povidone-iodine and Diabetic-Foot

The definition for the diabetic foot is infection, ulceration or destruction of deep tissues of the foot associated with neuropathy or peripheral vascular disease in the lower extremity of people with diabetes. Non-diabetic patients may suffer the same risks when neuropathy and arteriopathy are present. Knowing that 85% of amputations are preceded by foot ulcers, prevention is primordial. At the onset of an ulcer, immediate treatment must be undertaken and preferably by an interdisciplinary team. Delayed healing and increased risk of infection are often due to an associated vascular disease. While the array of dressings is expansive there is no «gold standard» treatment or «miracle dressing» described for foot ulcers. The management consists of wound analysis, debridement, woundcare and especially offloading.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Combined Modality Therapy; Debridement; Diabetic Angiopathies; Diabetic Foot; Diabetic Neuropathies; Humans; Necrosis; Povidone-Iodine; Wound Infection

To determine the effects of applying a natural polymer solution (shellac) to dry gangrene, and thereby prevent infection and progression to wet gangrene, in diabetic patients.. This randomized, controlled, pilot study included patients with type 2 diabetes mellitus who had unreconstructable peripheral vascular disease and were awaiting autoamputation. Eligible patients were contraindicated for surgery, had a limited life expectancy and/or had refused surgical amputations. All patients received the best possible medical treatment and were randomized to receive either topical shellac or antiseptic application of 10% povidone-iodine (PVP-I) solution to gangrenous areas.. A total of 26 diabetic patients were eligible for inclusion, of whom 23 completed the study: 13 were treated with shellac and 10 with PVP-I. The amputation rate was higher in the conventional treatment group versus the shellac group (60.0% versus 46.2%, respectively), although this difference was not statistically significant.. Shellac is a natural solution that may be used to embalm gangrenous tissue in selected diabetic patients. More studies are needed to assess the long-term outcomes of this technique.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Amputation, Surgical; Anti-Infective Agents, Local; Diabetes Mellitus, Type 2; Diabetic Foot; Female; Gangrene; Humans; Male; Middle Aged; Pilot Projects; Povidone-Iodine; Resins, Plant; Treatment Outcome

This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn(R) Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.

Topics: Aged; Anti-Infective Agents, Local; Colony Count, Microbial; Debridement; Diabetic Foot; Follow-Up Studies; Humans; Hydrogen Peroxide; Infection Control; Kaplan-Meier Estimate; Middle Aged; Postoperative Care; Povidone-Iodine; Recurrence; Safety; Skin Care; Time Factors; Treatment Outcome; Wound Healing; Wound Infection

To compare the effects of split-thickness skin grafts versus a conservative wound dressing on the healing times of diabetic foot ulcers and the length of hospital stay.. In this prospective case-controlled study, 50 patients consented to skin grafting (graft group) and 50 preferred to be managed by conservative dressings (control group). Wound management in both groups was standardised with regard to the dressing materials (which comprised a multilayer dressing including paraffin gauze and diluted povidone-iodine soaked gauze), wound care and surgeon involvement. Graft take, ulcer recurrence rate and donor-site morbidity were assessed. Healing times and the length of hospital stay were compared between the two groups.. A 100% skin graft take was recorded in 84% of the patients on the fifth postoperative day and in 62% on weeks 3 and 8. All patients in the graft group healed completely, but 8% had an ulcer recurrence and 4% a superficial infection within the following year. The mean healing time and mean length of hospital stay were significantly less in the graft group compared with the control group (p<0.001), reflecting results of similar studies.. Split-skin grafting is an effective method of managing diabetic foot ulcers as, compared with the conservative dressings used in this study, it reduced healing times and the length of hospital stay, while donor-site morbidity was minimal.

Topics: Anti-Infective Agents, Local; Bandages; Clinical Nursing Research; Cost-Benefit Analysis; Diabetic Foot; Female; Graft Survival; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Paraffin; Postoperative Care; Povidone-Iodine; Prospective Studies; Skin Care; Skin Transplantation; Sudan; Time Factors; Treatment Outcome; Wound Healing

Honey dressing has been used to promote wound healing for years but scanty scientific studies did not provide enough evidences to justify it benefits in the treatment of diabetic foot ulcers. We conducted a prospective study to compare the effect of honey dressing for Wagner's grade-II diabetic foot ulcers with controlled dressing group (povidone iodine followed by normal saline). Surgical debridement and appropriate antibiotics were prescribed in all patients. There were 30 patients age between 31 to 65-years-old (mean of 52.1 years). The mean healing time in the standard dressing group was 15.4 days (range 9-36 days) compared to 14.4 days (range 7-26 days) in the honey group (p < 0.005). In conclusion, ulcer healing was not significantly different in both study groups. Honey dressing is a safe alternative dressing for Wagner grade-II diabetic foot ulcers.

Topics: Adult; Aged; Bandages; Diabetic Foot; Female; Honey; Humans; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Wound Healing

The safety and efficacy of a novel superoxidized solution (Dermacyn Wound Care [DWC], Oculus Innovative Sciences, Petaluma, Calif) was evaluated for the treatment of wide postsurgical infected ulcers of the diabetic foot. A group (group A, n = 18) of patients with diabetes mellitus who had postsurgical lesions > 5 cm(2) without ischemia or infection were recruited consecutively and treated with DWC-saturated dressings. These dressings were renewed once daily and were compared with a group of patients that had been previously treated with diluted povidone iodine (group B, n = 15) using a quasi-experimental study design. Both sets of patients also received standard systemic antibiotic therapy, as per the practice in this center, and local surgical debridement. Patients had weekly assessments until wounds had re-epithelialized completely. Patients in group A had statistically significant shorter healing time and duration of antibiotic therapy and a higher healing rate at 6 months compared with those in group B (p < .01). Recurrence of infection, requirement for debridement procedures, and requirement for minor amputations were significantly less frequent during follow-up in group A patients (p < .05) when compared with those in group B. These preliminary data suggest that DWC used as a wound dressing together with other local and systemic therapies may have a role in reducing healing time as well as complications in patients with diabetes who have postsurgical lesions of the diabetic foot. These data propose the need for a robust controlled study of DWC-saturated dressings to explore its full potential.

Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages; Debridement; Diabetic Foot; Female; Humans; Male; Middle Aged; Povidone-Iodine; Treatment Outcome; Wound Healing

This study aimed to assess the efficacy of a new povidone-iodine (PVP-I) foam dressing (Betafoam) vs foam dressing (Medifoam) for the management of diabetic foot ulcers. This study was conducted between March 2016 and September 2017 at 10 sites in Korea. A total of 71 patients (aged ≥19 years) with type 1/2 diabetes and early-phase diabetic foot ulcers (Wagener classification grade 1/2) were randomised to treatment with PVP-I foam dressing or foam dressing for 8 weeks. Wound healing, wound infection, patient satisfaction, and adverse events (AEs) were assessed. The PVP-I foam and foam dressing groups were comparable in the proportion of patients with complete wound healing within 8 weeks (44.4% vs 42.3%, P = .9191), mean (±SD) number of days to complete healing (31.00 ± 15.07 vs 33.27 ± 12.60 days; P = .6541), and infection rates (11.1% vs 11.4%; P = 1.0000). Median satisfaction score (scored from 0 to 10) at the final visit was also comparable between groups (10 vs 9, P = .2889). There was no significant difference in AE incidence (27.8% vs 17.1%, P = .2836), and none of the reported AEs had a causal relationship with the dressings. The results of this study suggest that PVP-I foam dressing has wound-healing efficacy comparable with foam dressing, with no notable safety concerns. This study was funded by Mundipharma Korea Ltd and registered at ClinicalTrials.gov (identifier NCT02732886).

Topics: Adult; Aged; Aged, 80 and over; Bandages, Hydrocolloid; Diabetes Complications; Diabetic Foot; Female; Humans; Male; Middle Aged; Povidone-Iodine; Republic of Korea; Wound Healing; Wound Infection; Young Adult

Infected diabetic foot ulcers are always a problem for the surgeon, as well as, an economic burden upon the patient and state, in terms of increased hospital stay and cost of medications and dressings. Various methods have been devised for the treatment of infected wounds in history with varying results in different patients groups. The purpose of this study is to compare the effectiveness of topical insulin on the healing of diabetic foot ulcers with the conventional Pyodine. It was a quasi-experimental study done at Pakistan Institute of Medical Sciences Islamabad over a period of 20 months from January 2015 to September 2016. One hundred ten patients were included in the study. Sampling technique used was non-probability consecutive. Patients were assigned into two groups, group A receiving treatment with solution of 30 International Units Insulin Regular in 30 ml of normal saline and group B receiving conventional dressing with normal saline. The wound were compared for both groups at the days 7, 14 and 21 for wound healing. Complete healing time of diabetic foot ulcers was determined from patients' followup visits in outpatient department. Data was by analyzed by SPSS 20.. A total of 110 patients were enrolled in the study. Patients were divided equally into both control and experimental groups. The mean age of the patients was 53.23 ± 6.21 years. The mean pre-treatment wound diameter was 4.81 ± 0.85 cm in the placebo group, while it was 4.84 ± 0.81 cm in the topical insulin group (CI 0.29-0.35, P = 0.875). The mean post-treatment wound diameter was 3.90 ± 0.76 cm in the placebo group, while it was 2.46 ± 0.57 cm in the topical insulin group (CI 0.44-0.58, P = 0.022). The mean wound difference was 0.91 ± 0.25 cm in the placebo group, while it was 2.4 ± 0.34 cm in the topical insulin group (CI 0.40-0.20, P = 0.041). The mean percent reduction in wound diameter was 19.2 ± 4.6% in the placebo group, while it was 49.7 ± 5.2% cm in the topical insulin group (CI 10.6-6.1, P = 0.001).. There was significant contraction seen in the size of the ulcer in both the study groups depicting the healing process.

Topics: Administration, Topical; Anti-Infective Agents, Local; Bandages; Diabetic Foot; Female; Humans; Hypoglycemic Agents; Insulin; Middle Aged; Povidone-Iodine; Wound Healing

This study investigated whether a hyaluronic acid-povidone-iodine compound can enhance diabetic wound healing.. A dorsal skin defect (6 × 5 cm) in a streptozotocin-induced diabetes rodent model was used. Seventy male Wistar rats were divided into seven groups: I, normal control; II, diabetic control, no treatment; III, diabetic rats, lower molecular weight (100 kDa) hyaluronic acid; IV, rats, higher molecular weight (1000 kDa) hyaluronic acid; V, rats, 0.1% povidone-iodine; VI, rats, lower molecular weight hyaluronic acid plus povidone-iodine; and VII, rats, higher molecular weight hyaluronic acid plus povidone-iodine. Histologic examination was performed with hematoxylin and eosin staining. CD45, Ki-67, prolyl 4-hydroxylase, and vascular endothelial growth factor were evaluated with immunohistochemical staining.. Compared with the control, higher molecular weight hyaluronic acid plus povidone-iodine-treated rats had significantly reduced wound area (p < 0.001). Higher molecular weight hyaluronic acid plus povidone-iodine increased wound healing time when compared with higher molecular weight hyaluronic acid, povidone-iodine, or lower molecular weight hyaluronic acid plus povidone-iodine. Histology revealed significantly increased neovessels and suppressed inflammatory response in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the control group. Immunohistochemical staining revealed significantly increased Ki67, prolyl 4-hydroxylase, and vascular endothelial growth factor expression, and suppressed CD45 expression in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the other groups.. Higher molecular weight hyaluronic acid plus povidone-iodine complex dressing significantly facilitated diabetic wound healing via increasing neovascularization and tissue regeneration and suppressing a proinflammatory response.

Topics: Administration, Cutaneous; Animals; Anti-Infective Agents, Local; Bandages; Diabetes Mellitus, Experimental; Diabetic Foot; Drug Combinations; Humans; Hyaluronic Acid; Male; Molecular Weight; Povidone-Iodine; Rats; Rats, Wistar; Skin; Streptozocin; Treatment Outcome; Wound Healing

Here, a clinician compares 4 weeks of treatment with Prontosan Wound Gel with a subsequent 4 weeks of octenilin Wound Gel on a complex diabetic foot ulcer prone to recurrent infection. The data show that, following the switch to octenilin, the previously static wound started to heal.

Topics: Adult; Anti-Infective Agents, Local; Biguanides; Diabetes Mellitus, Type 2; Diabetic Foot; Disinfectants; Humans; Imines; Male; Povidone-Iodine; Pyridines; Treatment Outcome; Wound Healing

Examined 22 patients with diabetes mellitus (DM) type II of neuropathic form of diabetic foot syndrome (DFS). In 12 patients (comparison group) local povidone-iodine was used main in 10 (study group), except povidone-iodine, in the phase of exudation used tyrothricin in gel form, the granulation and epithelization phase, after cleaning the wounds, were injected intradermally 1 ml of injecting material for skin regeneration Lacerta. Trophic defects in 9 (90%) patients of the main group during the observation period healed completely, in the comparison group complete healing of the ulcer reached in 2 (16.7%) patients, the rest-wounds, although purified, however, were lethargic granulation, epithelization occurred very slowly. Consequently, the use of the proposed method allows to achieve more rapid healing of trophic ulcers that do not heal continued in patients of neuropathic forms of DFS.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Biological Factors; Diabetes Mellitus, Type 2; Diabetic Foot; Diabetic Neuropathies; Female; Humans; Male; Middle Aged; Povidone-Iodine; Protamines; Re-Epithelialization; Skin; Treatment Outcome; Tyrothricin

The authors report a series of thirty-six perforating ulcers of the foot in diabetic patients, evaluated using M.R.I. M.R.I. showed osteomyelitis in 16 cases, cellulitis in 15 cases, osteoarthropathies in 21 cases, tenosynovitis of flexor tendons in 2 cases, oedema in 2 cases and abscess in one case. In 19 cases, M.R.I. was used to improve diagnostic accuracy. The medical treatment made use of thermo-moulded soles allowing for the recovery of walking, with a hole facing the perforating ulcer of the foot. The application of insulin-soaked sponges in the event of clean perforating ulcer of the foot and iodized solution in the event of infected perforating ulcer of the foot promoted healing. The treatment was only conservative, when the lesions were limited to the soft tissues. Surgical treatment was performed in 19 cases due to a global involvement of soft and osteoarticular tissues. In fourteen cases the surgical treatment was limited and was performed through the perforating ulcer. Resection of metatarsal heads or metatarso-phalangeal joints was performed in 10 cases, with resection of surrounding pathologic tissue. The surgical treatment was limited to the soft tissues in 6 cases. In 4 cases, M.R.I. findings resulted into a transmetatarsal amputation because the vascular plexus was of poor quality and infection spread from the perforating ulcer to the dorsal aspect of the foot. In our opinion, dorsal infectious involvement in a perforating ulcer of the foot, is a factor of poor prognosis. A below-knee amputation has been performed in one patient.

Topics: Abscess; Administration, Cutaneous; Adult; Aged; Amputation, Surgical; Anti-Infective Agents, Local; Bacterial Infections; Cellulitis; Diabetic Foot; Edema; Equipment Design; Follow-Up Studies; Foot Diseases; Humans; Hypoglycemic Agents; Insulin; Magnetic Resonance Imaging; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Osteoarthritis; Osteomyelitis; Povidone-Iodine; Prognosis; Shoes; Tenosynovitis; Walking; Wound Healing

Topics: Diabetic Foot; Humans; Povidone-Iodine; Solutions