Diabetic foot ulcers are one of the most common complications of diabetes. It’s estimated that between one-fifth and one-third of diabetes patients will develop them at some point. And they can get serious. More than half of all diabetic foot ulcers become infected and about 20% of those with moderate to severe infection will require amputation of a toe. Among these statistics, however, is an encouraging one: regular foot examinations can reduce amputation rates by as much as 85%. Experts recommend a foot exam should be part of every diabetes patient’s visit to their healthcare provider.
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The standard treatment for diabetic foot ulcers in the 19th century was bed rest. As care improved, a basic process was developed for managing foot ulcers: debridement (the removal of dead or contaminated tissue), dressings to keep the wound moist, off-loading (keeping pressure off the foot), blood vessel assessment, treatment of infection and blood sugar control. Even so, diabetic foot ulcers remain stubbornly slow to heal.
A new study from researchers at the Konkuk University School of Medicine in Seoul, South Korea, however, now indicates that treatment with a newly formulated medical paste can improve the treatment of foot ulcers. For their research, the investigators reviewed data from 86 patients and enlisted 49 who had experienced grade 2 or 3 foot ulcers (on a scale of 1-5) for at least a month. Twenty-six of the patients were given conventional treatment with foam dressings that were changed every three to four days; the remainder of the patients received a recently developed paste formulation of acellular dermal matrix (ADM). ADM is a material that combines various substances (collagens, elastin, lycosaminoglycans and hyaluronic acids). Previous studies have explored the use of an ADM paste for various types of wounds; this new study was the first to examine its effectiveness for foot ulcers.
The treatment period lasted 60 days. To begin, the ulcers were debrided and irrigated. The amount of ADM paste used depended on the size and depth of the ulcers. After the paste was applied, foam dressings were used to cover the surface and absorb any discharge. Follow-up ulcer evaluations were done 20, 40 and 60 days after the initial paste application.
At the conclusion of the follow-up period, the researchers determined that 13 of the 23 paste-treated patients (56.52%) showed complete healing. Among the patients treated conventionally, only 6 out of the 26 (23.08%) showed complete healing. Not only that, the time needed to achieve complete healing was shorter in the ADM group than in the control group. Speedier healing is especially important, the scientists said, “because the poor vascularity associated with comorbid conditions renders the healing process in diabetic ulcers unpredictable.” The researchers also pointed out that “these findings occurred despite the mean initial wound area of the treatment group exceeding that of the control group.”
The researchers acknowledged that the number of subjects in the study was relatively small and said that their research is ongoing. They would especially like to study how the ADM paste works on diabetic foot ulcers that are more severe and difficult to treat than the ones they examined. However, they were able to conclude that their research had demonstrated the “healing effects of ADM paste” in grade 2 and grade 3 diabetic foot ulcers.