Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives（2）

Prevention, management and treatment strategies

Key points

● PU prevention includes: pressure reduction/ redistribution; friction and shear reduction; skin care; and nutrition

● DFU prevention includes; pressure redistribution; prescribing appropriate footware; nail care; emollient use

● Managing the underlying cause of the ulcer is key to treatment

● PU or DFU prevention: both must be tailored to the individual patient

● Ulcers should be monitored at least once a week to assess progress

Authors:

Karen Ousey, University of Huddersfield, England; Paul Chadwick, College of Podiatry, London, England; Arkadiusz Jawień, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland; Gulnaz Tariq, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Harikrishna K Ragavan Nair, Kuala Lumpur Hospital, Malaysia; José Luis Lázaro-Martínez, Diabetic Foot Unit, Universidad Complutense de Madrid, Spain; Kylie Sandy-Hodgetts, School of Human Sciences, University of Western Australia, Australia; Paulo Alves, Institute of Health Sciences, Catholic University of Portugal, Portugal; Stephanie Wu, Dr William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, United States; Zena Moore, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland

Review panel: Andrea Pokorná, Masaryk University, Czech Republic; Anna Polak, Jerzy Kukuczka Academy of Physical Education in Katowice, Poland; David Armstrong, Keck School of Medicine of University of Southern California, United States; Hiromi Sanada, University of Tokyo, Japan; Joon Pio Hong, Asan Medical Centre, University of Ulsan, South Korea; Leanne Atkin, University of Huddersfield, England; Nick Santamaria, University of Melbourne and Royal Melbourne Hospital, New South Wales, Australia; Peta Tehan, University of Newcastle, Australia; Ralf Lobmann, Klinikum Stuttgart, Germany.

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives(1)

Authors:

Karen Ousey, University of Huddersfield, England; Paul Chadwick, College of Podiatry, London, England; Arkadiusz Jawień, Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland; Gulnaz Tariq, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Harikrishna K Ragavan Nair, Kuala Lumpur Hospital, Malaysia; José Luis Lázaro-Martínez, Diabetic Foot Unit, Universidad Complutense de Madrid, Spain; Kylie Sandy-Hodgetts, School of Human Sciences, University of Western Australia, Australia; Paulo Alves, Institute of Health Sciences, Catholic University of Portugal, Portugal; Stephanie Wu, Dr William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, United States; Zena Moore, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland

Review panel:

Andrea Pokorná, Masaryk University, Czech Republic; Anna Polak, Jerzy Kukuczka Academy of Physical Education in Katowice, Poland; David Armstrong, Keck School of Medicine of University of Southern California, United States; Hiromi Sanada, University of Tokyo, Japan; Joon Pio Hong, Asan Medical Centre, University of Ulsan, South Korea; Leanne Atkin, University of Huddersfield, England; Nick Santamaria, University of Melbourne and Royal Melbourne Hospital, New South Wales, Australia; Peta Tehan, University of Newcastle, Australia; Ralf Lobmann, Klinikum Stuttgart, Germany.

The role of VR technology in wound management and education

Authors: Tomasz Bansiewicz, Ibrahim El-Nogoomi and Terry Swanson

Tomasz Bansiewicz, MD, PhD is Professor of Surgery, Department of General and Endocrinological Surgery and Gastroenterological Oncology at H. Święcicki Clinical Hospital in Poznan, Poland

Ibrahim El-Nogoomi, MS, MD, PhD, FRCS is Chair of Department of General Surgery, Kuwait Hospital Sharjah, United Arab Emirates

Terry Swanson, NPWM, MHSc, FMACNP is Fellow Wounds Australia (Co-chair), Wound Education Research Consultancy, Vice Chair International Wound Infection Institute

      As technology transforms all sectors in healthcare, there is a need for innovation in learning and professional development. Use of technology such as virtual reality in medical training allows higher levels of interactivity, and the ability to rehearse clinical procedures and refine relevant skills (Herur-Raman, 2021). The new HARTMANN Virtual Reality Wound Care Simulation Training was launched at the World Union of Wound Healing Societies Congress 2022, pioneering a new approach to wound care education.

Ten top tips: myth-busting wound care

Patricia B Hotaling is Clinical Assistant Professor, College of Nursing, University of Nebraska Medical Center, Omaha, US; Joyce M. Black is Florence Neidfelt Professor of Nursing, College of Nursing, University of Nebraska Medical Center, Omaha, US

Targeting oxygen free-radicals in diabetic wound healing: three case reports

Nafad Mohammad Elhadidi is Consultant General and Vascular Surgeon, General Surgery Department, Zulekha Hospital Sharjah, Al Zahra Street Al Nasserya, Sharjah, United Arab Emirates;

Ahmed Ramadan Wahdan is General Surgery Specialist, Department of Surgery, Al Hammadi Hospital – Al Olaya, Riyadh, Saudi Arabia; Mohamed Abouzeid

Ahmed Gaballa Ali is General Surgery Consultant, Diabetic Foot and Chronic Wounds care unit, Exir Subspecialities Medical Centre, Jahra, Kuwait

      The Arabian Gulf region has seen an increasing rise in diabetic foot ulcers (DFUs) with prevalence ranging from 4.7% to 19% in Saudi Arabia (Hu et al, 2014; Mairghani et al, 2017). Current practices for standard of care include wound debridement, wound offloading and dressings. The authors successfully managed diabetic foot ulcers with oxygen free-radical binding technology as an adjuvant therapy for our patients. HemaGel® (VH Pharma), a hydrophilic gel, contains sterically hindered amines that bind with reactive oxygen species (ROS) and thereby accelerates wound healing by showing an anti-inflammatory effect. The three case reports in this article discuss the use of targeted oxygen free radicals to promote wound healing by oxidant/antioxidant disequilibrium methodology in the authors’ patients. With supporting diabetes controlling medications and HemaGel, wound healing was achieved successfully in these patients.

Local management of diabetic foot ulcers with a polyabsorbent TLC-NOSF dressings — a real-life pilot study in real life from Kuwait

Authors (clockwise from top left): Naser Alhumaidi, Mariam Alessa, Abdul Aziz Alshahe and Emilio Galea

Naser Alhumaidi is Senior Specialist in General Surgery, Head of Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Mariam Alessa is Diabetes Specialist Podiatrist, Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Abdul Aziz Alshaheen is General Practitioner Surgery, Diabetic Foot Unit Department of Surgery, Farwaniya Hospital, Kuwait; Emilio Galea is International Medical Director, Urgo Medical

Chronic wounds are an international and regional concern affecting many patients, demanding substantial resources from healthcare systems. Managing patients with these wounds is costly in terms of time and resources required, not forgetting the detrimental impact on the quality of life of these individuals. Moreover, diabetic foot problems are very common throughout the world, and their recurrence is high. In 2016, the World Health Organization (WHO, 2022)reported that 14.7% of the population of Kuwait are suffering from diabetes, with very high percentages of overweight, obese and inactive individuals. It is inevitable that many of these individuals suffer and/or will suffer in the future from diabetes-related foot ulcers and complications, and the management of these wounds is complex. The authors reviewed the evidence behind a local treatment indicated for chronic wounds and specific in neuropathic diabetic foot ulcers. In view of the high level of evidence regarding this local treatment, a pilot study was conducted in 2021 to analyse the feasibility of a larger-scale observational study. The article highlights the results of the initial pilot and discusses the feasibility of conducting further research to justify implementation of technology lipido-colloid nano oligosaccharide factor(TLC-NOSF) dressings in the local management of patients with diabetic foot ulcers in Kuwait.