Do peripheral arterial disease and smoking impede diabetic ulcer healing?

Background: In some patients, diabetic foot ulcers may heal slowly despite tight control of blood glucose and normal limb circulation, implying the presence of multifactorial, unidentified factors to wound healing. Previous efforts to identify these factors using binary variables, such as amputation or specific healing timelines, inadequately reflect the complexities of wound healing capacity.

Aims: We aimed to identify factors associated with delayed diabetic foot ulcer healing.

Methods: Eight factors were assumed to affect diabetic foot ulcer healing; patient age, age at the onset of diabetes, sex, peripheral arterial disease (PAD), HbA1c, smoking as measured by the Brinkman index (BI), dialysis and bone infection. They were analysed using linear regression and multivariable analysis against three healing indices: total healing period (THP), granulation time (GT) and time to contraction onset (TCO).

Results: PAD and BI correlated positively with all three indices. Patients with PAD exhibited significantly extended THP, GT and TCO. An increase of 100 in BI corresponded with a 1.53 day increase in GT. Conclusion: PAD was associated with delayed healing according to every measure analysed, while BI was linked with slower granulation. Besides THP, the measurements of GT — and possibly TCO — could evaluate some aspects of healing capacity of diabetic ulcers.

Kazufumi Tachi

Senior Lecturer, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Koichi Gonda

Professor, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Takashi Kochi

Chief Surgeon, Department of Plastic Surgery, Sendai City Hospital, Sendai, Japan

Jyunya Niwa

Research Associate, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Key words

Diabetic foot ulcer

New index of wound healing

Brinkman index

Declarations

All authors have no conflicts of interest to declare.

The use of transparent porous cellulose membrane in a surgical site infection in postoperative bicaval orthotopic heart transplant patient in Mexico: a case report

Surgical site infections of post-transplanted heart patients, as well as wound care, have little scientific evidence in Mexico, although adequate treatment in infected wounds with advanced wound dressings or cellulose membranes that allow us to clearly assess the incision can reduce hospital stay, pain, anxiety and the infection itself, together with appropriate antibiotic therapy. The aim of this case report is to describe the management and care of the surgical site infection (Gram-negative bacillus) following a heart transplant that includes the transparent cellulose membrane.

Dalila Diana Bautista Uribe

Nurse Specialised in Wounds, Stomata and Burns, Centro Médico Siglo XXI Cardiología, Mexico City, CDMX, Mexico

Key words

• Surgical site infection
• Bacterial cellulose membrane

• Heart transplant

Powdered porcine urinary bladder matrix for treating chronic diabetic wounds: clinical case studies

This article is based on a presentation by Professor Steven Jeffery at the annual Wounds UK conference in Harrogate, on 7 November 2023. Professor Jeffery presented clinical studies on how a bioengineered wound therapy with a porcine urinary bladder matrix (UBM) may facilitate healing of chronic wounds.

Steven LA Jeffery

Medical Director Pioneer Wound Telehealth and Professor of Wound Study, Birmingham City University

John McRobert

Clinical Research Director, Pioneer Wound Telehealth

Key words

• Chronic diabetic wounds

• Urinary bladder matrix
• Macrophages
• Wound healing
• Meeting report
• Wound care services

This meeting report has been funded by an educational grant from Integra

Evaluation of a technology lipido-colloid non-adherent dressing with silver in the management of burn patients — a case series from India

Management, as well as prevention, of wound infection is key in the promotion of the healing process. In India, over one million people are moderately or severely burnt every year, and managing the challenging burn wounds is a daily reality for clinicians in the country. Silver has been used as an antimicrobial in burn wound management for decades and modern advanced dressings can provide safe prevention and management of infection in these cases. This article reports the cases of two adults, an infant and a child with burns, at risk of infection and managed with a Technology Lipido-Colloid non-adherent dressing with silver (TLC-Ag; UrgoTul Ag/Silver). The main benefits observed when using the evaluated dressing in these patients included rapid wound healing but also patient-related outcomes, such as decrease in pain and atraumatic removal.

Dr Venkateswaran

Plastic Surgeon, Jupiter Hospital, Mumbai, India

Dr Ravichander Rao A

Plastic Surgeon, Care Hospital, Hyderabad, India

Dr Krishna Kumar

Plastic, Aesthetics, Burns, Hand and Reconstructive Microsurgeon, Kovai Medical Centre & Hospital, Coimbatore, India

Dr Sankamithra

Consultant Plastic Surgeon, Lakshmi Medical center, Pollachi, India

Key words

• Burns
• Lipido-colloid non-adherent dressing

• Silver

Declarations

All authors have no particular conflicts of interest to declare regarding these cases.

EGF in the treatment of electrical burns and the decrease of bone resorption

Abstract: Electrical burns represent 5-8% of burns in developed countries (World Heath Organization, 2016). A multidisciplinary approach is required due to the variety and complexity of injuries, which are affected by the intensity of the electrical current, compromised tissues in the patient, and the duration of exposure. This paper presents a patient case and discusses complications to consider. The efficacy, tolerability and safety of recombinant human epidermal growth factor (rhEGF) is discussed together with other considerations and long-term outcomes.

Espitaleta Omaira

Department of Plastic and Reconstructive Surgery, Clínica Cartagena del Mar S.A.S.

Dr Román Carlos

Plastic Surgeon, Clínica General del Caribe

Gaviria N. Ángela María

BSc, MSc Epidemiology, Grupo Biociencias, Institución Universitaria Colegio Mayor de Antioquia

Carrillo B. Carlos Alberto

Epidemiologist, Sociedad Colombiana de Medicina Preventiva

Key words

• Electricai burns
• rhEGF
• Multidisciplinary

Impact of Freestyle Libre 2 on diabetes distress and glycaemic control in people on twice-daily pre-mixed insulin

Samina Ali

      In the UK, people with type 1 diabetes and those with type 2 diabetes managed with multiple daily insulin injections (MDI) meet the eligibility criteria for continuous glucose monitoring (CGM) use. Previous studies have shown that CGM results in improvements in diabetes distress and HbA1c in people with type 2 diabetes on MDI; however, studies in people with type 2 diabetes on pre-mixed insulin regimens have not been published to date. This service evaluation of ten people with type 2 diabetes on twice-daily pre-mixed insulin regimens using the FreeStyle Libre 2 CGM system demonstrates improvements in both diabetes distress scores and HbA1c. Although only a small study, the findings suggest that expanding CGM eligibility criteria to include this patient group may be beneficial.

Citation:  Ali S (2024) Impact of Freestyle Libre 2 on diabetes distress and glycaemic control in people on twice-daily pre-mixed insulin. Diabetes & Primary Care 26 : [ Early view publication]

Article points

1. There are limited studies on the use of continuous glucose monitoring (CGM) in people with type 2 diabetes on twice-daily pre-mixed insulin regimens.

2. In this small service evaluation, CGM use was associated with reductions in PAID (Problem Areas In Diabetes) scores of diabetes distress and in HbA1c.

3. Local and national guidelines may need to be amended to include twice-daily pre-mixed insulin in the eligibility criteria for CGM use in people with type 2 diabetes.

Key words

– Continuous glucose monitoring

– Insulin

– Pre-mixed insulin

– Type 2 diabetes

Author

Samina Ali, Advanced Practice Pharmacist, NHS Greater Glasgow and Clyde.