for Diabetes Care Clinicians
Pinjala Ramakrishna MS FRCS FICS
Chief of Vascular Endovascular Surgery at
Nizam's Institute of Medical Sciences, Hyderabad,
Editor, Vascular Endovascular Interventions and Surgery Update,
Tutor for the Royal College of Surgeons, Edinburgh UK
Diabetic wound management
is new in the
diabetic wound management -
with vascular problems ?
Has there been
any better wound dressing in the recent past?
Yes, graft skins (Tissue engineering techniques) – Dermagraft, Apligraf and other cultured skins. But they are available at premium cost like any other products. But debridement is essential to get faster healing of the ulcers. In one at end of 12 weeks of treatment 56% showed healing while only 38% showed healing in the controlled.
Is it possible
to change pressure points or reduce the pressure in the diabetic foot with
A recent randomized controlled study has shown that is possible to alter the pressure point in the diabetes patients with silicone injections. Van Schie CHM et al in diabetes care 2000; 23: 634-8.
Is PDGF (Becaplermin)
good for the diabetic wounds associated with neuropathy?
4 randomized controlled trials have shown that it is useful in early healing of the ulcers. It is not yet introduced in India. This is awaiting approvals in India.
is there any scientific basis for this treatment?
There seems to be benefit in the neuropathic, ischemic wounds with slough with larvae. However one has to sterile larvae for this purpose. There are no controlled trials for this evidence.
Can we consider
the combination of the statins and benzafibrate for diabetic dyslipidaemia?
There seems to be good benefit with this combination. Cardiovascular event rate has come down to 2% from 9.5% in 6 months time with this combination. Gavish D et al A J Intern Med 2000; 247:563-9.
Would you consider that in your diabetic foot patients with vasculopathy?
Clopidogrel – Is it better than Aspirin and Pentoxifylline in preventing the complications?
go to index page in www.diabetes.org.in