Chronic wound management of diabetic foot

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1: the application of saline wash the wound debridement, when necessary to clear the wound tissue fragments, application of sterile package

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1: the application of saline wash the wound debridement, when necessary to clear the wound tissue fragments, application of sterile package to absorb wound wound dressing inert excessive secretion, keep warm and moist wound and promote wound healing. (recommended strength: strong; the strength of evidence: low) 2: the first application of sharp instruments and remove wound decay of necrotic tissue, wound around the crust, which measures prior to other measures, but should pay attention to the relative contraindications, such as severe ischemia. Strength of recommendation: strong; strength of evidence: low

The use of biological enzymes or hydrogels for debridement is not supported by the evidence available

The efficacy of single method was studied. Worm (pupa) treatment did not get the support of those reviews, only 4 small studies are discussed, each have a high risk of bias. Of course, there are two recent RCT

To investigate the application of the treatment method for the treatment of venous ulceration of the lower extremities, the results show that there is no significant benefit to the healing of the wound. 4: do not use antibiotic dressings to improve wound healing or prevent wound infection two. (recommended strength: strength; strength of evidence: medium) reasons: three systematic reviews of classic treatment options to improve the healing of chronic foot ulcers in diabetic foot.

General health agencies do not use honey as a routine treatment for chronic wounds unless there is evidence that the treatment is effective.

Other classic anti microbial method, such as the application of dressing with silver or iodine, is also very common.

As long as it can keep the wound moist, prevent the production of a large number of secretions, low price dressing can be applied. Recommendation 5: for the classic hyperbaric oxygen therapy, the need for further application of blind randomized controlled studies to confirm its effectiveness and cost-effective. (recommended strength: weak; evidence strength: medium) 6: Classic negative pressure wound treatment technology used in surgical wound, proven effective and cost-effective. Strength of recommendation: weak; strength of evidence: medium)

Reason: negative pressure wound treatment technology is to provide continuous or intermittent negative pressure technology. A good application of this technology requires a clear understanding of the effects of various levels of pressure, or the nature of the wound covering various dressings

General. The basic theory of negative pressure suction can reduce the exudation of the wound, and it can make the wound clean and reduce the odor. Further negative pressure suction can stimulate granulation tissue regeneration and contraction wound. Using mechanical method

Increase tissue perfusion, but also decompression. Negative pressure is often used to stimulate wound healing, but not to promote epithelial formation. There are some side effects, including wound maceration, dressings, and wound infections. Recommendation 7: change the wound biological environment do not use some institutions report to obtain method has better effects on wound healing, including growth factors, biological engineering products and skin gel, conventional treatment with more effective suggestions. (recommended strength: strength; strength of evidence: low) method for the treatment of wounds by the use of poly. Although this is a high quality RCT study, the healing rate of the control group was significantly lower, with a lack of detailed information about the

Health economics data. Early reports suggested that the other products (derived from small intestinal submucosa acellular biological products, acellular dermal matrix) to change the biochemical and biological characteristics of the wound, but not

Provide sufficient data to demonstrate the benefits of these methods. Platelet concentrates and platelet derived growth factors have been used for many years in the treatment of chronic diabetic foot wounds. Early studies included autologous platelet factors, but their use in leg and foot wounds was limited, and the subjects were not

Diabetic。 There was a report on the use of platelet concentrates to improve wound healing, but the lack of a large sample study and the application of the protocol set (perprotocol) analysis. Autologous blood

Platelet gel problems of blood volume to overcome, so the recent RCT study is the application of blood bank to obtain blood platelet. Although the study has obtained positive results, the inclusion criteria are not described in detail

There is no infection, ischemia, and necrosis of the wound tissue, such patients in diabetic foot ulcers are a minority. In addition, there may be serious complications such as infection of non autologous platelets. The use of growth factors extracted from platelets has also been discussed, involving six RCT trials, but some have no significant effect compared with the control group, some statistical methods have problems. These methods cannot be used as a routine treatment until they provide evidence of their effectiveness and cost effectiveness.

Other growth factors including fibroblast growth factor, epidermal growth factor, vascular endothelial growth factor and so on. 2 studies on fibroblast growth factor did not provide clinical data; although epithelial growth factor

Is widely used, but only 3 of the larger RCT study found, therefore can not determine the wound healing effect and narrow. One trial was to inject a plasmid carrying the VEGF gene into the muscle

Some effective results were obtained to reduce the wound area, but need to be further confirmed. At present, there is little evidence that single growth factor is more beneficial to diabetic foot wound healing than conventional methods. Early studies used cultured dermal fibroblasts, keratinocytes, or co cultured two cells to treat wounds, but did not achieve higher healing rates, or statistical problems. Recently only 1 design comparisons

The complete RCT report showed that it had a better wound healing effect, and the patients received other treatments for a good wound. The effectiveness and cost of the above treatment remains to be confirmed. another

A study on the co culture of fibroblasts and keratinocytes on the artificial epithelium needs further confirmation. These applications involve complex operating procedures, high costs and potential for slow virus infection. So we

It is suggested that these treatments need more evidence to be a routine clinical treatment. Free skin graft is widely used in the absence of infection, ischemia and necrosis of the wound, including diabetic foot chronic wounds. order

The surprise is only a clinical study found, and the results were not considered adequate chronic wounds with improved healing in diabetes. Since the evidence is derived from an earlier three IWGDF review, published earlier, and the trial design is biased, it cannot be recommended as a routine clinical treatment. Recommendation 8: including the method, do not choose some institutions recommend about changing the physical environment in order to obtain the curative effect of chronic wounds: electronic, magnetic, ultrasonic wave and shock wave solutions, conventional treatment methods suggest more effective application. Strength of recommendation: strong; strength of evidence: low

Rationale: the use of electronic stimulation, ultrasound therapy, temperature therapy, magnetic therapy and laser therapy has not provided convincing evidence of its efficacy. It is reported that shock wave therapy is more effective than hyperbaric oxygen therapy, but

The application of the study is consistent with the solution set (perprotocol) analysis, or the presence of other program design issues. Therefore, there is no evidence that physical therapy is more effective than conventional treatment. Recommendation 9: do not use systemic therapy to improve the healing of chronic ulcers, including drugs and herbal treatment, it is recommended to give priority to the standard conventional treatment. Strength of recommendation: strong; strength of evidence: low

Reason: the application of low molecular weight heparin, iloprost herbal injection and treatment (the oral

Vee Glenn Dean, reported in 12 weeks for chronic wounds have a certain effect, but compared with the control group curative effect difference and two times the price, make people think that good clinical effect of this product may be established in a good application

Based on the clinical wound management. There is not enough evidence to evaluate the effectiveness of other systemic therapies in the treatment of diabetic foot chronic wound healing.

 

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