The role of rehabilitation in the management of diabetic foot wounds

Elif Aydın1, Mustafa Bülent Ertuğrul2

1 Department of Physical Medicine and Rehabilitation, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey

2 Department of Infectious Diseases and Clinical Microbiology, Reyap Hospital, Istanbul, Turkey

Received: March 19, 2021 Accepted: August 17, 2021 Published online: December 01, 2021

ABSTRACT

        Diabetes is one of the most common health problems worldwide. Diabetic foot wounds (DFWs) are hazardous complications of the disease. Patients are often referred to rehabilitation facilities at later stages of the diabetic complications, particularly after amputation surgery. There are potential benefits of rehabilitation practices in preventing and managing DFWs. Therefore, rehabilitation needs to be more involved in the management of DFWs and should be in all stages of diabetic care. In this review, we discuss literature data to bring rehabilitation perspective to the multidisciplinary management of DFWs.

Keywords: Diabetic foot, exercise, foot ulceration, plantar pressure, rehabilitation.

Worldwide Research Trends on Diabetic Foot Ulcers (2004–2020): Suggestions for Researchers

Pin Deng,1 Hongshuo Shi ,2 Xuyue Pan ,1 Huan Liang ,1 Shulong Wang ,1Junde Wu,1 Wei Zhang ,3 Fasen Huang ,1 Xiaojie Sun ,1 Hanjie Zhu ,1and Zhaojun Chen1

1 Department of Hand and Foot Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China

2 College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250000, China

3 Orthopaedic Center, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China

Correspondence should be addressed to Zhaojun Chen; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Received 9 August 2021; Revised 18 December 2021; Accepted 5 January 2022; Published 27 January 2022

Academic Editor: Ferdinando Carlo Sasso

Copyright © 2022 Pin Deng et al. This is an open access article distributed under the Creative Commons Attribution License,

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

       Objectives. Diabetic foot ulcer (DFU) is one of the devastating complications of diabetes. It has high mortality and disability rates. The number of research articles on DFUs has increased. This study was designed to explore the global trends and research hotspots of DFUs to benefit researchers in shaping future research directions. Methods. Literatures relating to DFU from 2004 to 2020 were retrieved from the Science Citation Index Expanded (SCI-expanded) of Web of Science Core Collection (WoSCC). The current status of DFU research (including publications, journals, the performances of relevant countries, institutions, and authors and the research trends and hotspots of DFU) was analyzed with the WoSCC. VOSviewer v1.6.10.0 was utilised for cocitation, coauthorship, cooccurrence analyses, and bibliographic coupling. Results. A total of 5869 publications on DFUs were retrieved. We performed a longitudinal review of publications over 17 years: 4500 articles and 865 review articles on DFUs published from 2004 to 2020 were analyzed. The total citation was 107,296. The USA (n = 1866), England (n = 606), and China (n = 599) were the three largest contributors. The University of Washington had the greatest number of publications within this time period (n = 103), and it had the most cooperative units and was in the core position in all research institutions, followed by the University of Manchester (n = 94) and the University of Miami (n = 92). Armstrong DG (91/1.69%) and Lavery LA (55/1.19%) should be regarded as scholars who have made outstanding contributions. The top journal with the greatest total link strength was Diabetes Care. Analysis showed that the global research hotspots of DFU focused on lower limb amputation, diabetic foot infection, and treatment and management of DFU. Studies on osteomyelitis, wound therapy and management, multidisciplinary integration and mechanism of DFUs, and its related diseases are the research fronts that should be closely watched in the future. Conclusions. This study revealed the current research status and hotspots in the domain of DFU over the past 17 years, which can help researchers to further pinpoint potential perspectives on hot topics and research frontiers.

A randomized trial of negative pressure wound therapy technology combined with intermittent instillation in the treatment of neck anastomotic leakage after esophageal cancer surgery

Background: This study aimed to examine the effects of applying the negative pressure wound therapy (NPWT) combined with intermittent instillation (NPWTi) in patients with cervical anastomotic leakage (AL) after esophageal cancer surgery.

Methods: From July 2019 to June 2021, 64 patients undergoing AL after esophageal cancer surgery were selected from our Hospital’s Thoracic Department, and randomly allocated to the conventional nursing group (20 patients), the hospital central NPWTi group (23 patients), and the portable NPWTi group (21 patients). The hospital central NPWTi group was treated with central negative pressure combined with intermittent instillation, and the portable NPWTi group was treated with portable negative pressure combined with intermittent instillation. Indicators of fistula healing, healing days, treatment costs, comfort, and nursing satisfaction were examined in each group.

Results: The fistula healing rate, healing days, nursing satisfaction, and comfort level of the hospital central NPWTi group and the portable NPWTi group were better than those of the conventional nursing group (P<0.05). There was no difference in the fistula healing rates and healing days between the hospital central NPWTi group, and the portable NPWTi group (P>0.05). The treatment costs of the hospital central NPWTi group were lower than those of the portable NPWTi group (P<0.05).

Conclusions: Negative pressure treatment technology combined with the intermittent instillation of the neck anastomotic fistula improved the fistula microenvironment, strengthened the sterilization effect, drained the leachate effectively, shortened the fistula healing time, improved the fistula cure rate, and increased patients’ satisfaction with nursing. In relation to the negative pressure source, there was no difference in the therapeutic effects of hospital central NPWTi compared to the portable negative pressure meter, but the hospital central NPWTi treatment costs were lower and patients’ acceptance of NPWT instillation was higher. Thus, central NPWT instillation treatment is worthy of promotion.

Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052240.

Keywords: Neck anastomotic fistula; negative pressure wound therapy combined with intermittent instillation; nursing Submitted Sep 03, 2021. Accepted for publication Nov 12, 2021. doi: 10.21037/jgo-21-605

View this article at: https://dx.doi.org/10.21037/jgo-21-605

A Modified Technique for Applying Closed Incision Negative Pressure Therapy Dressing Following Total Joint Arthroplasty

Abstract

         Postoperative incisional management subsequent to total joint replacement arthroplasty is of importance to the orthopedic surgical team. The application of closed incision negative pressure therapy (ciNPT) to surgical incisions following replacement arthroplasty has demonstrated positive outcomes in orthopedics.This paper describes a technique involving the postoperative application of ciNPT over closed incisions originating from joint arthroplasty to facilitate a reduction in the incidence of surgical site complications (SSCs). To address any potential challenges that may be associated with ciNPT application and removal, the ciNPT dressing was applied to the knee incision with approximately 15 degrees of flflexion utilizing the total knee bump to allow the knee to rest with flflexion at that angle. For posterior hip replacements or revisions, the readily adjustable ciNPT dressing was enlisted for use to cover curvilinear incisions. The adhesive drape over the foam ciNPT dressing would be blocked to ensure that drain placement, if used, would not be incorporated with the hydrocolloid portion of the dressing. In order to properly apply the dressing, it was imperative that the hydrocolloid portion was not subject to any buckling. The dressing was walked over the foam ciNPT dressing to ensure that there was an absence of tension on the dressing. The manufacturer’s instructions support dressing use for a maximum of seven days with continuous subatmospheric pressure (-125 mmHg) applied to the closed incision. Applying the adhesive ciNPT drape over the ciNPT foam dressing with a minimal amount of tension is integral to attaining positive outcomes using ciNPT. Employing ciNPT may reduce the risk of delayed incisional healing and SSCs, which may alleviate providers from extra postoperative global visits.

Categories: Orthopedics, Therapeutics

Keywords: orthopedics, arthroplasty, hip replacement, knee joint, closed incision negative pressure therapy, cinpt, incisional negative pressure wound therapy.

Up-regulation of caveolin 1 mediated by chitosan activates Wnt/ β-catenin pathway in chronic refractory wound diabetic rat model

ABSTRACT

Diabetes mellitus (DM) can be implicated in the perturbations of vascular integrity and the dysfunction of angiogenesis. Chitosan has the advantage of promoting the vascular endothelial cell proliferation. However, the molecular mechanism of action in the promotion of wound healing by chitosan derivatives is still debated. In the current study, DM with chronic wound (CW) model rats were prepared and treated with chitosan. Vascular endothelial cells isolated from granulation tissues were conducted by RNA sequencing. Two thousand three hundred and sixteen genes were up-regulated, while 1,864 genes were down-regulated after chitosan treatment compared to CW group. Here, we observed that caveolin 1 (CAV1) was highly expressed induced by chitosan. Furthermore, we observed that CAV1 knockdown could compromise the activation of Wnt pathway by reduction of β-catenin in rat aortic endothelial cells (RAOECs) and brain endothelium four cells (RBE4s). Moreover, we determined a direct interaction between CAV1 and β-catenin by IP assay. The C-terminus of CAV1 and β-catenin (24 to 586 amino acids contributed to the interaction of these two proteins. Finally, the protein docking analysis indicated that the fragments of β-catenin (253–261 ‘FYAITTLHN’ and 292–303 ‘KFLAITTDCLQI’) might have affected the structure by CAV1 and facilitated the resistance to degradation. Taken together, our study demonstrates that chitosan can up-regulate CAV1 expression, and CAV1 can interact with β- catenin for promotion of canonical Wnt signaling pathway activity. Our results deepens the molecular mechanism of the Wnt pathway in vascular endothelial cells and is beneficial to developing new targets to assist in enhancing the pharmacological effect of chitosan on wound healing and angiogenesis against DM.

KEYWORDS

CAV1; β-catenin; chitosan;Wnt pathway; angiogenesis; diabetes mellitus.

Direct oral mucosal epithelial transplantation supplies stem cells and promotes corneal wound healing to treat refractory persistent corneal epithelial defects

ABSTRACT：Persistent corneal epithelial defects (PED) can lead to irreversible blindness, seriously affecting the social function and life quality of these patients. When it comes to refractory PED, such as limbal stem cell deficiency (LSCD), that does not respond to standard managements, stem cell therapy is an ideal method. Oral mucosal epithelium (OME) abundant with stem cells within the base, is a promising autologous biomaterial, with much resemblance to corneal epithelial structures. In this experiment, uncultured autologous rat OME was directly applied to alkali burned corneas. Clinical evaluations and histological analyses showed that the transplantation accelerated the healing process, presenting faster re-epithelization and better formation of corneal epithelial barrier. To further investigate the therapeutic mechanism, oral epithelium was transplanted to de-epithelialized cornea in vitro for organ culture. It could be observed that the oral epithelial cells could migrate to the corneal surface and form smooth and stratified epithelium. Immunofluorescence staining results showed that the reformed epithelium derived from OME, maintained stemness and transformed to corneal epithelial phenotype to some extent. Corneal stroma may provide the suitable microenvironment to promote the trans-differentiation of oral stem cells. Thus, both in vivo and in vitro experiments suggested that oral epithelium could play a positive role in treating refractory PED.

Keywords: Persistent corneal epithelial defects Oral mucosal epithelial transplantation Organ culture Stem cell microenvironment.