Using a combination therapy to combat scalp necrosis: a case report

Diabetic foot ulcer with osteomyelitis, successfully treated with the holistic approach of multiple ayurvedic treatment modalities - A case report

INTRODUCTION

Diabetic foot ulcer (DFU) with osteomyelitis is the devastating condition, which is a challenge to surgeons in saving the limb of the patient and in many circumstances ends up with amputation, which leaves physical and psychosocial trauma for both the patient and patient's family.

PRESENTATION OF CASE

A 48-year-old female patient with uncontrolled type 2 diabetes presented with swelling and gangrenous deep circular ulcer of size approx. 3 × 4 cm on plantar aspect of great toe of her left foot with involvement of first webspace from last three months. Plain X ray showed disrupted and necrotic proximal phalanx suggestive of diabetic foot ulcer with osteomyelitis. Despite using antibiotics and antidiabetic drugs for past three months she didn't get significant response and was suggested for toe amputaion. Hence, she approached our hospital for further treatment. We successfully treated the patient with the holistic approach of surgical debridement, medicinal leech therapy (MLT), irrigation of the wound with triphala decoction, jatyadi tail dressings, oral ayurvedic antidiabetic drugs to control blood sugar levels and a mixture of herbo mineral drug which is having antimicrobial property.

DISCUSSION

DFU may lead to infection, gangrene, amputation, death of the patient. Hence it is the need of the hour to look for limb salvage treatment modalities.

CONCLUSION

The holistic approach of these ayurvedic treatment modalities are effective and safe in treating DFUs with osteomyelitis and in preventing amputation.

The Effectiveness of Negative Pressure Therapy: Nursing Approach

INTRODUCTION

Complex wounds require advanced techniques for their management and care. Wound care costs are high, so healthcare professionals need to be aware of available therapies. Negative pressure therapy is a technology for which more and more data on its effectiveness in complex wounds are being collected.

OBJECTIVE

The objectives of this review were to analyze if the application of negative pressure therapy in complex wounds is effective; to compare the effectiveness of negative pressure therapy with other conventional treatments, as well as its combination with other therapies; and to evaluate the quality of life of patients undergoing negative pressure therapy and collect their main characteristics.

METHODOLOGY

A bibliographic review focused on articles published between November 2015 and June 2022 was carried out. The following databases were consulted: PubMed (Medline), Google Scholar, Web of Science (WOS), Scielo and Scopus.

RESULTS

The most used pressures in the studies coincide at -125 mmHg and in the range of -125 mmHg to -150 mmHg. In the pediatric population, pressure levels vary by age group. A pressure of -75 to -125 mmHg is recommended for children over 12 years of age, and -50 to -75 mmHg is recommended for children under 2 years of age.

CONCLUSIONS

Negative pressure therapy stands out for its rapid rate of granulation, the prevention and effective treatment of infections, the variety and malleability of dressings, its various applications and the possibility of using it with other therapies to accelerate wound closure.

Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report

INTRODUCTION AND IMPORTANCE

A diabetic foot ulcer (DFU) is one of the major diabetes complications that may lead to limb amputation. Amputation can have profound physical and psychological effects on an individual's life. Nowadays, the prevention of limb amputation and treatment of DFUs are known as the major health challenges.

CASE PRESENTATION

The present case report is of a 72-year-old woman with a 20-year history of type 2 diabetes who has had asymmetrical and superficial DFUs with sizes of 6 × 5 cm and 3 × 3 cm on the heel and the sole of the right foot, respectively. The ulcers were infected by S. aureus and E. coli. The patient had been hospitalized several times for receiving treatment, and not only the ulcers had not been healed, but also they had considerably extended so that the risk of foot amputation had been greatly increased. The patient was transferred to our wound care service. After conducting one session of surgical debridement, the patient underwent ten sessions of maggot therapy (one session every two days) using sterile Lucilia sericata. After about six months, the patient's DFUs were completely healed.

CLINICAL DISCUSSION

DFU can affect a patient's quality of life and lead to infection, sepsis, amputation, and even patient death. Therefore, using effective treatment approaches is very important for the management of DFUs.

CONCLUSION

The combined use of surgical debridement and maggot therapy is a safe and effective method for improving diabetic foot ulcers and preventing amputation.

Surgical debridement, maggot therapy, negative pressure wound therapy, and silver foam dressing revive hope for patients with diabetic foot ulcer: A case report

Introduction and importance

Diabetic foot ulcers (DFUs), as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of d DFUs are among the most critical challenges for the patients and their families.

Case presentation

The present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had DFU for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6 × 4 cm and 6 × 8 cm, the sole as a superficial ulcer with a size of 6 × 3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. The patient was transferred to our wound management team. DFU was treated and managed using a combination of surgical debridement, maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition.

Clinical discussion

DFUs are caused by various pathological mechanisms, the monotherapy strategy would lead to a very low level of recovery. Therefore, DFU management requires multimodal care and interdisciplinary treatment.

Conclusion

Based on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this case report to treat refractory DFU.

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DFUs can lead to amputation.

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DFUs do not respond to standard drug therapies.

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DFUs can be managed by combination therapy.

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The medical teams can benefit from combination therapy.

Recent Advances and Applications of Bacterial Cellulose in Biomedicine

Bacterial cellulose (BC) is an extracellular polymer produced by Komagateibacter xylinus, which has been shown to possess a multitude of properties, which makes it innately useful as a next-generation biopolymer. The structure of BC is comprised of glucose monomer units polymerised by cellulose synthase in β-1-4 glucan chains which form uniaxially orientated BC fibril bundles which measure 3-8 nm in diameter. BC is chemically identical to vegetal cellulose. However, when BC is compared with other natural or synthetic analogues, it shows a much higher performance in biomedical applications, potable treatment, nano-filters and functional applications. The main reason for this superiority is due to the high level of chemical purity, nano-fibrillar matrix and crystallinity. Upon using BC as a carrier or scaffold with other materials, unique and novel characteristics can be observed, which are all relatable to the features of BC. These properties, which include high tensile strength, high water holding capabilities and microfibrillar matrices, coupled with the overall physicochemical assets of bacterial cellulose makes it an ideal candidate for further scientific research into biopolymer development. This review thoroughly explores several areas in which BC is being investigated, ranging from biomedical applications to electronic applications, with a focus on the use as a next-generation wound dressing. The purpose of this review is to consolidate and discuss the most recent advancements in the applications of bacterial cellulose, primarily in biomedicine, but also in biotechnology.