Monitoring of Systemic Inflammatory Response in Diabetic Patients with Deep Foot Infection Treated with Negative Pressure Wound Therapy

2012 ◽  
Vol 33 (10) ◽  
pp. 832-837 ◽  
Author(s):  
Łukasz Dzieciuchowicz ◽  
Łukasz Kruszyna ◽  
Zbigniew Krasiński ◽  
Gaudencio Espinosa
Keyword(s):  
Inflammatory Response ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Systemic Inflammatory Response ◽  
Diabetic Patients ◽  
Wound Therapy

scholarly journals Associating Insulin Instillation with Negative Pressure Wound Therapy Reduces Insulin Resistance in Diabetic Patients with Infected Foot Wounds

2020 ◽  
Vol 7 (3) ◽  
pp. 1-8
Author(s):  
Xin-long Chen
Keyword(s):  
Insulin Resistance ◽  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Serum Levels ◽  
Treated Group ◽  
Post Treatment ◽  
Diabetic Patients ◽  
Wound Therapy ◽  
Tnf Α

In this work we investigated whether a joint treatment with insulin instillation and negative pressure wound therapy (NPWT) would reduce insulin resistance (IR) in diabetic patients with infected diabetic foot ulcers (DFUs) and improve their healing. We also studied the effects of insulin+NPWT treatment on the inflammatory response coupled with wound healing. Seventy-five diabetic patients with infected DFUs were recruited and randomly divided into equal (n=25) groups treated respectively with NPWT alone, NPWT+insulin, and conventional dressings (controls). Thereafter, the ulcers’ healing progress was assessed. The serum levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2), and Interleukin-6 (IL-6) were measured at 1 day before and at 7, 14, and 21 days after each treatment using specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA). Serum glucose was measured via a glucose-oxidase method, and serum insulin via radioimmunoassay. In each patient, IR was appraised via the Homeostasis Model Assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Our results showed that at 7, 14 and 21 days post-treatment, with respect to the control group the two NPWT-treated groups had (i) significantly (p < 0.05) lower serum levels of TNF-α, IL-2 and IL-6; (ii) a significantly (p < 0.01) greater reduction in IR; and (iii) significantly (p < 0.05) higher wound healing rates. Moreover, at 14- and 21-days post-treatment, the NPWT+insulin-treated group had a significantly (p < 0.05) higher wound healing rate than the NPWT alone-treated group. In conclusion, the combined NPWT+insulin instillation treatment gave superior results by improving wound healing, decreasing inflammation at the wounds surface, and reducing IR in diabetic patients with infected DFUs.

scholarly journals Effect of negative pressure wound therapy for legs in complex wound diabetic patients: Therapeutic challenge and review

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110259
Author(s):  
Túlio Fabiano de Oliveira Leite ◽  
Elpidio Ribeiro da Silva ◽  
Edwaldo Edner Joviliano
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Multidisciplinary Treatment ◽  
Limb Amputation ◽  
Medical Attention ◽  
Diabetic Patients ◽  
Wound Therapy ◽  
Dermal Matrix ◽  
Therapeutic Challenge

Diabetic foot is one of the main chronic complications caused by diabetes mellitus and can lead to limb amputation. Among the various wound treatment options, negative pressure wound therapy is a treatment modality based on vacuum-sealed drainage and vacuum-assisted closure to create a localized controlled negative pressure environment. In this case report, the patient sought medical attention and underwent surgical debridement of the dorsum of the right foot. Upon worsening of the wound condition, the patient was referred to our hospital for debridement and Renesys Smith Nephew dressing was implanted. After complete coverage of the granulation tissue without infection, elastic suturing was performed in the leg compartment to reduce the size of the dermis and epidermis graft. The patient then underwent a dermal matrix implant procedure, and an epidermis graft was removed from the ipsilateral thigh and placed on the wound. The aim of this study is to report a therapeutic challenge in an extensive wound in diabetic foot using a dressing negative pressure wound therapy and multidisciplinary treatment.

Effect of negative-pressure wound therapy on the circulating number of peripheral endothelial progenitor cells in diabetic patients with mild to moderate degrees of ischaemic foot ulcer

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 381-389 ◽  
Author(s):  
Shichang Mu ◽  
Qiaoqiao Hua ◽  
Yangyang Jia ◽  
Ming-Wei Chen ◽  
Yizhong Tang ◽  
...  
Keyword(s):  
Progenitor Cells ◽  
Endothelial Progenitor Cells ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Foot Ulcer ◽  
Diabetic Patients ◽  
Endothelial Progenitor ◽  
Wound Therapy ◽  
Significant Change

Objective To investigate the effect of negative-pressure wound therapy (NPWT) on the circulating number of endothelial progenitor cells (EPCs) in diabetic patients with mild to moderate degrees of ischemic foot ulcer. Methods We selected 84 diabetic patients who had a foot ulcer with a duration of at least four weeks and who had an ankle-brachial index of 0.5–0.9. Patients were assigned to one two groups according to 2:1 randomization: NPWT group ( n = 56) and non-NPWT (patients who did not receive NPWT) group ( n = 28). The control group (NC group) was composed of 18 patients who had normal glucose tolerance and lower extremity ulcer without arteriovenous disease. NPWT was performed on the ulcer after debridement for one week for patients in both the NPWT group and the NC group, and the patients in the non-NPWT group received conventional treatment process. The circulating number of EPCs was measured before and after various treatments, and the factors influencing their changes were analysed. Results After NPWT, the circulating number of EPCs significantly increased in both the NPWT group and the NC group ((85.3 ± 18.1) vs. (34.1 ± 12.5)/106 cells; (119.9 ± 14.4) vs. (66.1 ± 10.6)/106 cells, both P < 0.05). In contrast, the circulating number of EPCs had no significant change in the non-NPWT group ((45.2 ± 19.4) vs. (34.7 ± 16.8)/106 cells, P > 0.05). In addition, the circulating levels of vascular endothelial growth factor (VEGF) and the protein expressions of VEGF and stromal cell-derived factor-1α (SDF-1α) in the granulation tissue significantly increased after NPWT in both the NPWT and the NC group, but there was no significant change in the non-NPWT group. Compared with the non-NPWT group, the changes in VEGF and SDF-1α levels in the sera and granulation tissue were all significantly higher in both the NPWT and NC groups ( P < 0.05, P < 0.01, respectively). There was no significant difference in changes in the circulating number of EPCs in the peripheral blood and levels of VEGF and SDF-1α in the sera and granulation tissue between the NPWT and NC groups. Correlation analysis showed that the change in the circulating number of EPCs was correlated with the changes of VEGF and SDF-1α levels in the sera and granulation of the NPWT and NC groups ( P < 0.05). Conclusion NPWT may increase the circulating number of EPCs in diabetic patients with mild to moderate ischaemic foot ulcer as in non-diabetic controls, which may be attributed to the upregulation of systemic and local VEGF and SDF-1α levels.

scholarly journals Comparison of negative pressure wound therapy with moist wound therapy in the treatment of diabetic foot ulcers with non-revascularisable peripheral vascular disease

2017 ◽  
Vol 4 (7) ◽  
pp. 2173
Author(s):  
Someshwara Rao Narayana Pallela ◽  
Padmavathi Narahari
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Foot Ulcers ◽  
Control Group ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Wound Therapy

Background: Diabetic foot problems are the commonest reason for hospitalization of diabetic patients (about 30% of admissions) and absorb some 20% of the total health-care costs of the disease more than all other diabetic complication. The numbers of patients with chronic wounds and wound complications continues to increase. Wound management is a challenge in diabetic wound. Chronic wounds require significant medical, nursing and financial input with poor long-term results. One-third of all diabetic patients have significant peripheral neuropathy and/or peripheral vascular disease (PVD). In India prevalence of foot ulcers in diabetic patients in clinic population is 3%. Over the past several years negative pressure wound therapy (NPWT) using vacuum- assisted closure has emerged as the treatment of complex wounds of the diabetic foot. Many reports on the use of Vacuum Assisted Closure (VAC) therapy after failed revascularization have found increased chances of success. Clinicians should consider negative pressure wound therapy as an adjunct to other modalities in an effort to avoid complications.Methods: Total of 51 patients were included in this prospective study. They were randomly divided into two groups, negative pressure wound therapy (NPWT) group (25 patients) and control group (26 patients) who were treated with regular dressings. All the patients included had peripheral vascular disease which was declared non-revascularisable after vascular workup. Initial mean surface area was measured in each patient. Transcutaneous oxygen pressure was recorded in all the patients and each patient followed up based on their granulation tissue development and need for amputation in each group.Results: After wound management, mean surface area of the diabetic wounds was 39.08cm2 in the NPWT group (P=0.019), and 38.63cm2 in the control group (P=0.327). The use of NPWT may be an effective initial wound therapy to achieve faster wound bed granulation showing signs of healing in 19 among 25 patients (76%) compared to control group 7 showed granulation among 26 patients (26%) (P=0.001). The incidence of secondary higher amputation in NPWT group is 6/25 (24%), the control group 17/26 (65%) (P=0.003), suggesting reduced incidence of secondary higher amputations in NPWT group. After treatment, the experimental group significantly improved in measures of foot ulcer surface area compared with the control group. Further studies are needed to clarify the effects and indications and to modify the technique of this alternative treatment for use on non healing wounds.Conclusions: NPWT-treated patients reached a successful wound treatment endpoint more rapidly, and the benefit was apparent in all wound sizes. NPWT appears to be a safer and efficacious method, than moist wound therapy for the treatment of diabetic foot ulcers. 

scholarly journals Effectiveness of negative pressure wound therapy in the management of chronic diabetic ulcers: a prospective study

2017 ◽  
Vol 4 (4) ◽  
pp. 1313 ◽  
Author(s):  
Dhruv Sharma ◽  
Biplav Singh ◽  
K. S. Jaswal ◽  
Vishal Thakur ◽  
Vibhor Nanda ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Diabetic Patients ◽  
Wound Therapy ◽  
Diabetic Ulcers ◽  
Silicone Catheter ◽  
Patients With Diabetes ◽  
The Moment ◽  
A Prospective Study ◽  
Dressing Change

Background: Chronic ulcers in patients with diabetes are complex and treatment is often difficult. At the moment, negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in chronic diabetic ulcers is scarce. The aim of this study was to evaluate the efficacy of NPWT to treat chronic diabetic ulcers.Methods: Prospective time bound comparative study. Diabetic patients aged 18 years or older with an ulcer were assigned to treatment with NPWT. Primary efficacy end point was time in reaching complete ulcer closure. A size of sample of 15 patients was used. NPWT was prepared with a polyurethane foam dressing, a Silicone catheter, a transparent adhesive drape and continuous negative pressure of 125 mm Hg. The wound was treated for cycles of 5 days and evaluated at every dressing change. Descriptive and analytical statistics were used.Results: There were 15 patients, with a mean age of 54.4 years (73.3% men). The average time to complete ulcer closure was (41.2 [8.5] days).Conclusions: NPWT is an effective modality of treatment of chronic diabetic ulcers with early appearance of granulation tissue and faster rates of overall complete wound closure.

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