Transcript MANAGEMENT OF DIABETIC FOOT SYNDROME

MANAGEMENT OF DIABETIC
FOOT SYNDROME
BY
DR AKPOJEVWE E.O.
CONSULTANT ORTHOPAEDIC/TRAUMA SURGEON
DELSUTH
OGHARA
NIGERIAN MEDICAL ASSOCIATION, DELTA STATE
CME SERIES MAY 2014
OUTLINE
•
OVERVIEW
•
PATHOPHYSIOLOGY
•
CLINICAL PRESENTATION
•
GRADING
•
INVESTIGATION
•
TREATMENT OPTIONS
•
LOCAL/ REGIONAL CHALLENGES
•
RECENT ADVANCES
•
PREVENTION
•
CONCLUSION
OVERVIEW
•
GROUP OF METABOLIC DISEASES CHARACTERISED BY
HYPERGLYCAEMIA
•
DEFECTS IN INSULIN SECRETION, INSULIN ACTION OR BOTH
•
LONG TERM DAMAGE AND DYSFUNCTION OF MULTIPLE ORGAN
SYSTEMS
•
TYPE 1 DIABETES MELLITUS AND TYPE 2 DIABETES MELLITUS
•
OTHER TYPES- GESTATIONAL, ENDOCRINOPATHIES,
DRUG/CHEMICAL INDUCED, IMMUNE-MEDIATED, DISEASES OF
THE EXOCRINE PANCREAS
•
IMPAIRED GLUCOSE TOLERANCE
•
IMPAIRED FASTIG GLUCOSE
•
•
•
FASTING BLOOD SUGAR
<100MG/DL
NORMAL
100-125MG/DL
IMPAIRED FASTING GLUCOSE
≥126MG/DL
PROVISIONAL DIAGNOSIS OF DM
2- HOURS POST PRANDIAL GLUCOSE
<140MG/DL
NORMAL GLUCOSE TOLERANCE
140-199MG/DL
IMPAIRED GLUCOSE TOLERANCE
≥200MG/DL
PROVISIONAL DIAGNOSIS OF DM
DIAGNOSIS OF DIABETES MELLITUS
FBS ≥ 126MG/DL OR
SYMPTOMS OF HYPERGLYCAEMIA + RBS >200MG/DL OR
2-HOURS POST PRANDIAL GLUCOSE ≥ 200MG/DL
HbA1c ≥ 6.5%
•
•
•
•
•
•
•
•
•
•
•
WORLD WIDE EPIDEMIC
171 MILLION CASES OF DM WORLDWIDE IN 2000 (2.8%
PREVALENCE)
366 MILLION CASES PROJECTED FOR 2030 (4.4% PREVALENCE)
15% OF DIABETICS DEVELOP DFU THEIR LIFETIME
11.7- 19.1% PREVALENCE OF DFU AMONG DIABETICS IN NIGERIA
AMPUTATION RATES UP TO 53%
MORTALITY RATES UP TO 29%
MEAN COST OF TREATMENT N180,581.60K
$28,000.00 SPENT PER PATIENT OVER 2 YEARS FOR EACH EPISODE
OF DFU
LEADING CAUSE OF NON-TRAUMATIC LOWER EXTREMITY
AMPUTATIONS IN USA
LEADING CAUSE OF LOWER EXTREMITY AMPUTATIONS IN
NIGERIA
•
MALE PREPONDERANCE UP TO 85%
•
TYPE 2 DM IN UP TO 88% OF CASES
•
MEAN AGE IS THE 6TH DECADE OF LIFE
•
50% NEUROISCHAEMIC, 35% NEUROPATHIC, 15%
ISCHAEMIC
•
POLYMICROBIAL CULTURES COMMONEST IN CHRONIC
ULCERS
•
STAPHYLOCCOCUS AUREUS AS SINGLE ISOLATE IN
38% ON NON-GANGRENOUS LIMBS
•
ANAEROBES; 16% GAS GANGRENE
•
60% RESISTANCE TO PENICILLINS
HIGHLIGHT
ONE LIMB IS
AMPUTATED EVERY
20 SECONDS DUE TO
DIABETIC
COMPLICATIONS
PATHOPHYSIOLOGY
•
MULTIFACTORIAL
•
TETRAD OF NEUROPATHY, VASCULOPATHY, DEFORMITY AND INFECTION
•
IMPAIRED IMMUNITY
•
ATHEROSCLEROSIS AND NEUROPATHY OCCUR WITH INCREASED FREQUENCY
IN DM
•
NON-ENZYMATIC GLYCOSYLATION OF LIGAMENTS CAUSING STIFFNESS
•
STIFFNESS + NEUROPATHY INCREASES MECHANICAL STRESSES ON FOOT
DIABETIC ATHEROSCLEROSIS
•
THICKENED CAPILLARY BASEMENT MEMBRANE
•
ARTERIOLAR HYALINOSIS
•
ENDOTHELIAL PROLIFERATION
•
MONCKEBERG’S SCLEROSIS
•
HIGH AFFECTATION OF INFRAPOPLITEAL AND DIGITAL
ARTERIES
•
HIGH LDL, VLDL,
•
ELEVATED PLASMA VON WILLEBRAND FACTOR
•
INHIBITION OF PROSTACYCLIN SYNTHESIS
•
ELEVATED PLASMA FIBRINOGEN
•
INCREASED PLATELET ADHESIVENESS
DIABETIC PERIPHERAL
NEUROPATHY
•
OCCLUDED VASA NERVORUM
•
ENDONEURAL DYSFUNCTION
•
DIMINISHED Na-K ATPase ACTIVITY
•
CHRONIC HYPEROSMOLARITY CAUSING NERVE TRUNK OEDEMA
•
EFFECTS OF INCREASED SORBITOL AND FRUCTOSE
•
LOSS OF SENSATION – REPETITIVE STRESS, UNNOTICED
INJURIES AND FRACTURES
•
STRUCTURAL FOOT ABNORMALITIES
•
UNNOTICED EXCESSIVE HEAT/COLD
•
PRESSURE FROM ILL FITTING SHOES
COMMON PRECIPITATING FACTORS
•
•
•
•
•
•
•
TRAUMA
BLISTERING
ILL FITTING/NEW SHOES
NAIL CUTTING
BURNS
TINEA PEDIS
FURUNCLES
RISK FACTORS FOR FOOT ULCERATION
•
PREVIOUS HISTORY OF FOOT ULCERATION OR
AMPUTATION
•
VISUAL IMPAIRMENT
•
DIABETIC NEPHROPATHY
•
POOR GLYCAEMIC CONTROL
•
CIGARETTE SMOKING
•
MALESEX
•
LOW SOCOECONOMIC STATUS
•
POOR EDUCATION
•
POOR ACCESS TO HEALTH CARE
CLINICAL PRESENTATION
•
PRESENT AS INFECTION, ULCER, ABSCESS OR GANGRENE
•
4% -13.1% NEWLY DIAGNOSED AS DIABETIC AT
PRESENTATION
•
11.7% - 21.1% OF DIABETIC ADMISSIONS IN NIGERIA
•
MEAN DURATION OF DM 7-12 YEARS
•
ONSET OF SYMPTOMS TO PRESENTATION AVERAGELY 6
WEEKS
SYMPTOMS
•
SYMPTOMS OF DM
POLYURIA
POLYDIPSIA
POLYPHAGIA
WEIGHTLOSS
•
SYMPTOMS OF PERIPHERAL NEUROPATHY
HYPERESTHESIA
HYPOESTHESIA
PARAESTHESIA
DYSESTHESIA
ANHYDROSIS
RADICULAR PAIN
•
SYMPTOMS OF PERIPHERAL ARTERIAL INSUFFICIENCY
INTERMITTENT CLAUDICATION
REST PAIN
NON-HEALING ULCERATION OF FOOT
FRANK ISCHAEMIA
•
SYMPTOMS OF INFECTION
GANGRENE
SEPSIS: LOCAL, GENERALISED
•
SYMPTOMS REFERRABLE TO OTHER ORGAN SYSTEMS
RETINOPATHY, NEPHROPATHY, HYPERTENSION
PHYSICAL EXAMINATION
•
GENERAL EXAMINATION – FEVER, PALLOR, JAUNDICE, DEHYDRATION,
REGIONAL LYMPH NODES, LEG SWELLING, WEIGHT LOSS
•
FULL SYSTEMIC EXAMINATION
•
MANDATORY EYE EXAMINATION
•
MUSCULOSKELETAL SYSTEM EXAMINATION
FOOT/ULCER
POWER
SENSATION
REFLEXES
PULSES
EXAMINATION OF THE ULCER
•
LOCATION, SIZE, DEPTH
•
DETERMINE TYPE- NEUROPATHIC, ISCHAEMIC OR NEUROISCHAEMIC
•
MUSCULOSKELETAL SYSTEM ABNORMALITIES
•
COLOUR AND STATE OF WOUND
•
EXPOSED BONE
•
NECROSIS OR GANGRENE
•
INFECTION: LOCAL AND SYSTEMIC
•
MALODOROUS
•
LOCAL PAIN
•
EXUDATE
•
WOUND EDGE : CALLUS, MACERATION, OEDEMA
•
CLINICAL PHOTOGRAPHS
DFU FEATURES ACCORDING TO AETIOLOGY
FEATURE
NEUROPATHIC
ISCHAEMIC
NEUROISCHAEMIC
SENSATION
SENSORY LOSS
PAINFUL
DEG OF SENSORY LOSS
CALLUS/ NECROSIS
OFTEN THICK CALLUS
NECROSIS COMMON
MINIMALCALLUS
PRONE TO NECROSIS
WOUND BED
PINK, GRANULATING,
SURROUNDING CALLUS
PALE, SLOUGHY, POOR
GRANULATION
POOR GRANULATION
FOOT TEMP/
PULSES
WARM, BOUNDING PULSES
COOL, ABSENT PULSES
COOL, ABSENT PULSES
OTHER
DRY SKIN, FISSURING
DELAYED HEALING
HIGH RISK OF INFECTION
TYPICAL LOCATION
WEIGHT BEARING AREAS
OF FOOT
TIPS OF TOES, NAIL BEDS,
B/W TOES, LATERAL
BORDER OF FOOT
MARGIN OF FOOT AND
TOES
PREVALENCE
35%
15%
50%
GRADING SYSTEMS
SEVERAL SYSTEMS IN USE
• OLDER CLASSIFICATIONS
WAGNER-MEGGIT
UNIVERSITY OF TEXAS CLASSIFICATION
GIBBONS
FORREST
FRYKBERG AND COLEMAN’S
•
•
NEWER CLASSIFICATIONS
PEDIS
KINGS
KOBE’S
AMIT JAIN’S
SAD
WAGNER-MEGGIT CLASSIFICATION OF DIABETIC FOOT
•
DEVELOPED IN 1977
•
WIDELY ACCEPTED, UNIVERSALLY USED,SIMPLE
•
DOES NOT ADDRESS DIABETIC ULCERATIONS AND INFECTION
ADEQUATELY
•
LIMITED IN IDENTIFYING/DESCRIBING VASCULAR DISEASE
•
GRADE 0
FOOT AT RISK
•
GRADE 1
SUPERFICIAL ULCER
•
GRADE 2
DEEP ULCER
•
GRADE 3
ULCER WITH BONE INVOLVEMENT
•
GRADE 4
FOREFOOT GANGRENE
•
GRADE 5
FULL FOOT GANGRENE
UNIVERSITY OF TEXAS CLASSIFICATION
•
VALIDATED, GENERALLY PREDICTIVE OF OUTCOME
•
INCREASING USE IN CLINICAL TRIALS AND DIABETIC FOOT CENTERS
GRADE 0
GRADE 1
GRADE 2
GRADE 3
STAGE A
PRE- OR POST
SUPERFICIAL WOUND,
ULCERATIVE LESION,FULLY NIL TENDON, CAPSULE
EPITHELISED
OR BONE INVOLVED
WOUND
PENETRATING TO
CAPSULE OR
TENDON
WOUND
PENETRATING TO
BONE OR JOINT
STAGE B
INFECTION
INFECTION
INFECTION
INFECTION
STAGE C
ISCHAEMIA
ISCHAEMIA
ISCHAEMIA
ISCHAEMIA
STAGE D
INFECTION AND
ISCHAEMIA
INFECTION AND
ISCHAEMIA
INFECTION AND
ISCHAEMIA
INFECTION AND
ISCHAEMIA
DIABETIC FOOT SEVERITY SCORE(DFSS)UMEBESE AND OGBEMUDIA
•
BEING VALIDATED
•
GRADES ULCER, PULSES, SENSATION, COLOUR, AGE
AND RADIOGRAPHS OF THE FOOT
•
PREDICTS LIMB SALVAGEABILITY
•
≤ 11 UNSALVAGEABLE
•
21 BEST PROGNOSTIC INDEX
•
6 WORST PROGNOSTIC INDEX
•
COMPLEX
•
DIFFICULT TO MEMORISE
•
•
•
COLOUR OF FOOT
NORMAL
3
DARKER DISCOLOURATION
2
BLACK
1
PERIPHERAL PULSES
DORSALIS PEDIS AND POSTERIOR TIBIAL PALPABLE
4
POSTERIOR TIBIAL ONLY
3
DORSALIS PEDIS ONLY
2
NONE
1
SENSATION
NORMAL LIGHT TOUCH AND PIN PRICK
3
DIMINISHED HYPOESTHESIA
2
INSENSIBILITY TO INSENSATE
1
•
ULCER GRADING
GANGRENE LIMITED TO 1 OR 2 TOES
5
FULL THICKNESS ULCERATION OF DORSALSKIN
4
ULCER INVOLVEMENT OF >2 TOES OR BALL OF FOOT
3
OPEN PENETRATING ULCER >50% OF SOLE
2
WHOLE FOOT GANGRENE + SUPRAMALLEOLAR
1
NECROTISING CELLULITIS
•
AGE
40 YEARS
•
3
41- 60 YEARS
2
> 61 YEARS
1
RADIOGRAPH OF FOOT
NORMAL
3
COM OR CALCIFIED PERIPHERAL VESSELS
2
COM + CPV
1
DIFFERENTIAL DIAGNOSES
•
DIABETIC DERMOPATHY
•
ERUPTIVE XANTHOMAS
•
NECROBIOSIS LIPOIDICA
•
ARTHRITIS
•
MUSCLE PAIN
•
THROMBOPHLEBITIS
•
RADICULAR PAIN
•
MYEXDEMA
•
VASCULITIC NEUROPATHIES
•
METABOLIC NEUROPATHIES
•
AUTONOMIC NEUROPATHY
INVESTIGATIONS
•
ESTABLISH DIAGNOSIS/ GLYCAEMIC CONTROL
FASTING BLOOD SUGAR
2-HOUR POST PRANDIAL GLUCOSE
HbA1c ASSAY
•
BASELINE
FULL BLOOD COUNT
ERYTHROCYTE SEDIMENTATION RATE
C-REACTIVE PROTEIN ASSAY
ELECTROLYTE/UREA/CREATININE
URINALYSIS
24-HOUR URINE FOR PROTEIN ESTIMATION
•
DIABETIC FOOT
DEEP TISSUE CULTURE/HISTOLOGY
ASPIRATE M/C/S
PULSE VOLUME RECORDING(PVR)
ANKLE-BRACHIAL INDEX
PLAIN RADIOGRAPHS
DOPPLER/DUPLEX ULTRASOUND SCANS
MONOFILAMENT TESTING
BIOTHESIOMETER
CONTACT THERMOGRAPHY
•
CT SCAN/MRI
•
BONE SCANS
•
ANGIOGRAPHY
•
TRANSCUTANEOUS TISSUE OXYGEN STUDIES
•
INVESTIGATE FOR RETINOPATHY, NEPHROPATHY,
CARDIAC DISEASE ETC
TREATMENT
•
NON-SURGICAL
•
SURGICAL
APPROACH CONSIDERATIONS FOR TREATMENT
•
OFFLOAD THE WOUND WITH APPROPRIATE FOOT WEAR
•
DEBRIDEMENT
•
DAILY WOUND DRESSING
•
ANTIBIOTICS
•
OPTIMAL CONTROL OF GLUCOSE, HYPERTENSION AND HYPERLIPIDAEMIA
•
EVALUATE/ CORRECT PERIPHERAL VASCULAR INSUFFICIENCY
•
MULTIDISCIPLINARY
ENDOCRINOLOGIST
INFECTIOUS DISEASE SPECIALIST
CARDIOLOGIST
PLASTIC SURGEON
NEPHROLOGIST
PROSTHETIST/ ORTHOTIST
PODIATRIST
NUTRITIONIST
ORTHOPAEDIC SURGEON
WOUND CARE SPECIALIST
VASCULAR SURGEON
NON-SURGICAL TREATMENT
•
WOUND DRESSING
•
AUTOLYTIC DEBRIDEMENT
•
ENZYMATIC DEBRIDEMENT
•
LARVAL THERAPY
•
VACUUM ASSISTED CLOSURE
•
HYDROTHERAPY
•
HYPERBARIC OXYGEN THERAPY
•
OFFLOADING THE FOOT: TCC, RCW, ITCC, CRUTCHES,
WHEEL CHAIR
•
ANTIBIOTICS
•
HEMORRHEOLOGIC AGENTS: PENTOXIFYLLINE, CILOSTAZOL
•
ANTIPLATELET AGENTS: CLOPIDOGREL, SOLUBLE ASPIRIN
•
WOUND HEALLING AGENTS: BECAPLERMIN
GEL(REGRANEX)
•
SUPPORTIVE THERAPY: ANALGESIA, FLUID AND ELECTROLYTE
CORRECTION, BLOOD TRANSFUSION, GLYCAEMIC CONTROL
DRESSING AGENTS
•
WET TO DAMP DRESSINGS
•
ABILITY TO ABSORB EXUDATE AND PROTECT HEALTHY SKIN
•
OPSITE; TEGADERM
•
NORMAL SALINE
•
ISOTONIC SALINE GEL(NORMGEL)
•
HYDROCOLLOIDS: DUODERM, INTRASITE – DRY WOUNDS
•
CALCIUM ALGINATES: KALTOSTAT, CURASORB – EXUDATIVE
WOUNDS
•
IMPREGNATED GAUZE (MESALT) – VERY EXUDATIVE WOUNDS
•
HYDROFIBRES (AQUACEL) – VERY EXUDATIVE WOUNDS
•
DERMAZINE, BACITRACIN, NEOSPORIN – INFECTED WOUNDS
•
DRY DRESSING + BETADINE – ESCHAR
•
HONEY – INFECTED WOUNDS
•
CYTOTOXIC AGENTS: NOT ADVISED EXCEPT IN INFECTED
WOUNDS
HYDROGEN PEROXIDE
POVIDONE IODINE
SODIUM HYPOCHLORITE
ACETIC ACID
EUSOL
SURGICAL TREATMENT
•
SHARP DEBRIDEMENT
•
REVISION SURGERIES
•
VASCULAR RECONSTRUCTION
•
SOFT TISSUE COVERAGE
•
AMPUTATION
SHARP DEBRIDEMENT
•
MUST PRECEDE NON-SURGICAL TREATMENT
•
REMOVE INFECTED AND NON-VIABLE TISSUES
•
REMOVE EXCESS CALLUS
•
CURETTAGE OF UNDELYING OSTEOMYELITIC BONES
•
REDUCES PRESSURE
•
ALLOWS FULL INSPECTION OF UNDERLYING TISSUES
•
HELPS DRAINAGE OF SECRETIONS AND PUS
•
HELPS OPTIMSE EFFECTIVENESS OF TOPICAL PREPARATONS
•
STIMULATES HEALING
VASCULAR RECONSTRUCTION
•
EARLY REFERRAL TO THE VASCULAR SURGEON
•
INTRACTABLE REST OR NOGHTPAIN
•
INTRACTABLE FOOT ULCERS
•
IMPENDING GANGRENE
•
FEMORO-POPLITEAL BYPASS
REVISION SURGERIES
•
FOR BONY ARCHITECTURE
•
REMOVE PRESSURE POINTS
•
RESECTION OF METATARSAL HEADS, OSTECTOMY
SOFT TISSUE COVERAGE
•
SKIN GRAFTING
AUTOGRAFT
CADAVERIC
•
TISSUE CULTURED SKIN SUBSTITUTES
DERMAGRAF
APLIGRAF
•
XENOGRAFT
AMPUTATION
•
85% OF AMPUTATIONS ARE PRECEDED BY ULCERS
•
AMPUTATION RATES AVERAGELYBETWEEN 5-24%
•
53% AMPUTATION RATES HAVE BEEN QUOTED
•
26% RE-AMPUTATION RATE
•
PREDICTORS FOR MAJOR AMPUTATION
SMOKING
LIMB ISCHAEMIA
OSTEOMYELITIS
ULCER SIZE
ELEVATED WBC,ESR,CRP
REDUCED Hb, ALBUMIN
LOCAL OR DIFFUSE GANGRENE
INDICATONS FOR AMPUTATION
•
ISCHAEMIC REST PAIN THAT CANNOT BE MANAGED BY
ANALGESIA OR REVASCULARISATION
•
LIFE THREATENING FOOT INFECTION THAT
CANNOTBE MANAGED BY OTHER MEASURES
•
NON-HEALING ULCER ACCOMPANIED BY HIGHER
BURDEN OF DISEASE THAN WOULD RESULT FROM
AMPUTATION
TYPES OF AMPUTATION
•
RAY AMPUTATION
•
FOOT CONSERVING AMPUTATIONS: TRANSMETATARSAL,
LISFRANC’S
•
BELOW KNEE AMPUTATION
•
ABOVE KNEE AMPUTATIONS
•
DISARTICULATIONS
STEPS TO AVOID AMPUTATION:
GLOBAL WOUND CARE PLAN
•
DIAGNOSIS OF DM +/- PERIPHERAL SENSORY NEUROPATHY
DFU PREVENTION CARE PLAN
TREAT COMORBIDITIES
GOOD GLYCAEMIC CONTROL
OFFLOAD FOOT
ANNUAL PROFESSIONAL FOOT EXAMINATION
REGULAR REVIEW AND PATIENT EDUCATION
•
DEVELOPMENT OF DFU
DETERMINE CAUSE OF ULCER
AGREE TREATMENT WITH PATIENT AND IMPLEMENT WOUND CARE PLAN
INITIATE ANTIBIOTIC TREATMENT
REVIEW OFFLOADING DEVICE
OPTIMISE GLYCAEMIC CONTROL
VASCULAR ASSESSMENT
PATIENT EDUCATION
•
DEVELOPMENT OF VASCULAR DISEASE
EARLY REFERRAL TO VASCULAR SURGEON
OPTIMSE DM CONTROL
•
INFECTED ULCER
ANTIMICROBIALS
OFFLOAD PRESSURE
THERAPY DIRECTED AT BIOFILM
REASONS FOR POOR TREATMENT OUTCOMES
•
POOR HEALTH LITERACY
•
LOW ACCESS TO QUALITY MEDICAL CARE
•
NON-COMPLIANCE TO MEDICATION
•
LACK OF ACCESS TO DIABETES INFORMATION AND SERVICES
•
WEAK REFERRAL SYSTEMS
•
ABSENCE OF ROUTINE SCREENING FOR DM
•
POVERTY
•
LACK OF CAPACITY FOR MANAGEMENT OF DM IN LOWER LEVELS
OF HEALTH CARE
•
BELIEF IN ALTERNATIVE REMEDIES
LOCAL AND REGIONAL CHALLENGES
•
LATE PRESENTATION
•
ALTERNATIVE UNORTHODOX CARE
•
THE MIRACLE PHENOMENON
•
POOR PERIPHERAL HEALTH CARE SERVICES
•
DEARTH OF SKILLED MANPOWER
•
LACKED OF DEDICATED FOOT SERVICE
•
DELAYED REFERRALS
•
POOR PATIENT COMPLIANCE
•
POOR FOLLOW UP
•
REFUSAL TO GIVE CONSENT FOR SURGERY
•
LOW LEVELS OF COMMUNITY/ PATIENT AWARENESS AND PRACTICES
•
LACK OF POLITICAL WILL
PREVENTION
•
DAILY FOOT INSPECTION
•
GENTLE SOAP AND WATER CLEANSING
•
APPLICATION OF SKIN MOISTURISERS
•
INSPECTIONS OF SHOES FOR SUPPORT AND FIT
•
PROMPT TREATMENT OF MINOR WOUNDS
•
AVOID HOT SOAKS,HEATING PADS,IRRITATING TOPICAL AGENTS
•
STOP CIGARETTE SMOKING
•
CONTROL OF BLOOD SUGAR, BLOOD PRESSURE AND SERUM LIPIDS
•
PROPHYLACTICPODIATRIC SURGERY
•
AVOID USE OF SHARPS TO PARE NAILS
•
WEAR CLEAN SOCKS
•
NEVER WALK BARE FOOT
•
CHECK INSIDE SHOES BEFORE WEARING THEM
RECENT ADVANCES
•
BIOENGINEERED SKIN SUBSTITUTES: DERMAGRAF
•
EXTRACELLULAR MATRIX PROTEINS: HYAFF,PROMOGRAN
•
MMP MODULATOR(MATRIX METALLOPROTENASES): DERMAX
•
AUTOLOGOUS PLATELET-RICH PLASMA
CONCLUSION
•
INCREASING PREVALENCE OF DM AND ITS ATTENDANT
COMPLCATIONS
•
POOR KNOWLEGDE, ATTITUDE AND PRACTICES
•
LOCAL CHALLENGES RESULT IN HIGH AMPUTATION RATES
•
PARADIGM SHIFT TO PREVENTIVE CARE NEEDED
THANK
YOU!
REFERENCES
1.
W. Amogne, A. Reja, A. Amane; Diabetic Foot Disease In Ethiopian Patients: A Hospital Based
Study; Ethiopian Journal Health Dev; 2012; 25(1): 17-21
2.
P. Olabisi, A. Fasanmade, A.Fatai, P. Ekama; The Outcome Of 60-Second Foot Screen Tool
Education For Health Care Workers At University College Hospital, Nigeria; Wound Healing
Southern Africa; 2012; 5(2):91-95
3.
R. Gadepalli, B. Dhawan et al; A Clinico-microbiological Study Of Diabetic Foot Ulcers In An Indian
Tertiary Care Hospital; Diabetes Care; August 2006; vol 29;No 8: 1727-1732
4.
A.K.C Jain; A New Classification Of Diabetic Foot Complications: A Simple And Effective Teaching
Tool; The Journal Of Diabetic Foot Complications; 2012; vol 4; issue 1; No 1: 1-5
5.
B.U. Aguocha, J.O. Ukpabi, U.U. Onyeonoro,P. Njoku, A.U. Ukegbu; Pattern Of Diabetic Mortality
In A Tertiary Health Facility In Southern Nigeria; African Journal Of Diabetes Medicine;May
2013; vol 21; No 1
6.
N.E. Ngim, W.O. Ndifon, A.M. Udosen, I.A. Ikpeme, E. Isiwele; Lower Limb Amputation In
Diabetic Foot Disease: Experience In A Tertiary Hospital In Southern Nigeria; African Journal
Of Diabetes Care; May 2012; vol 20; No 1
7.
A.E. Edo, E. Eregie, I.U. Ezeani; Diabetic Foot Ulcer Following Rat Bite; African Journal Of
Diabetes Medicine; Nov 2010; vol 18; No 2
8.
A.O.Ogbera, O. Fasanmade, A.E. ohwovoriole, O. Adediran; An Assessment Of The Disease
Burden Of Foot Ulcers In Patients With Diabetes Mellitus Attending A Tertiary Hospital In
Lagos Nigeria; Internal Journal of Lower Extremity Wounds; Dec 2006; vol 5;No 4: 244-249
9.
A.K.C. Jain, S. Joshi; Diabetic Foot Classifications: A review of Literature; Medicine
Science;2013; 2(3):715-721
10.
J.O. Adeleye; Diabetic Foot Disease: The Perspective Of A Nigerian Tertiary Helth Care
Center; Practical Diabetes International; Sep 2000; vol 2; Issue 6: 211-214
11.
A.A. Musa; Diabetic Foot Lesions As Seen In A Nigerian Teaching Hospital: Pattern And A Simple
Classification; East African Journal Public Health; March 2012; 9(1): 50-52
12.
V.L. Rowe; Diabetic Ulcers; Medscape; Sep 2012
13.
I. Adigun, J. Olarinoye; Foot Complications In People With Diabetes: Experience With 105
Nigerian Africans; Wounds International; May 2014; vol 5; Issue 2
14.
F. Ogunlesi; challenges Of Caring For Diabetic Foot Ulcers In Resource Poor Settings; The
Internet Journal Of Advanced Nursing Practice; 2013; vol 10; No 2
15.
K. Alexiadou. J. Duopis; Management Of Diabetic Foot Ulcers; Diabetes Therapy; April 2012; 3(1);
4
16.
S.Yesil et al; Predictors Of Amputation In Diabetics With Foot Ulcer: Single center Experience
In A Large Turkish Cohort; Hormones; 2009;8(4): 286-295
17.
A.A. Otu et al; Profile, Bacteriology And Risk Factors For Foot Ulcers Among Diabetics In A
Tertiary Hospital In Calabar Nigeria; Ulcers; 2013; ID 820468
18.
A.E. Edo, O.G. Edo, I.U. Ezeani; Risk Factors, Ulcer Grade And Management Outcomes Of
Diabetic Foot Ulcers In A Tropical Tertiary Care Hospital; Nigerian Medical Journal; Jan- Feb
2013; vol 54; Issue 1: 59-63
19.
N.E. Ngim, P. Amah, I. Abang; Tropical Diabetic Hand Syndrome: Report of 2 Cases; The Pan
African Medical Journal; 2012;12; 24
20.
Y.Z. Lawal, M. Ogirima et al; Tropical Diabetic Hand Syndrome: Surgical Management And
Proposed Classification; Arch Int Surg (Serial Online); 2013; 3: 124-127
21.
International Best Practice Guidelines: Wound Management In Diabetic Foot Ulcers; Wounds
International; 2013
22.
E. Igbinovia; Diabetic Foot Ulcers: Current Trends In Management; Journal Of Post Graduate
Medicine; 2009; vol 11; No 1: 130-138
23.
L.A. Lavery, D.G. Armstrong, A. Boulton; Screening For Diabetic Peripheral Neuropathy;
Neuropathy; 2004; 17-19
24.
O.O. Desalu, F.K. Salawu, A.K. Jimoh, A.O. Adekoya, O.A. Busari, A.B. Olokoba; Diabetic Foot Care:
Self Reported knowledge And Practice Among Patients Attending Three Tertiary Hospitals In
Nigeria; Ghana Medical Journal; June 2011;vol 45; No 2: 60-65
25.
K.O. Ngwogu, E.C. Umez-Emeana, A.C. Ngwogu; The Burden Of Diabetic Foot Ulcers In Aba, Abia
State,Nigeria; International Journal Of Basic, Applied And Innovative Research; 2013; 2(4): 118124
26.
A.O Ogbera et al; The Foot At Risk In Nigerians With Diabetes Mellitus- The Nigerian Scenario;
Int J Endocrinol Metab; 2005; 4: 165-173