Modern trends in local treatment of diabetic foot


Authors: Emil Martinka
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
Published in: Forum Diab 2019; 8(2): 88-97
Category:

Overview

Diabetic foot (DF) is a frequent and medically serious complication of diabetes mellitus (DM) with significant socio-economic impact as well as impact on patient’s quality of life. It is the most common (85%) cause of lower limb amputation and is associated with increased mortality which is comparable with cancer. This highlights the need to address this issue and seek new treatment options. According to data from the National Center of Health Information (NCZI), there were 8,596 (prevalence of 2.4%) of diabetic patients with DF with lesion and 4,196 (prevalence of 1,19%) of patients with a history of DF-amputation registered in Slovakia in 2017. The annual incidence of DF with a lesion was 1,325 new cases (3.74 /1,000 patients per year/PPY) and an incidence of amputations was 413 cases (1.17/1,000 PPY). Thus, the incidence and prevalence of DF and amputations for DF in Slovakia are comparable, or lower than the most commonly reported average in European countries or the US literature. However, direct comparison of these data is limited. The characteristic medical problem of DF is the complexity of pathophysiology, and, due to functional and physical changes induced by diabetes and the deploying processes, failure of repair process, transition to chronicity, non-responsiveness to local treatment, increased bacterial load by pathogenic biofilm, deficiency of growth factors, increased content and degradation by proteases, accelerated cell aging, chronic inflammatory organism and others. During wound healing, ulceration passes through several phases, which can be divided into a purification phase/infection elimination, granulation phase and epithelialization phase. The basis of the treatment of diabetic ulcerations is local leg relief, regular mechanical or enzymolytic debridement, treatment of infection, treatment of ischemia, relief, moist dressing. If basic care is not enough, other options include vacuum therapy, topical application of growth factors, hyperbaric oxygen therapy, and other methods that we have dealt with in other publications. Procedures that have recently been included in our therapeutic armamentaria include treatment with air plasma and exogenous nitric oxide (NO), using Plason, promoting binding epithelialization by applying the Amnioderm lyophilized human amniotic membrane-based biological healing membrane and topical cream based on goat colostrum containing lactoferrin and other biologically active ingredients.

Keywords:

diabetic foot – nitric oxide – Plason – Amnioderm – goat colostrum


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