Advertisement

Fundamentals of Local Treatment

  • Dirk Hochlenert
  • Gerald Engels
  • Stephan Morbach
  • Stefanie Schliwa
  • Frances L. Game
Chapter

Abstract

This chapter describes local therapy of ulcers both in terms of medical management and surgical procedures. The natural process of tissue repair and wound closure is poorly understood. The possibilities for accelerating this process without surgery are limited. Thus, mechanisms of tissue repair are presented here in basic terms. Methods of plastic reconstructive surgery are presented more in detail because they offer the opportunity to really change the natural course of an ulcer and may avoid amputation.

References

  1. 1.
    Edmonds M, Lazaro-Martinez JL, Alfayate-Garcia JM, Martini J, Petit JM, Rayman G, Lobmann R, et al. Sucrose octasulfate dressing versus control dressing in patients with neuroischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol. 2017.  https://doi.org/10.1016/S2213-8587(17)30438-2.
  2. 2.
    Game FL, Attinger C, Hartemann A, Hinchliffe RJ, Londahl M, Price PE, Jeffcoate WJ, Foot International Working Group on the Diabetic. IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):75–83.  https://doi.org/10.1002/dmrr.2700.CrossRefPubMedGoogle Scholar
  3. 3.
    Bakker K, Apelqvist J, Schaper NC, Board International Working Group on Diabetic Foot Editorial. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28(Suppl 1):225–31.  https://doi.org/10.1002/dmrr.2253.CrossRefPubMedGoogle Scholar
  4. 4.
    Medizin, Ärztliches Zentrum für Qualität in der. Nationale VersorgungsLeitlinie Typ-2-Diabetes Präventions- und Behandlungsstrategien für Fußkomplikationen. Programm für Nationale VersorgungsLeitlinien; 2006.Google Scholar
  5. 5.
    Ruttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M. Local treatment of chronic wounds: in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes. Dtsch Arztebl Int. 2013;110(3):25–31.  https://doi.org/10.3238/arztebl.2013.0025.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Armstrong DG, Jude EB. The role of matrix metalloproteinases in wound healing. J Am Podiatr Med Assoc. 2002;92(1):12–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Lobmann R, Ambrosch A, Schultz G, Waldmann K, Schiweck S, Lehnert H. Expression of matrix-metalloproteinases and their inhibitors in the wounds of diabetic and non-diabetic patients. Diabetologia. 2002;45(7):1011–6.  https://doi.org/10.1007/s00125-002-0868-8.CrossRefPubMedGoogle Scholar
  8. 8.
    Lobmann R, Schultz G, Lehnert H. Proteases and the diabetic foot syndrome: mechanisms and therapeutic implications. Diabetes Care. 2005;28(2):461–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Winter GD. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963;200:378–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Singer AJ, Clark RA. Cutaneous wound healing. N Engl J Med. 1999;341(10):738–46.  https://doi.org/10.1056/nejm199909023411006.CrossRefPubMedGoogle Scholar
  11. 11.
    Falanga V. Wound healing and its impairment in the diabetic foot. Lancet. 2005;366(9498):1736–43.  https://doi.org/10.1016/s0140-6736(05)67700-8.CrossRefPubMedGoogle Scholar
  12. 12.
    Coerper S. Indikation und Technik der limitierten, fußerhaltenden Knochenresektion beim Diabetischen Fußulcus. Zeitschrift f Wundheilung. 2003;5:169–74.Google Scholar
  13. 13.
    Dissemond J, Goos M. Optionen des Débridements in der Therapie chronischer Wunden. JDDG. 2004;9(2):743–51.CrossRefGoogle Scholar
  14. 14.
    Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg. 1996;183(1):61–4.PubMedGoogle Scholar
  15. 15.
    Steinsträßer L, Hasler R, Hirsch T, Langer S, Steinau HU. Therapieoptionen der Zukunft bei chronischen Wunden. Chirurg. 2008;79(6):555–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Baer WS. The classic: the treatment of chronic osteomyelitis with the maggot (larva of the blow fly). Clin Orthop Relat Res. 2011;469(4):920–44.  https://doi.org/10.1007/s11999-010-1416-31931.CrossRefPubMedGoogle Scholar
  17. 17.
    Armstrong DG, Salas P, Short B, Martin BR, Kimbriel HR, Nixon BP, Boulton AJ. Maggot therapy in “lower-extremity hospice” wound care: fewer amputations and more antibiotic-free days. J Am Podiatr Med Assoc. 2005;95(3):254–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Thomas S, Jones M, Shutler S, Jones S. Using larvae in modern wound management. J Wound Care. 1996;5(2):60–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Thomas S, Jones M, Wynn K, Fowler T. The current status of maggot therapy in wound healing. Br J Nurs. 2001;10(22 Suppl):S5–8, S10, S12.CrossRefPubMedGoogle Scholar
  20. 20.
    Peters T, Rennekampf HO. Mechanisches débridement. Wund Manag. 2008;5:224–8.Google Scholar
  21. 21.
    König M, Vanscheidt W, Augustin M, Kapp H. Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial. J Wound Care. 2005;14(7):320–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Fikri R, Bicknell CD, Bloomfield LM, Lyons SP, Samarasinghe DG, Gibbs RG, Valabhji J. Awaiting autoamputation: a primary management strategy for toe gangrene in diabetic foot disease. Diabetes Care. 2011;34(8):e134.  https://doi.org/10.2337/dc11-0848.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Levy L, Luft S. Healing in an uncontrolled diabetic following severe infection and spontaneous amputation of the fifth toe. J Am Podiatry Assoc. 1962;52:836–7.PubMedGoogle Scholar
  24. 24.
    Londahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010;33(5):998–1003.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Fedorko L, Bowen JM, Jones W, Oreopoulos G, Goeree R, Hopkins RB, O’Reilly DJ. Hyperbaric oxygen therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: a prospective, double-blind, randomized controlled clinical trial. Diabetes Care. 2016;39(3):392–9.  https://doi.org/10.2337/dc15-2001.CrossRefPubMedGoogle Scholar
  26. 26.
    Santema KTB, Stoekenbroek RM, Koelemay MJW, Reekers JA, van Dortmont LMC, Oomen A, Smeets L, et al. Hyperbaric oxygen therapy in the treatment of ischemic lower- extremity ulcers in patients with diabetes: results of the DAMO2CLES multicenter randomized clinical trial. Diabetes Care. 2018;41(1):112–9.  https://doi.org/10.2337/dc17-0654.CrossRefPubMedGoogle Scholar
  27. 27.
    Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev. 2013;10:Cd010318.  https://doi.org/10.1002/14651858.CD010318.pub2.CrossRefGoogle Scholar
  28. 28.
    Armstrong DG, Attinger CE, Boulton AJ, Frykberg RG, Kirsner RS, Lavery LA, Mills JL. Guidelines regarding negative wound therapy (NPWT) in the diabetic foot. Ostomy Wound Manage. 2004;50(4B Suppl):3S–27S.PubMedGoogle Scholar
  29. 29.
    Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. Am J Clin Dermatol. 2005;6(3):185–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dirk Hochlenert
    • 1
  • Gerald Engels
    • 2
  • Stephan Morbach
    • 3
  • Stefanie Schliwa
    • 4
  • Frances L. Game
    • 5
  1. 1.Amb. Zentrum für DiabetologieEndoskopie & Wundheilung GemeinschaftspraxisKölnGermany
  2. 2.Department of Wound SurgerySt. Vinzenz Hospital and MVZ St. MarienKölnGermany
  3. 3.Department of Diabetes and AngiologyMarienkrankenhaus GmbHSoestGermany
  4. 4.Institute of Anatomy, Anatomy and Cell BiologyUniversity of BonnBonnGermany
  5. 5.Department of Diabetes and EndocrinologyDerby Hospitals NHS Foundation TrustDerbyUK

Personalised recommendations