FOOT CARE AND ULCER MANAGEMENT AT VASCULOCARE: OUR AIM TO SALVAGE FOOT.
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Foot ulcers are a common complication of peripheral arterial disease and a major cause of disability of patients. It is worse when associated with diabetes. Ischemic and diabetic foot ulcers lead to amputation if not managed properly.
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Diabetic Foot Ulcer.pptx
Diabetic foot ulcers are a major complication of diabetes, affecting around 15% of people with the disease. They are caused by neuropathy, peripheral vascular disease, and foot deformities resulting from diabetes. Treatment involves wound debridement, managing any infection, revascularization if needed, and strict offloading of pressure on the affected foot to aid healing. Left untreated, diabetic foot ulcers can lead to amputation in around 50-70% of cases.
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Diabetic Foot, Prevalence, how to approach, Assessment of risk factors, Examination, treatment of diabetic foot at Primary Care Center.
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The document discusses diabetic foot complications, which are common, serious problems that negatively impact patient health and society costs. Most complications can be prevented through blood sugar control and daily foot care. Screening high risk groups allows early detection. Treatment requires a multidisciplinary team and specialized care centers. The prognosis is best when complications are identified and managed early.
DIABETIC FOOT PRESENTATION.pptx
This document discusses diabetic foot disease and its management. It defines diabetic foot disease and provides statistics on its prevalence and impact. It covers the pathophysiology of neuropathy and peripheral vascular disease in causing foot complications. Treatment involves a multidisciplinary approach including wound care, infection treatment, offloading, and possible amputation. Surgical and nonsurgical options are presented for different wound severities. Patient education is emphasized for prevention and reducing recurrence of foot problems.
Diabetic foot
This document discusses diabetic foot disease, including its pathophysiology, clinical manifestations, management, and prevention. It notes that diabetic foot disease is caused by neuropathy, ischemia, and infection leading to tissue breakdown. The pathophysiology involves both metabolic neuropathy and neuroischemia. Clinical manifestations depend on whether the foot is primarily neuropathic or ischemic. Management involves debridement, wound dressing, antibiotic therapy, metabolic control, and potentially vascular interventions or amputation. Prevention emphasizes good foot care, inspection, and control of diabetes and related conditions.
Diabetic foot ulcer / surgical wounds
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Orthotic management of diabetes mellitus foot
This document discusses orthotic management for diabetes mellitus patients. It describes the types and causes of diabetes, common foot deformities and complications like diabetic foot ulcers. It explains that diabetic foot ulcers are wounds on the feet that occur in 15% of diabetics and increase the risk of lower extremity amputation. The document outlines various orthotic options for managing diabetic feet, including prescription footwear, total contact casts, removable cast walkers, half shoes, scotchcast boots, compressive wraps, shoe inserts, socks, and surgery in severe cases of infection or non-healing ulcers.
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offering a wide range of dental certified courses in different formats.
Diabetic Foot Ulcer.pptx
Diabetic foot ulcers are a major complication of diabetes, affecting around 15% of people with the disease. They are caused by neuropathy, peripheral vascular disease, and foot deformities resulting from diabetes. Treatment involves wound debridement, managing any infection, revascularization if needed, and strict offloading of pressure on the affected foot to aid healing. Left untreated, diabetic foot ulcers can lead to amputation in around 50-70% of cases.
Diabetic Foot .pptx
Diabetic Foot, Prevalence, how to approach, Assessment of risk factors, Examination, treatment of diabetic foot at Primary Care Center.
The diabetic foot; state of the art
The document discusses diabetic foot complications, which are common, serious problems that negatively impact patient health and society costs. Most complications can be prevented through blood sugar control and daily foot care. Screening high risk groups allows early detection. Treatment requires a multidisciplinary team and specialized care centers. The prognosis is best when complications are identified and managed early.
DIABETIC FOOT PRESENTATION.pptx
This document discusses diabetic foot disease and its management. It defines diabetic foot disease and provides statistics on its prevalence and impact. It covers the pathophysiology of neuropathy and peripheral vascular disease in causing foot complications. Treatment involves a multidisciplinary approach including wound care, infection treatment, offloading, and possible amputation. Surgical and nonsurgical options are presented for different wound severities. Patient education is emphasized for prevention and reducing recurrence of foot problems.
Diabetic foot
This document discusses diabetic foot disease, including its pathophysiology, clinical manifestations, management, and prevention. It notes that diabetic foot disease is caused by neuropathy, ischemia, and infection leading to tissue breakdown. The pathophysiology involves both metabolic neuropathy and neuroischemia. Clinical manifestations depend on whether the foot is primarily neuropathic or ischemic. Management involves debridement, wound dressing, antibiotic therapy, metabolic control, and potentially vascular interventions or amputation. Prevention emphasizes good foot care, inspection, and control of diabetes and related conditions.
Diabetic foot ulcer / surgical wounds
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Orthotic management of diabetes mellitus foot
This document discusses orthotic management for diabetes mellitus patients. It describes the types and causes of diabetes, common foot deformities and complications like diabetic foot ulcers. It explains that diabetic foot ulcers are wounds on the feet that occur in 15% of diabetics and increase the risk of lower extremity amputation. The document outlines various orthotic options for managing diabetic feet, including prescription footwear, total contact casts, removable cast walkers, half shoes, scotchcast boots, compressive wraps, shoe inserts, socks, and surgery in severe cases of infection or non-healing ulcers.
Journal reading New trends in Orthopaedic management of diabetic foot.pptx
This document summarizes new trends in the orthopaedic management of diabetic foot problems. It discusses prevention methods, classification systems, diagnostic technologies, treatment options including wound care, offloading, surgery, and the management of Charcot foot and infection. Despite improvements, diabetic foot remains a major public health problem due to lack of education and high recurrence rates. Further research is still needed to identify optimal treatment strategies and understand the pathogenesis of diabetic foot complications.
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Dr. Vinay Jain presented on diabetic foot. Some key points:
1. Diabetes can cause nerve damage (neuropathy), poor circulation (peripheral arterial disease), and foot deformities which make the feet susceptible to ulcers and infection.
2. About 15% of diabetics develop foot lesions in their lifetime, with an amputation rate 15 times higher than non-diabetics.
3. Risk factors for foot complications include long diabetes duration, neuropathy, past ulcer/amputation, and poor blood sugar control.
4. Treatment depends on the severity of the ulcer and includes wound cleaning, offloading pressure (casts, special shoes), surgery if needed, and amputation in
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This document discusses diabetic foot, which is an important but often neglected entity. Around 25% of people with diabetes will develop a diabetic foot ulcer in their lifetime, which can lead to amputation and increased mortality. Proper management of diabetic foot involves optimal diabetes and blood pressure control, foot care including regular inspection and debridement of wounds, offloading of pressure areas, and treatment of infections. Assessing the foot involves testing for loss of sensation and vascular status, classifying any wounds, and looking for signs of infection.
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The document discusses diabetes as a global epidemic and leading cause of death. It notes that the number of people with diabetes is expected to rise significantly by 2030. Diabetes is a major risk factor for foot ulcers and lower limb amputation. The document then examines in detail the risk factors and pathophysiology of diabetic foot ulcers and amputation, including neuropathy, foot deformities, peripheral artery disease, and the multidisciplinary approach needed for prevention and treatment.
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The document discusses the evaluation and treatment of diabetic foot problems. It outlines the importance of assessing a patient's medical history, examining the foot and lower limb for issues like neuropathy, vascular disease and foot deformities, and investigating for conditions like infection. Treatment involves wound care, reducing pressure on ulcers through offloading techniques, managing infection, improving vascular issues, and potentially surgical interventions like debridement or amputation.
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A man of 45 years, came by way of a limp, because severe pain in the joints of the right big toe. Experienced by patients while awake this morning, according to the patient, last night he still had time shopping at the mall with friends. Medical history of reoccurens that happens often.
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The document discusses diabetic foot complications, including:
1) Diabetic foot ulcers affect 1-4% of diabetics annually and have a 15-25% lifetime risk, with 15% resulting in lower extremity amputation.
2) Risk factors for diabetic foot ulcers include peripheral neuropathy, a major contributing factor. Comprehensive foot exams assess dermatological, nerve, osseous, and vascular risks.
3) Current treatments include addressing dry skin, fungal infections, calluses, ulcers, and more through debridement, dressings, offloading, and advanced therapies like skin grafts and platelet-rich plasma.
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This document provides guidelines for nursing care of patients with diabetic foot syndrome (DSF). It discusses key aspects of managing DSF including regular examination of at-risk feet; identifying risk factors; educating patients, families, and healthcare providers; ensuring appropriate footwear; and treating non-ulcerative issues. When foot ulcers are present, the document outlines evaluating the cause, type, site, and depth of ulcers as well as signs of infection to guide further treatment.
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Recent advances in treatments for diabetic foot ulcers have allowed for limbs to be healed that were previously thought unsalvageable, provided a variety of individualized treatment options, and reduced healing times. Key factors that impair wound healing in diabetics include peripheral arterial disease, neuropathy, infection, and structural foot problems. Advanced treatments such as growth factors, skin substitutes, negative pressure therapy, and hyperbaric oxygen can enhance healing when wounds are not responding to traditional care. Recurrent ulcers can be prevented through education, good foot care, appropriate footwear, and surgical correction of deformities when needed.
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The document discusses diabetic foot care and amputation prevention at Aster Medcity in Kochi. It outlines their preventative management which includes screening patients for foot problems through tests to assess circulation, neuropathy, and plantar pressures. For patients with foot issues, they provide education, specialized footwear, medication and other therapies. Surgically, they treat infections, revascularization procedures, and Charcot's foot reconstructive surgeries using techniques like arthrodesis and internal fixation to normalize foot shape and function and prevent amputation. They have also developed novel "Sling" and PMMA prosthesis techniques for stabilization after surgery.
Diabetic Foot Ulcer
Diabetic foot ulcers are a major complication of diabetes and a leading cause of non-traumatic lower extremity amputations. They result from an interaction of neuropathy, abnormal foot biomechanics, peripheral arterial disease, and poor wound healing in diabetes patients. Ulcers are classified based on their depth and degree of ischemia. Treatment involves strict glycemic control, antibiotic treatment of infections, wound care including debridement and dressings, and offloading pressures on the foot. Prevention relies heavily on patient education regarding foot care, protective footwear, and monitoring for early signs of infection or other issues.
Foot problem
Foot problems in diabetics can occur due to neuropathy, peripheral vascular disease, and trauma which can lead to foot ulcers and infection. Clinical features include neuropathy symptoms like numbness and pain as well as ischemia symptoms like claudication. Management involves treating infection, avoiding weight-bearing, good glycemic control, and assessing need for vascular reconstruction. Prevention focuses on daily foot inspection, washing, moisturizing, nail cutting, sock changes, and wearing proper footwear to avoid recurrence of ulcers or Charcot neuropathy complications.
Diabetic Foot
Diabetic foot disease is one of the most significant complications of diabetes. It involves foot ulcers associated with neuropathy and/or peripheral arterial disease in patients with diabetes. There are three main pathologies that contribute to diabetic foot disease: neuropathy, which causes loss of sensation and makes patients unaware of foot injuries; vasculopathy, which involves premature hardening of the arteries; and immunopathy, which compromises the body's immune response and increases risk of infection. Medical treatment of diabetic foot disease focuses on risk identification, foot examination, patient education, and management of diabetes, foot care, and medications to promote circulation and prevent ulcers.
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The synovium lines joints and produces synovial fluid. It contains two cell types - type A macrophages and type B fibroblasts. Synovial fluid contains hyaluronic acid and lubricates joints. Crystal synovitis occurs when urate or calcium pyrophosphate crystals deposit in the synovium, causing inflammation. Gout is caused by monosodium urate crystals and often affects the big toe joint. Pseudogout is caused by calcium pyrophosphate crystals and commonly affects large joints like the knee. Both present with sudden onset severe pain and swelling that usually resolves within 1-2 weeks. Diagnosis involves identifying the characteristic crystals in synovial fluid under polarized microscopy.
Synovium & crystal synovitis
The synovium lines joints and produces synovial fluid. It contains two cell types and secretes hyaluronic acid. Synovial fluid contains water, proteins, and nutrients. The two main types of crystal synovitis are gout caused by monosodium urate crystals typically in the big toe, and pseudogout caused by calcium pyrophosphate crystals usually in large joints like the knee. Both involve crystal deposition in the synovium and similar acute inflammatory attacks. Risk factors, investigations, and treatments aim to reduce crystal levels and attack frequency or progression. Complications can include joint damage and renal problems if untreated.
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Journal reading New trends in Orthopaedic management of diabetic foot.pptx
This document summarizes new trends in the orthopaedic management of diabetic foot problems. It discusses prevention methods, classification systems, diagnostic technologies, treatment options including wound care, offloading, surgery, and the management of Charcot foot and infection. Despite improvements, diabetic foot remains a major public health problem due to lack of education and high recurrence rates. Further research is still needed to identify optimal treatment strategies and understand the pathogenesis of diabetic foot complications.
Diabetic foot vinay 1
Dr. Vinay Jain presented on diabetic foot. Some key points:
1. Diabetes can cause nerve damage (neuropathy), poor circulation (peripheral arterial disease), and foot deformities which make the feet susceptible to ulcers and infection.
2. About 15% of diabetics develop foot lesions in their lifetime, with an amputation rate 15 times higher than non-diabetics.
3. Risk factors for foot complications include long diabetes duration, neuropathy, past ulcer/amputation, and poor blood sugar control.
4. Treatment depends on the severity of the ulcer and includes wound cleaning, offloading pressure (casts, special shoes), surgery if needed, and amputation in
Diabetes Mellitus and it's orthotic management
Diabetes mellitus refers to a group of diseases that affect how the body uses blood sugar (glucose). diabetic ulcer formation in diabetes.
Diabetic foot
This document discusses diabetic foot, which is an important but often neglected entity. Around 25% of people with diabetes will develop a diabetic foot ulcer in their lifetime, which can lead to amputation and increased mortality. Proper management of diabetic foot involves optimal diabetes and blood pressure control, foot care including regular inspection and debridement of wounds, offloading of pressure areas, and treatment of infections. Assessing the foot involves testing for loss of sensation and vascular status, classifying any wounds, and looking for signs of infection.
1362571102 a.r. undre
Prof. Dr. A.R. Undre discusses the role of CO2 laser in treating diabetic foot ulcers. Diabetes is a growing problem in India, with high rates of foot ulcers and amputations. CO2 laser therapy aims to conserve limbs and promote healing by accelerating collagen production and converting moist gangrene to dry gangrene. Case studies show CO2 laser treatment healing large, infected ulcers and saving limbs from amputation. The non-invasive laser therapy results in rapid healing with minimal pain and reduced hospital stays compared to conventional treatments.
Diabetic Foot slide show vascular surgery
The document discusses diabetes as a global epidemic and leading cause of death. It notes that the number of people with diabetes is expected to rise significantly by 2030. Diabetes is a major risk factor for foot ulcers and lower limb amputation. The document then examines in detail the risk factors and pathophysiology of diabetic foot ulcers and amputation, including neuropathy, foot deformities, peripheral artery disease, and the multidisciplinary approach needed for prevention and treatment.
Diabetic zarina present
The document discusses the evaluation and treatment of diabetic foot problems. It outlines the importance of assessing a patient's medical history, examining the foot and lower limb for issues like neuropathy, vascular disease and foot deformities, and investigating for conditions like infection. Treatment involves wound care, reducing pressure on ulcers through offloading techniques, managing infection, improving vascular issues, and potentially surgical interventions like debridement or amputation.
PBL MODUL NYERI SENDI BLOK MUSKULOSKELETAL
A man of 45 years, came by way of a limp, because severe pain in the joints of the right big toe. Experienced by patients while awake this morning, according to the patient, last night he still had time shopping at the mall with friends. Medical history of reoccurens that happens often.
Diabetic foot lecture 2010
The document discusses diabetic foot complications, including:
1) Diabetic foot ulcers affect 1-4% of diabetics annually and have a 15-25% lifetime risk, with 15% resulting in lower extremity amputation.
2) Risk factors for diabetic foot ulcers include peripheral neuropathy, a major contributing factor. Comprehensive foot exams assess dermatological, nerve, osseous, and vascular risks.
3) Current treatments include addressing dry skin, fungal infections, calluses, ulcers, and more through debridement, dressings, offloading, and advanced therapies like skin grafts and platelet-rich plasma.
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This document provides information on the management of patients with musculoskeletal disorders. It discusses osteoarthritis, including risk factors, clinical manifestations, medical management using pharmacologic and non-pharmacologic therapies, and potential surgical interventions. It also covers pyogenic osteomyelitis and osteoporosis, defining each condition and outlining their treatment objectives, investigations and management approaches.
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This document provides guidelines for nursing care of patients with diabetic foot syndrome (DSF). It discusses key aspects of managing DSF including regular examination of at-risk feet; identifying risk factors; educating patients, families, and healthcare providers; ensuring appropriate footwear; and treating non-ulcerative issues. When foot ulcers are present, the document outlines evaluating the cause, type, site, and depth of ulcers as well as signs of infection to guide further treatment.
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Advances in healing of diabetic foot ulcers
Recent advances in treatments for diabetic foot ulcers have allowed for limbs to be healed that were previously thought unsalvageable, provided a variety of individualized treatment options, and reduced healing times. Key factors that impair wound healing in diabetics include peripheral arterial disease, neuropathy, infection, and structural foot problems. Advanced treatments such as growth factors, skin substitutes, negative pressure therapy, and hyperbaric oxygen can enhance healing when wounds are not responding to traditional care. Recurrent ulcers can be prevented through education, good foot care, appropriate footwear, and surgical correction of deformities when needed.
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The document discusses diabetic foot care and amputation prevention at Aster Medcity in Kochi. It outlines their preventative management which includes screening patients for foot problems through tests to assess circulation, neuropathy, and plantar pressures. For patients with foot issues, they provide education, specialized footwear, medication and other therapies. Surgically, they treat infections, revascularization procedures, and Charcot's foot reconstructive surgeries using techniques like arthrodesis and internal fixation to normalize foot shape and function and prevent amputation. They have also developed novel "Sling" and PMMA prosthesis techniques for stabilization after surgery.
Diabetic Foot Ulcer
Diabetic foot ulcers are a major complication of diabetes and a leading cause of non-traumatic lower extremity amputations. They result from an interaction of neuropathy, abnormal foot biomechanics, peripheral arterial disease, and poor wound healing in diabetes patients. Ulcers are classified based on their depth and degree of ischemia. Treatment involves strict glycemic control, antibiotic treatment of infections, wound care including debridement and dressings, and offloading pressures on the foot. Prevention relies heavily on patient education regarding foot care, protective footwear, and monitoring for early signs of infection or other issues.
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Foot problems in diabetics can occur due to neuropathy, peripheral vascular disease, and trauma which can lead to foot ulcers and infection. Clinical features include neuropathy symptoms like numbness and pain as well as ischemia symptoms like claudication. Management involves treating infection, avoiding weight-bearing, good glycemic control, and assessing need for vascular reconstruction. Prevention focuses on daily foot inspection, washing, moisturizing, nail cutting, sock changes, and wearing proper footwear to avoid recurrence of ulcers or Charcot neuropathy complications.
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Diabetic foot disease is one of the most significant complications of diabetes. It involves foot ulcers associated with neuropathy and/or peripheral arterial disease in patients with diabetes. There are three main pathologies that contribute to diabetic foot disease: neuropathy, which causes loss of sensation and makes patients unaware of foot injuries; vasculopathy, which involves premature hardening of the arteries; and immunopathy, which compromises the body's immune response and increases risk of infection. Medical treatment of diabetic foot disease focuses on risk identification, foot examination, patient education, and management of diabetes, foot care, and medications to promote circulation and prevent ulcers.
synoviumcrystalsynovitis-140504010215-phpapp02.pdf
The synovium lines joints and produces synovial fluid. It contains two cell types - type A macrophages and type B fibroblasts. Synovial fluid contains hyaluronic acid and lubricates joints. Crystal synovitis occurs when urate or calcium pyrophosphate crystals deposit in the synovium, causing inflammation. Gout is caused by monosodium urate crystals and often affects the big toe joint. Pseudogout is caused by calcium pyrophosphate crystals and commonly affects large joints like the knee. Both present with sudden onset severe pain and swelling that usually resolves within 1-2 weeks. Diagnosis involves identifying the characteristic crystals in synovial fluid under polarized microscopy.
Synovium & crystal synovitis
The synovium lines joints and produces synovial fluid. It contains two cell types and secretes hyaluronic acid. Synovial fluid contains water, proteins, and nutrients. The two main types of crystal synovitis are gout caused by monosodium urate crystals typically in the big toe, and pseudogout caused by calcium pyrophosphate crystals usually in large joints like the knee. Both involve crystal deposition in the synovium and similar acute inflammatory attacks. Risk factors, investigations, and treatments aim to reduce crystal levels and attack frequency or progression. Complications can include joint damage and renal problems if untreated.
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Daflon 1000 cvd
This document discusses chronic venous disease and the treatment drug Daflon. It begins with an introduction to chronic venous disease and epidemiology studies showing its prevalence. It then discusses Daflon's active ingredients from rutaceae aurantiae, its efficacy in reducing symptoms compared to other treatments, and its recommendation in clinical guidelines for treating all stages of chronic venous disease. Studies show Daflon significantly reduces pain when used with medical procedures for chronic venous disease.
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ROLE OF ANKLE BRACHIAL INDEX TO PREDICT PERIPHERAL ARTERIAL DISEASE, A STUDY ...
ROLE OF ANKLE BRACHIAL INDEX TO PREDICT PERIPHERAL ARTERIAL DISEASE, A STUDY ...Shantonu Kumar Ghosh
The presence of peripheral arterial disease (PAD) is associated with higher cardiovascular morbidity and mortality, regardless of gender or its clinical form of presentation (symptomatic or asymptomatic). PAD is considered an independent predictor for cardiovascular mortality, more important for survival than clinical history of coronary artery disease.¹
The ankle brachial index (ABI) is a sensitive and cost-effective screening tool for PAD. ABI is valuable for screening of peripheral artery disease in patients at risk and for diagnosing the disease in patients who present with lower-extremity symptoms. Normal cut-off values for ABI are between 0.9 and 1.4. An abnormal ankle-brachial index- below 0.9 - is a powerful independent marker of cardiovascular risk.²
Vascular surgery in Bangladesh: where do we stand
Bangladesh
Small country according to it’s land, only 56,980 square mile.
Large population (180 million as on july 2019).
Population density - 2,889.45/square mile
Rank- 10th in the world.
The emerging tiger of Asia
Huge population is the strength
Skilled manpower working all over the world
Earning billions of dollars
Stronger economy- fastest growing in South Asia
Growing fast in infrastructure, knowledge and science
Lower middle income country
Hospital
Hospital beds – 4 (per 10,000 population) (WHO-2015)
Density of physicians - 3.0 (per 10,000 population)
Vascular centers in the country:
04 (Government Hospital and University) – 3 in Capital
07 (Private) – all in Capital
Government free beds – 30 (male + female)
Endovascular facilities – 7 centers
Vascular Surgery
Total number of vascular surgeons - 36 (as on September 2019) for 180 million people
Population per vascular surgeon: 5.00 million !!!
QUALITY OF LIFE AS A PREDICTOR OF POST OPERATIVE OUTCOME FOLLOWING REVASCULAR...
QUALITY OF LIFE AS A PREDICTOR OF POST OPERATIVE OUTCOME FOLLOWING REVASCULAR...Shantonu Kumar Ghosh
World Health Organization (WHO) defines quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.8
QOL encompasses the concept of health-related quality of life (HRQOL) and other domains such as environment, family and work. HRQOL is the extent to which one’s usual or expected physical, emotional and social well-being is affected by a medical condition or its treatment.9
For patients suffering from peripheral arterial disease (PAD), quality of life (QoL) has become as important as medical outcome end points, such as mortality and morbidity, to evaluate the effect of disease and treatment.10
Foam sclerotherapy during varicose vein surgery/ EVLA: should we avoid to min...
Foam sclerotherapy during varicose vein surgery/ EVLA: should we avoid to min...Shantonu Kumar Ghosh
Introduction:Cutaneous necrosis followed by ulceration and formation of abscess is not a rare complication of foam sclerotherapy. As sclerotherapy reduces the surgery burden and time consuming; it became popular for destroying varicose veins. Sometimes this complication may make the post operative period unpleasant.
Material & Methods:Forty three patients with varicose vein who had undergone surgery at three centers during a period of six months by same surgical team were included in the study.
Intra-lesional injection of sodium tetradecyl sulphate (STS) was used for varicosities during surgery in seventeen patients of flush ligation and eight patients of EVLA (endovenous laser ablation). Foam was applied in another eleven patients of flush ligation and seven patients of EVLA one month after surgery during follow up visit. All patients were followed up for two months.
Result:Among 50 patients 6 were (12%) female and 44 were (88%) male.
Of the total patients, 16 (38%) were between 20 and 30 years of age, 15 (34%) were between 30 and 40 years, 8 (18%) were between 40 and 50 years, 3 (8%) were between 50 and 60 years, and only 1 (2%) were >60 years of age.
With immediate sclerotherapy after flush ligation and stripping of GSV only one patient developed ulcer.
None had ulcer when sclerotherapy practiced after one month of flush ligation with stripping of GSV.
With immediate sclerotherapy following EVLA, three patients developed ulcer.
Sclerotherapy after one month of EVLA one patient was found developed infected ulcer.
In my small study I found infected skin ulceration as a common complication which occurred in both open surgery and EVLA patients. It was more common in EVLA group. It was also common when foam applied along with surgical/ EVLA procedure.
Conclusion:Infected skin ulcer presented as the most common complication in cases those who had foam sclerotherapy along with EVLA.
In open surgery patients, skin ulceration was also common.
In both group of patients, number of skin ulceration was more when foam was applied along with surgical/ EVLA procedure in comparison to those where it was practiced after two months during follow up period.
In my observation, skin ulceration was more common in EVLA patients. Further study is required to find any correlation between laser therapy and sodium tetradecyl sulphate.
Also, my opinion prefers foam sclerotherapy to be avoided during operative procedure /intervention.
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- 1. FOOT CARE AND ULCER MANAGEMENT AT VASCULOCARE: OUR AIM TO SALVAGE FOOT. DR. SHANTONU KUMAR GHOSH MS (CVTS) VASCULAR, ENDOVASCULAR & LASER SPECIALIST SURGEON
- 2. Foot ulcers are a common complication of peripheral arterial disease and a major cause of disability of patients. It is worse when associated with diabetes. Ischemic and diabetic foot ulcers lead to amputation if not managed properly.
- 3. Diabetic ulcer results from microangiopathy and neuropathy. Sensory loss and lack of blood supply lead to biochemical abnormalities, dryness of skin due to decreased sweating, all lead to vulnerability of skin and ultimately ulceration.
- 4. Reduced oxygen and nutrition supply to ulcer area hampers ulcer healing. This makes a favorable environment for bacterial growth and ultimately leads to necrosis of tissue. In chronic cases ulcer involve bone leading to osteomyelitis.
- 5. Amputation leads to disability of patient and grossly hampers quality of life.
- 6. Our aim at Vasculocare is to prevent or minimize level of amputation and reduce the disease burden.
- 7. If there is any ulcer with discharge, we first do the culture and sensitivity test and use antibiotic accordingly.
- 9. Primary goal: Revascularization Surgical- Aorto iliac bypass Ilio-femoral bypass Femoro-popliteal bypass Femoro-distal bypass Endovascular- ?
- 10. Primary goal: Revascularization Extensive medical management- Prostaglandin E1
- 11. Limb care: Moisturization- Coconut oil Prevent dependent oedema Management of skin disease
- 12. Care of ulcer: Dressing with betadine/ eusol/ H2O2 Wound debridement Application of platelet rich plasma
- 13. Use of special dressing material Recombinant Human PDGF 0.01% Silver Gel 0.002%
- 15. Common amputations for foot: Selective amputation of toes/ foot Partial amputation of toes Total amputation of toes Ray amputation Sims amputation Disarticulation
- 17. Rehabilitation/ life style modification Sole Shoes Phosthetic limb
- 19. Prosthetic limb
- 20. At Vasculocare we apply all these techniques to prevent limb loss or at least reduce the level of amputation with the target to reduce morbidity of patient. Post operative foot care, life style modification and control of diabetes is essential to maintain the successful result.
- 21. Dr. Shantonu Kumar Ghosh MBBS, MS (CVTS) Vascular, Endovascular and Laser Specialist Surgeon Vasculocare Trauma Center, 22/8/A, Shyamoli, Dhaka, Bangladesh Secretary for International Affairs, Bangladesh Vascular Society Treasurer, SAARC Society of Vascular Surgery President of Bangladesh Chapter, World Young Experts Committee of IUA Contact- +8801715405567 Corresponding Member- ESVS, Life Member- VSI, VAI E-mail- shantonukumarghosh@gmail.com Website- www.vasculocare.com Facebook- www.facebook.com/vasculocare