Chronic wounds are a common cause of morbidity world wide. The frequent lack of any clinical assessment of patients in the community has led to long periods of ineffective and often in appropriate treatment.When considering any health care problem it is useful to have a clear impression of scale of the problem and the burden of care it represents.The prevalence of leg ulceration has been the subject of study for more than 20 years.A leg ulcer is not a discrete disease with clear diagnostic criteria rather it is the consequence of various kinds of underlying disease process.The range of diseases and conditions with the potential for leg ulceration is broad.Although diagnostic and therapeutic decisions in patients with vascular diseases are guided primarily by the history and physical examination, the use of non invasive investigations has increased significantly in recent years mainly as a result of technological advances in ultrasonography
The first edition of Leg Ulcers by David Negus was published in 1991. Since then, developments in the management of venous disorders and, in particular, of venous ulceration, have continued apace. Prominent among these has been the development of duplex ultrasound scanning, which now enables the diagnosis and treatment of venous ulceration to be undertaken with a sound knowledge of the underlying anatomy. Treatment options now include PIN stripping of the long saphenous vein, endoscopic perforating vein interruption and ultrasound-guided foam sclerotherapy. All of these developments, and more, are covered in this comprehensive guide to the management of this unpleasant and often socially unacceptable disorder. The book covers a wide diversity of subjects with authority and detail, including the relationship between venous ulcers and primary venous insufficiency as well as post-thrombotic syndrome, risk factors for deep vein thrombosis, recent advances in wound healing and microcirculatory changes in venous ulceration. Written by a team of internationally recognised experts, this third edition of Leg Ulcers contains comprehensive reviews of the relevant literature and provides advice for those faced with difficult diagnostic and therapeutic problems, whatever their clinical setting.
This book focuses on the clinical evaluation and management of ulcers of the lower limbs. There are numerous causes for ulceration in the lower limbs and each variety requires careful clinical evaluation and management approach. In 29 chapters, written by highly experienced surgeons, the book covers prevalence, types, healing mechanisms, clinical evaluation and microbiology of the ulcers, followed by detailed review of each ulcer variety. Chapters on pyoderma gangrenosum, diabetic foot, grafts and flaps, amputation, pain control strategy and documentation of these cases provide a complete coverage from management stand-point. The book is essential reading not only for general surgeons and vascular surgeons, but also has relevance for orthopedic surgeons, podiatrists, dermatologists and oncologists who manage such cases. Also serves as reference guide for post-graduate examination.
StreamtAbstract - Diabetic FootTopictComplications - footAbstract titletDeterminants and risk factors of recurrence in diabetic foot ulcers: a prospective 2 year followup studyCo-authorstA. Vijayakumar1, S. Ganapathy Kumari1, V. Gadadharan1, R. Vijayakumar1.1Medical Trust Hospital Kulanada, General Medicine, Pathanamthitta, India.Abstract bodytBackgroundPeople with diabetes has a 15% chance of developing a lower extremity ulcer at some point of time. Risk of recurrent ulceration in patients with history of foot complications is very high. Patient compliance is an important part of management of foot ulcer. Health care providers should be able to provide a realistic estimate of the chances of healing and the time taken for healing to the patient to ensure patient cooperation.AimTo evaluate the outcome of diabetic foot ulcers and to study the risk factors for recurrent foot ulcers in a diabetic foot care centre .MethodA cohort of 100 patients with diabetic foot ulcer were selected randomly from those admitted in the diabetic foot care department of the hospital and they were followed up prospectively for a period of 2 years. Patients without follow-up visit at the diabetic foot clinic were excluded from the study. History, general examination , relevant investigations and foot examination details were noted at the time of initiation of study and relevant changes were noted at every followup visit. Tactile sensation, vibration perception with the help of a biothesiometer, 10 g monofilament test and vascular assessment with the help of a hand held doppler were done initially. A reulceration was defined as an ulcer at the same location as a previous one. A recurrent ulcer was defined as any secondary ulcer regardless of its location.ResultsAmong the study participants, 46% of patients belong to the 55- 65 age group and majority of them were males(72%). Of the study participants 30% were smokers and 36% of them had long duration of diabetes. (DM>20 yrs). Regarding the recurrence of ulcers , 40% of the patients had either recurrence or reulceration and among them 8% had multiple recurrences. Majority of index ulcers were big toe plantar ulcers(32%). Most frequent site of recurrence or reulceration also was big toe. Amputation was needed for 18% of patients for the index ulcer. Protective foot wears were used by 84% of the patients following development of index ulcer, but 36% of patients still developed a new ulcer. Of the study participants 96% had severe peripheral neuropathy and 30% had peripheral vascular disease. Peripheral vascular disease has a significant association with recurrence of foot ulcer( p value>0.05). Some form of foot deformity was present in 12% of the patients and among the index ulcers 10% did not heal. Majority of the non healing ulcers are on the plantar aspect of foot. Among the study participants 48% had an HbA1c between 8- 10 % and 11% had an HbA1c of >10% at the time of presentation of the index ulcer. Patients with HbA1c >8 % at the time of index ulcer had a high chance of recurrence and poor outcome. Nephropathy was present in 18% of the patients.DiscussionThe risk factors associated with recurrence of foot ulcer are mainly peripheral vascular disease, poor glycemic control and location of index ulcer with big toe plantar aspect the most common site.Conflict of InteresttI have no potential conflict of interest to disclose.
This book presents essential information on biomechanical features of the diabetic foot, which could help to minimize the risk of future diabetic foot problems. India has recently been classified as the ‘diabetic capital’ of the world. Type 2 diabetes mellitus has become a serious concern for Indian society, where the prevalence rate is increasing exponentially. Similarly, the comorbidities and foot complications of type 2 diabetes mellitus are worsening day by day. Of all complications, diabetes peripheral neuropathy is the most common, and leads to foot deformities, pain, altered sensation, loss of foot arch, etc. The ultimate fate can even be gangrene and amputation. Accordingly, foot complications of diabetes represent a pressing medical issue. Sharing insights into diabetic foot syndrome, its causative factors, prevention and management, this book offers a valuable resource for medical and paramedical students, researchers, podiatrists, surgeons, and physicians alike.
This book discusses essential aspects of diabetic foot ulcers, including evidence-based information on its pathogenesis and pathophysiology, as well as the molecular mechanisms and biomechanics of the diabetic foot. It also highlights the need for a multidisciplinary team to be involved in the management of diabetic patients with foot ulcers, and describes available and future tools for evaluating patients who are at risk. Exploring the main current therapies as well as the latest developments, future directions and potential new treatments, such as growth factors, stem cell therapy, alternative medicine and nanotechnology, the book is a valuable resource for clinicians and medical graduates but will also appeal to researchers working in the field.
Health care needs assessment provides information to plan, negotiate and change services for the better, and to improve health in other ways. The first edition of this series established itself as a key source on health care needs for specific conditions supported by the Department of Health. Now in its second edition it provides vital updates taking into account how health care has moved on and how the structure of the UK's health service has changed. Each of the chapters follows the same structure; each analysing its topic, reviewing the incidence and prevalence, the range of services available, and the effectiveness of those services. It describes the central role and aim of health care needs assessment in the NHS health care reforms and explains the 'epidemiological approach' to needs assessment and its effectiveness. Volume 1 includes diabetes mellitus, renal disease, stroke, lower respiratory disease, coronary heart disease, colorectal cancer, cancer of the lung, osteoarthritis affecting the hip and knee, cataract surgery and groin hernia. Volume 2 includes varicose veins and venous ulcers, benign prostatic hyperplasia, severe mental illness, Alzheimer's disease, alcohol misuse, drug misuse, learning disabilities, community child health services and contraception, induced abortion and fertility services. All health professionals, including policy makers and shapers and those assessing quality of service will find this book an essential resource.
Diabetes can limit blood supply to the feet resulting in loss of feeling, which means foot injuries do not heal well and may go unnoticed. People with diabetes are 15 times more likely to have a limb amputated due to gangrene (NHS Choices). This book is a complete guide to the care of diabetic foot. Beginning with the basics of the condition, clinical examination and assessment, the following chapters describe management strategies for diabetic foot resulting from different disorders. This comprehensive manual includes more than 300 images, illustrations and tables, and each chapter offers suggestions for further reading. Key points Complete guide to care of the diabetic foot Covers diagnosis and management strategies for the condition resulting from different disorders Includes more than 300 images, illustrations and tables Extensive further reading suggestions
Providing vital updates, this two volume set describes the central role and aim of health care needs assessment in the NHS health care reforms, and explains the 'epidemiological approach' to needs assessment, and the effectiveness and availability of services.
