?LU,Cem Zeki ESENYEL,Cem Din?ay BüYüKKURT
Trakya Universitesi Tip Fakultesi Dergisi , 2008,
Abstract: Objectives: We aimed to evaluate the effect of vascular occlusion on debridement and/or amputation levels in diabetic foot patients with regulated blood glucose levels and without deep tissue infection. Patients and Methods: The study included 31 patients (19 males, 12 females; mean age 65 years; range 52 to 81 years) followed up between 2002 and 2005. Mean follow-up was 25 months (18-59). Mean hospitalization time was 22 days (3-77). Thirty patients were discharged in good condition and one patient died. Results: All included cases had regulated blood glucose levels. A. dorsalis pedis and a. tibialis posterior were found totally occluded on Doppler ultrasonography. Despite occlusion, amputation levels were adjacent to necrotic areas. Eighteen patients had metatarsophalengeal joint disarticulation, 11 had transmetatarsal amputation, two had Syme amputation. Twenty-four patients (77%) were discharged without complications. During follow-up, six patients (19%) had new necrotic areas postoperatively, and underwent below-knee amputation. One case (4%) who had Syme amputation died after operation due to cardiac problems. Conclusion: We observed that instead of high levels of amputations which vascular surgeons suggest in diabetic food patients with vascular occlusion, tissue protective surgery is more appropriate.
The Diabetic Foot Research in Arabs’ Countries  [PDF]
Owiss H. Alzahrani, Yousef S. Badahdah, Moataz S. Bamakrid, Abdullah S. Alfayez, Mossab S. Alsaeedi, Amro M. Mansouri, Hasan A. Alzahrani
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2013, DOI: 10.4236/ojemd.2013.33023

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.

Effect of Carbon Dioxide Therapy on Diabetic Foot Ulcer  [PDF]
Naeem Shalan, Abdulrahman Al-Bazzaz, Israa Al-Ani, Fadi Najem, Mohammad Al-Masri
Journal of Diabetes Mellitus (JDM) , 2015, DOI: 10.4236/jdm.2015.54035
Abstract: Ulceration of diabetic foot represents one of the most concerning complications associated with uncontrolled blood sugar in diabetes mellitus. The aim of this study is to evaluate the condition of twenty-two diabetic patients with different degrees of ulceration in their feet after daily secessions of carbon dioxide therapy. Blood flow to the affected foot was measured by Doppler; also the size, color, degree of ulceration and sensation of the ulcerative area were all evaluated. Results showed improvement of blood flow to the affected foot as well as improvement in the sensation and color of the ulcerative area. It was concluded that carbon dioxide therapy of diabetic foot was promising and needed thorough investigation to be brought widely into application.
Evaluation of Charcot Neuroarthropathy in Diabetic Foot Disease Patients at Tertiary Hospital  [PDF]
Ahmed M. A. Kensarah, Nisar Haider Zaidi, Abdulhaleem Noorwali, Hager Aref, Ahmed Mohammed Makki, Afaf Ghunaim, Wail Tashkandi, Sara Mohammad Beayari, Adel Johari
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.76036
Abstract: Purpose: To evaluate Charcot neuroarthropathy in diabetic foot patients at tertiary hospital. Methods and Material: It is a retrospective study from 2005 to 2015 of Charcot foot patients in diabetic patients admitted in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Sixty-four patients were admitted as diabetic foot disease and were studied by reviewing patients records of demography, pain, discharge, duration of disease, duration and types of diabetes IDDM [Insulin Dependant Diabetes Mellitus] NIDDM [Non Insulin Dependent Diabetes Mellitus], history of trauma, peripheral vascular disease, obesity, hypertension, co-morbid conditions, previous surgery, involvement of fore foot/midfoot/hindfoot, deformity, ulcer and treatment like casts, offloading devices, pharmacological like biphosphonates, debridement, osteotomy, arthrodesis, exostectomy, and amputation. Results: Majority of patients were males (81.2%). Mean age was 61.75 years. Pain was reported in 25% of patients, numbness in 12.5%, foot deformity in 23.4%, pus discharge in 73.4%, difficulty in walking in 12.5%, and 10.9% had history of trauma. Majority of patients were NIDDM 68.8%, IDDM 31.3%, (62.5% had DM more than 10 years and 36.9% had DM less than 10 years), controlled DM in 21.9% and uncontrolled DM in 73.4%, nephropathy in 46.3%, neuropathy in 59.4%, retinopathy in 40.6%, cardiomyopathy in 48.4% and vasculopathy in 56.3%. Charcot arthropathy was in 28.1% of cases and forefoot was involved in 65.5%, midfoot in 4.7% and hindfoot/ankle in 21.9%. It was forefoot which was mainly involved in Charcot joint disease. It was demonstrated by X-rays which showed subluxation in 40.6%, dislocation in 54.7%, disorganized foot joints in 42.2%, bone resorption in 23.4%, osteomyelitis in 14.1%, fractures in 50%, joint collapse in 39.1% and destruction of articular surfaces in 37.5%. Debridement was done in 25% of cases while 75% of patients underwent some sort of amputation. 14.1% of patients underwent above knee amputation, 10.9% below knee amputation, 10.9% transmetatarsal and 39.1% toe amputation. Debridement and amputation were the main treatment offered. Conclusions: Diabetic patients with Charcot joint disease pose great challenge in management. Emphasis should be given for early detection, investigations and prompt treatment. Treatment should be tailored according to stage of disease and patient occupation.
Risk Factors for Amputation in Patients with Diabetic Foot Diseases in Sokoto, Nigeria  [PDF]
M. Oboirien, S. P. Agbo, L. O. Ajiboye
Health (Health) , 2018, DOI: 10.4236/health.2018.105050
Abstract: Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations in diabetics and to correlate these risks with mortality in our environment. Patients and methods: An audit of consecutive patients who were referred and had amputation as a result of diabetic foot diseases in a tertiary institution in Sokoto, northwest Nigeria over a 2-year period was done. Parameters studied using a predetermined protocol included the bio-data, socioeconomic status, vascular status, Meggit-Wagner grading status, indications for amputation and outcome. Results: There were nineteen amputations done in 19 patients with age range of 45 to 75 years and a mean age of 57.94 ±?8.92. There were more females (68%) than males (32%) giving a M:F ratio of 1:2. Forty-one percent of patients were housewives and 89.5% were of middle socioeconomic status. Seventy-three percent of the patients had no formal education while 31.6% has had diabetes for between 6 and 10 years. All the patients had comorbidity and 78.9% were Wagner's grade V. Ascending cellulitis and sepsis (68.4%) was the commonest indication for amputation. Trans femoral amputation was carried out in 47.4% and 21.1% had reamputation. A mortality rate of 15.8% was recorded and 52.6% defaulted from follow-up. There was no correlation between the risk factors and outcome in these patients (p > 0.05). Conclusions: Amputation was commonly done in the female diabetic housewife with no formal education. Educating these patients, improving their socioeconomic status will help them modify behaviours and identify foot at risk and complications.
Therapeutic Itinerary and Causes of Delay in Specialized Consultation of Patients Admitted for Diabetic Foot  [PDF]
Comlan Jules Gninkoun, Mensah S. Attikleme, Roberto Dossou Torès Prudencio, Adébayo Sabi Cossi Alassani, Fran?ois Djrolo
Journal of Diabetes Mellitus (JDM) , 2018, DOI: 10.4236/jdm.2018.84012
Abstract: Introduction: Amputation remains a common practice in patients admitted for diabetic foot. The delay in consultation is one of the main reasons. The objective of this work was to analyze patients’ itinerary care and to identify the causes of delay in consultation in patients admitted for diabetic foot. Method: This is a descriptive cross-sectional study, including all patients hospitalized for diabetic foot. A wait of at least seven (7) days before consulting the Endocrinology department of Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) after the foot injury occurred was considered as delay in consultation. The data were recorded and analyzed in the EPI INFO software. The description of the sample was made according to the usual statistics (frequency, average, standard deviation). Results: Seventy-six (76) diabetic foot cases were admitted during the period of the study. The mean age of the patients was 56.64 ± 10.71 years with extremes of 29 years and 84 years. Patients were most often received at an advanced stage of the foot injury, 3D stage of Texas classification in 87% of cases and Wagner grades 4 and 5 in 52% of cases. The amputation rate was 38.16%. An analysis of the first care places reveals that 90.8% of patients had consulted conventional medicine, 13.2% in traditional medicine; 1.2% had religious practices and 18.7% had declared self-medication at home. Consultation period at CNHU HKM was more than 7 days in 80% of cases and less than 7 days in 20% of cases. The average consultation time was 44.08 ± 26.43 days with extremes of 1 and 480 days. The main reasons for the delay in seeking hospital care cited by diabetic patients were fear of amputation (47.8% of cases), economic difficulties (32.5% of cases) and awareness lack of the situation seriousness (22.4%). Conclusion: The therapeutic itinerary of patients with diabetic foot was particularly long. The main reasons of late appeal to specialized care were fear of amputation and economic difficulties. The implementation of universal health insurance and an information, education and communication program could certainly reduce the periods allowed for recourse to care and therefore to reduce the amputation rate.
Evaluation of Peripheral Neuropathy in Diabetic Adults with and without Foot Ulcers in an African Population  [PDF]
Osita Ede, Gabriel O. Eyichukwu, Kenechi A. Madu, Iheuko S. Ogbonnaya, Kelechukwu A. Okoro, Chinonso Basil-Nwachuku, Kelechi A. Nwokocha
Journal of Biosciences and Medicines (JBM) , 2018, DOI: 10.4236/jbm.2018.612007
Abstract: Background: Foot ulcers frequently precede lower extremity amputations (LEA) in diabetic subjects. Peripheral neuropathy (PN) is a strong risk factor for diabetic foot ulceration. Majority of diabetic patients with PN are asymptomatic; hence foot ulceration may be the first clinical presentation. Early detection of PN can forestall the development of foot ulcers through active preventive strategies. Few studies have been done to assess PN in diabetic individuals in Africa. The study aims to evaluate the incidence and risk factors for PN in diabetic adults with and without foot ulcers in an indigenous African population. Method: This cross-sectional study involved 90 diabetic adults, 45 with foot ulcers and 45 without foot ulcers. Assessment of PN was done with the Michigan Neuropathy Screening Instrument (MNSI), the 10 g Semmes-Weinstein monofilament (SWM) and the 128-Hz vibrating tuning fork (VTF). Demographic data were collected by questionnaire. Associations between PN and risk factors such as age, alcohol consumption, duration of diabetes, cigarette smoking, BMI, height and sex were also investigated. Results: There were 59 males (65.6%) and 31 females (34.4%) in the study. The mean age of the subjects with foot ulcers was 59.62 years (SD = 6.47), while those without ulcers was 57.47 years (SD = 6.94). Forty-two subjects (93.33%) with foot ulcers have PN using the MNSI, while 33 subjects without foot ulcers (73.33%) have PN. Both the SWM and the VTF showed a high positive correlation with themselves and with the MNSI. Advancing age, duration of diabetes, alcohol intake, hyperglycaemia and cigarette smoking showed a significant association with peripheral neuropathy, while BMI, height and sex did not. Conclusion: The incidence of PN is quite high in diabetic adults in Africa. This calls for early screening and aggressive control of risk factors to prevent the development of diabetic foot ulceration.
Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis
Esther García-Morales,José Luis Lázaro-Martínez,Javier Aragón-Sánchez,Almudena Cecilia-Matilla
Diabetic Foot & Ankle , 2012, DOI: 10.3402/dfa.v3i0.19000
Abstract: Background: The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods: Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results: The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion: Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot.
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