Diabetic Foot Ulcer And Usage Of Amniotic Membrane For Foot Ulcer.

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diabetic foot ulcer

Introduction:

A diabetic foot ulcer is a common complication of poorly controlled diabetes that occurs in approximately 10 to 15 percent of diabetes patients and generally located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication. Patients with poor glucose control confront complications sooner. Unfortunately, the majority of lower leg and foot amputations are performed on patients with diabetes mellitus . The chances of lower extremity amputation are 15 to 46 times higher in diabetics compared to persons who do not have diabetes mellitus. The majority of diabetic foot complications resulting in amputation start with the formation of skin ulcers. The most significant risk factors for foot ulceration are diabetic neuropathy, peripheral arterial disease, and consequent traumas of the foot. Diabetic neuropathy is the common factor in 90% of diabetic foot ulcers. Damage to nerve in diabetes impact the motor, sensory, and autonomic fibers. Motor neuropathy result into paresis, muscle weakness and atrophy. Sensory neuropathy results in reduction of protective sensation of pain, pressure, and heat. Autonomic dysfunction causes vasodilation and decreased sweating which further leads to loss of skin integrity, providing a site susceptible to microbial infection. Advance detection and applicable treatment of these ulcers may inhibit up to 85 % of amputations. Worldwide prevalence of diabetic foot is 6.3%, and the incident rate in, Asia, Europe, Africa, Oceania and North America was 5.5%, 5.1%, 7.2% , 3.0% and 13.0%,  respectively. According to a study diabetic foot ulcer was more prevalent in males compared to females, and more prevalent in type 2 diabetic in comparison to type 1 diabetic. According to the international diabetes federation, approximately 80% people with diabetes live in low to middle income countries including India, having second highest number of diabetic patients in the world after China.

diabetic foot ulcer

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 Management of diabetic foot ulcer:

Treatment of diabetic foot ulcer generally addresses three major issues such as debridement, offloading, and infection control.

  • Debridement
  • Offloading
  • Infection control
  • Bioengineered Skin Substitutes
  • Negative-Pressure Wound Therapy

Usage of Amniotic Membrane (AM) for diabetic foot ulcer

Regenerative medicine provides immense potential for skin regeneration following injury and disease. One of the major aspects of tissue engineering is regenerative medicine which aims to reinstitute, maintain and ameliorate the functions of lost tissues via in developing or reconstructing the biological substitutes. An essential constituent of tissue engineering is the supporting matrix (scaffold) which support structurally and provide suitable environment for cell attachment, growth and differentiation. Amniotic membrane is tissue obtained from human placenta rich in growth, cytokines and stem cells which having the potential to inhibit infection, improve healing, and stimulate regeneration. Recently, several studies have demonstrated the potential of human amniotic membrane allografts healing diabetic foot ulcers. According to the study conducted by Zelen et al, 97 percent of patients (31/32) treated with Epifix (dehydrated amnion product) demonstrated complete healing at 12 weeks compared with 73% of patients with Apligraf (bioengineered skin substitute) and 51% of patients with SOC (standard of care) respectively. In conclusion, AM graft can be an ideal choice for the treatment of foot ulcerations, this approach require advance knowledge and more clinical data which further supports its use in the treatment of diabetic foot ulcer.

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References:

  1. Diabetic foot ulcer prevention & treatment. https://www.bbraun.com/en/products-and-therapies/wound-management/diabetic-foot-ulcers.html
  2. Lavery LA, Ashry HR, van HW, et al. Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care 1996;19:48–52.
  3. Kleopatra A, John D, et al. Management of Diabetic Foot Ulcers. Diabetes Ther. 2012 Dec;3(1):4.
  4. United States National Diabetes Advisory Board. The national long-range plan to combat diabetes. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 1987; NIH publication number 88-1587.
  5. Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of Medicine. 2017;49(2).
  6. International Diabetes Federation. IDF Diabetes, 7 ed. Brussels, Belgium: International Diabetes Federation; 2015.
  7. Alexiadou K, Doupis J. Management of diabetic foot ulcers. Diabetes Ther. 2012;3(1):4.
  8. Kannaiyan J, Narayanan SS., Palaniyandi M, et al. Amniotic membrane as a scaffold in wound healing and diabetic foot ulcer: an experimental technique and recommendations. Int J Res Med Sci. 2016;4(8):3654-3660.
  9. Haugh AM, Witt JG, Hauch A, et al. Amnion Membrane in Diabetic Foot Wounds: A Meta-analysis. Plast Reconstr Surg Glob Open. 2017;5(4):e1302.
  10. Fetterolf D, Snyder R. Scientific and clinical support for the use of dehydrated amniotic membrane in wound management. Wounds. 2012;24(10):299-307.
  11. Zelen CM, Serena TE, Gould L, et al. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost. Int Wound J. 2016;2:272–282.

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