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Introduction

COMPARATIVE STUDY OF THE CLINICAL OUTCOME OF THREE TYPES OF DRESSINGS IN THE MANAGEMENT OF DIABETIC FOOT ULCERS Dr. Nafees Javed Qureshi Dr. M S Sridhar. Introduction . Diabetic Foot Ulcers (DFU) – common complication. India leads the world with 40.9 million population with diabetes.

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Introduction

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  1. COMPARATIVE STUDY OF THE CLINICAL OUTCOME OF THREE TYPES OF DRESSINGS IN THE MANAGEMENT OF DIABETIC FOOT ULCERS Dr. NafeesJavedQureshi Dr. M S Sridhar

  2. Introduction • Diabetic Foot Ulcers (DFU) – common complication. • India leads the world with 40.9 million population with diabetes. • Foot ulcers are single most important risk factor for non-traumatic amputations. • Diabetic foot ulcers need standard care with multi-disciplinary approach.

  3. OBJECTIVES • To compare the clinical outcome of three types of dressings in the management of diabetic foot ulcers. - Alginate+Hydrocolloid dressings. - Povidone iodine +Hydrogen peroxide dressings. - Normal Saline soaked gauze dressings.

  4. Materials and methods • Randomised Prospective study. • 3 group of patients - Group (A)- Alginate+hydrocolloid dressings. - Group (B)- Povidoneiodine+hydrogen peroxide dressing - Group (C)- Normal saline soaked gauze dressings. • For classification of wounds, S(AD)SAD classification system was used. • Study period - September 2011 to November 2013.

  5. Criteria • INCLUSION CRITERIA- (A). Type 1 or Type 2 diabetic patients with foot ulcers. (B). Age 18 years or above. (C). Able and willing to give informed consent. • EXCLUSION CRITERIA- (A). Patients with peripheral vascular disease. (B). Patients with known allergy to iodine. (C). Patients on immunosuppressive/corticosteroid therapy

  6. S(AD) SAD Classification

  7. All patients were followed up personally after 1 week, 15 days, 1 month and 3 months. • Size of the ulcer was measured on a transparent sheet using a marker pen at first visit and on subsequent follow up visits.

  8. Follow Up Criteria • Ulcer • Size on transparency: • Floor: • Discharge: • Surrounding Area: • Signs of inflammation: • GRBS :

  9. Follow Up • All patients seen personally. • Total 46 patients. • Lost to follow up / excluded – 13 patients. • Final Analysis – 33 • Group A – 10 patients • Group B – 13 patients • Group C – 10 patients

  10. Follow up • Group A – 10 patients. • Group B – 13 patients. • Group C – 10 patients.

  11. Results

  12. Results

  13. First Visit

  14. Follow up

  15. Group A • Complete Healing within 3 months – 4 • 50 % Size Reduction - 3 • < 50% Size reduction - 3 • 1 patient developed wound infection after 2 months follow up, but was managed with debridement.

  16. Group B • Complete healing within 3 months - 6 • Size reduction 50 % - 4 • Size reduction 10-30 % 3

  17. Group C • Complete healing within 3 months - 4 • Size reduction 50 % - 4 • Size reduction 25 % - 2

  18. SAD score & wound healing • Odds ratio =0.769( 95% CI (0.301, 1.968) , P=0.584 • With every 1 unit increase in SAD score, healing of ulcers decreased upto 25 %.

  19. Review of Literature

  20. Comparison with Literature • Foam dressings were associated with higher odds of ulcer healing compared with basic wound contact dressings. Estimate was considered to be of low quality. • In general, estimates had large uncertainty due to low sample sizes. • No significant difference between foam dressings v/s basic contact dressings.

  21. Review of Literature • Foot ulcers occur in 12-25% patients with diabetes. • Precedes 84% of all non-traumatic amputations. • Amputations are 15 times more common in patients with Diabetes. • Standard care heals 24% of ulcers in 24 weeks. - Removal of mechanical stress. - Debridement. - Moist wound environment.

  22. Alginate + Hydrocolloid Dressings • Alginates are highly absorbent, gel-forming materials with haemostatic properties. • Calcium alginate dressings inhibits growth of Staphylococcus aureus in vitro, with no increase in growth of Pseudomonas, Streptococcus pyogenes, or Bacteroidesfragilis. • Safe to use on infected foot ulcers, provided there are regular and thorough dressing changes. • Hydrocolloids provide moist environment.

  23. Povidone-iodine + Hydrogen Peroxide Dressings • Povidone iodine - decreases bacterial count of ulcers, - promote revascularization, - do not cause the emergence of drug-resistance - have broader antimicrobial spectrum. • Hydrogen peroxide - wound antiseptic. - greatest activity is towards Gram-positive bacteria. - loosens debris and necrotic tissue of wound. • In-vitro studies – Povidone iodine shown to be cytotoxic to cells essential to the wound healing process, such as fibroblasts, keratinocytes, leukocytes.

  24. Normal Saline Dressings • Physiologically normal • Isotonic with plasma • Provide moist environment for healing of wounds. • As the water in gauze evaporates, dressing becomes hypertonic, draws fluid from wound by osmosis. • Wound fluid then dilutes - to reach dynamic equilibrium. • Movement of wound fluid into sponge contribute to its effectiveness as a dressing.

  25. Limitations • Small sample size.

  26. Conclusion • No significant difference between clinical outcome of 3 types dressings in diabetic foot ulcers. • SAD score helps in predicting healing of ulcers.

  27. Thank You

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