Diabetic foot ulcer treatment 2013,new research on type 2 diabetes nieuws,medical errors stories 2010 64 - Plans On 2016


Though previous studies showed that topical Retin-A was a bit helpful in enhancing wound healing in patients with diabetes and some results were discussed by different scientifics, a group of researchers tried to know if tretinoin really helped or not to these patients. The research was carried out with 24 volunteers who had diabetic foot ulcers but who showed no evidence of infection or circulation problems in their extremities.
There was no statistical significance of adverse events, though some patients experienced mild pain at the ulcer site.
The researchers were pleased with the results, although they were a bit concerned because tretinoin irritates and they thought that the patients would become so irritated that they wouldn’t be able to continue the research. A conclusion for the researchers was that they hope that diabetic foot clinics know about this and use Retin-A when other therapies that they use don’t work.
The majority of the population can maintain healthy feet through education, advice and prompt care.
Weight bearing areas and areas of high friction and stress with footwear are common ulcerative sites. A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot.
Diabetes is the leading cause of non-traumatic lower extremity amputation, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation.
Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Appropriate wound management includes the use of dressings and topically-applied medications.
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer.
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound.
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Learning how to check your feet is crucial so that you can find a potential problem as early as possible.
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Acknowledgements: This chapter was developed by Dr Brian Malcolm (a GP principal, trainer and Associate Specialist in Dermatology, in Barnstaple, North Devon), and further enhanced by Geraldine Bellerby (dermatology nurse specialist at the Middlesbrough Primary Care Skin Service). Leg ulcers are of huge socio-economic importance costing the NHS over one billion pounds per year.


The history must include medications, as drugs such as beta-blocker, steroids, non-steroidal anti-inflammatories (NSAID) and immunosuppressive agents can all adversely influence ulcer healing.
Venous oedema - tends to be pitting and to go down when the patient elevates their legs at night, may be unilateral.
Sclerosing panniculitis - this is the acute form characterised by painful inflammation of the lower legs, above the ankles, resembling cellulitis.
There may also be signs of arterial compromise such as pallor, loss of hair, nail dystrophy, coldness and diminished capillary refill. Alginates eg Kaltostat ® - derived from seaweed, very absorbent, hydrating and haemostatic. The Doppler ultrasound detects the flow of blood in the blood vessels This must ONLY be performed by a skilled clinician that has received training and been deemed as competent. Diabetic patients - all patients with foot ulcers must be referred to a diabetes foot clinic. If the ankle circumference is less than 18 cm extra padding should be used, as compression must never be applied to an ankle with a circumference less than 18 cm. Such patients are systemically well and often have a symmetrical bilateral distribution of well-demarcated stable erythema on their legs. Eczema can be improved with the use of an appropriate topical steroid eg Betnovate-C ® cream until symptoms improve. Most patients needing referral should be directed to community leg ulcer (tissue viability) clinics or dermatology departments. Remember that leg ulcers can result from diverse pathology, the images below are just a few examples.
A compound of vitamin A called topical Retin-A also known as tretinoin, mainly used to treat acne problems, enhances the healing of foot ulcers in patients with diabetes, according to a report of the Archives of Dermatology. Some patients were assigned to 4 weeks of daily treatment with topical 0.05 per cent tretinoin solution meanwhile the control group was assigned to a treatment with a saline solution. 18 per cent of patients in the control group (2 of the 11 ulcers) and 46 per cent of patients in the treated group (6 of the 13 ulcers) achieved a complete healing at the end of 16 weeks.
However, this situation didn’t seem to be a problem in most cases, as they explained. It allows Podiatrists to interpret movements, identify problems and suggest treatment options.
It is composed of the outer skin layer, the vascular system, neuromuscular system and skeletal system. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.


Foot ulcers in patients with diabetes should be immediately treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications. Pressure from shoes, and bandages, or injury to the foot, may subsequently go unnoticed and eventually leads to the development of a neuropathic ulcer. All dressings, however, have the common goal of achieving an optimal environment for wound healing, which is moist but not macerated, with an optimal ph and temperature, permeable to air, and free of infection, toxins, allergens and irritants. Dopplers may give false readings, there is often additional small vessel disease, and the long-term medications used for treating rheumatoid arthritis can delay ulcer healing. Excessive pressure applied to bony prominences could lead to pressure necrosis, which may extend to the tendons and bone (Moffatt, 1992). An ankle circumference of greater than 25 cm may require an extra bandage when using short stretch, or a different size when using 4-layer systems. Therefore in the absence of rest pain it is suitable for mixed aetiology ulcers (Marston, Vowden.
However, patients in groups 2 or 7 should be referred to vascular surgeons, and diabetic ulcers to the diabetic clinic. Research has shown, however, that the development of a foot ulcer is preventable and when they occur rapid treatment helps prognosis- here is were podiatry plays an important role. Other causes include diabetes, thromboangiitis, vasculitis, pyoderma gangrenosum, thalassaemia, and sickle cell disease, some of which may predispose to the formation of atheroma. It is important that doctors should have a basic understanding of the different categories of dressings in order to have an informed conversation with their nursing colleagues. Protection of these areas can be gained by applying a protective layer eg pad, foam or orthopaedic wool. Further damage to the arterial system occurs with concurrent hypertension through damage of the intimal layer of the artery. Lipodermatosclerosis tends to be painful and can prevent patients from tolerating compression therapy.




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