Diabetic foot: epidemiological data and current topical treatment options


Authors: E. Martinka
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, diabetologické oddelenie, primár doc. MUDr. Emil Martinka, PhD., Ľubochňa ;  MMM Consulting, Bratislava
Published in: Forum Diab 2013; 2(2): 74-83
Category:

Overview

Risk of diabetic foot amputation is 15–40 times higher than in the general population and is linked to diabetic foot syndrome (SDN), a condition defined as infection, ulceration and / or tissue destruction as a result of foot neuropathy and / or ischemia. SDN in the course of the disease may develop in up to 15% of patients with diabetes mellitus. SDN prevalence in developed form (presence of defects / ulceration), according to several authors in the range of 3–10% of all diabetics, the annual incidence is 2–11%. Advanced stages as defects complicated by osteomyelitis or gangrene, develop in about 2.2 to 4% of patients. Amputation power leg is still evaded about 0.25 to 1.8% of patients per year. According to data from NCZI in 2011, when the total number of reported patients with diabetes mellitus was 336,552, foot lesions were observed in 2.3% of patients, what represents just a slight decline in comparison to the previous years. According to the various sources, the risk of amputation could be reduced by up to 40–85%. It requires active search for patients at risk, early detection of defects, good organization of care, establishing podiatric centers, functioning interdisciplinary care (cooperation between diabetologist, surgeon, podiatrist, neurologist, orthoprotetist or dermatologist), well-led treatment and education and cooperation of patients . In addition to traditional pillars of treatment, such as optimization of metabolic control, treatment of blood circulation, treatment of neuropathy, infection or relieving a local treatment with lots of modern dressings materials, has recently appeared several newer methods that are currently now in Slovakia.

Maggot therapy. In the treatment of diabetic wounds larvae successfully used on infected wounds, especially in multi-drug resistant pathogens cultured (for example, Pseudomonas aeruginosa, MRSA, etc). They are used to aseptically reared larvae of Lucilia sericata. They are applied directly to the dregs of the defect. Feed on dead and infected tissue and act as “biological knife” and defect perfectly mechanically cleaned, and do not attack healthy tissue. Debridement is essential for the subsequent start of the process of healing and even accentuate their biologically active substances contained in the saliva of the larvae.

Treatment with controlled vacuum (Vacuum assisted Closure Therapy – VAC). It is used as an effective method for promoting granulation and speed up the natural healing process in larger defects including. When applying negative pressure to the puncture increases capillary blood flow, reduces the interstitial edema and also bacterial colonization defect suction inflammatory debris that contributes to the promotion of granulation base of the defect and fundamental accelerating all phases of healing.

Treatment with live cell lines – Apligraf. It is a method intended primarily for the treatment of chronic, non-healing wounds are long using live cells from human skin (fibroblasts and keratinocytes) technologically processed into double-layer formulation, which in structure resembles the skin. This is not a skin graft. Essence of the method lies in the fact that the cells produce a product delivered to the wound a number of biologically active factors what exactly are growth factors and cytokines that promote the healing process of the wound itself.

Other newer methods include treatment with blood concentrate rich in platelets, special dressings and other materials.

Key words:
diabetic foot – maggot therapy – treatment with controlled vacuum – treatment with live cell lines


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Labels
Diabetology Endocrinology Internal medicine
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