MATERIALS AND METHODS: A cross-sectional design was used in this study involving 245 participants of type 2 diabetes mellitus (T2DM) was conducted at a Kitamura Wound Care Clinic, PKU Muhammadiyah, located in Pontianak, West Kalimantan, Indonesia, between September 2022 and February 2023. The Kruskal-Wallis test was used to assess the relationship between the foot care practices and infection status. A linear regression test to examine the independent risk factors.
RESULTS: Wounds' characteristics regarding foot care practice group were significantly including more than 5 months wound heal from previous wounds (p = 0.045), the percentage of wound site on dorsal was higher in the foot care practice group (p < 0.001), the percentage had no deformity feet was higher in the foot care practice group (p < 0.001), the percentage had no previous amputation feet was higher in the foot care practice group (p < 0.001). Also, the percentage had grade three was higher in the foot care practice group (p < 0.001), the percentage had grade three was higher in the foot care practice group (p < 0.001), and the percentage had mild infection status was higher in the foot care practice group (p < 0.001). The predictors of diabetic foot infection were Wagner and SHID classification and foot care (p < 0.001, p < 0.001, and p < 0.01) respectively.
CONCLUSION: This study demonstrated that foot-care behaviour in diabetic patients in Indonesia is poor. In addition, this study also has shown Wagner grading, SHID grading, and foot-care are predictors of infection in recurrent DFUs.
MATERIALS AND METHODS: A single dose of 30 Gy of linear electron beam radiation was applied to the hind limb of nude mice before creating the skin lesion (area of 78.6 mm). Monolayer tissue-engineered skin substitutes (MTESSs) were prepared by entrapping cultured keratinocytes in fibrin matrix, and bilayer tissue-engineered skin substitutes (BTESSs) were prepared by entrapping keratinocytes and fibroblasts in separate layers. Bilayer tissue-engineered skin substitute and MTESS were implanted to the wound area. Gross appearance and wound area were analyzed to evaluate wound healing efficiency. Skin regeneration and morphological appearance were observed via histological and electron microscopy. Protein expressions of transforming growth factor β1 (TGF-β1), platelet-derived growth factor BB (PDGF-BB), and vascular endothelial growth factor (VEGF) in skin regeneration were evaluated by immunohistochemistry (IHC).
RESULTS: Macroscopic observation revealed that at day 13, treatments with BTESS completely healed the irradiated wound, whereas wound sizes of 1.1 ± 0.05 and 6.8 ± 0.14 mm were measured in the MTESS-treated and untreated control groups, respectively. Hematoxylin-eosin (H&E) analysis showed formation of compact and organized epidermal and dermal layers in the BTESS-treated group, as compared with MTESS-treated and untreated control groups. Ultrastructural analysis indicates maturation of skin in BTESS-treated wound evidenced by formation of intermediate filament bundles in the dermal layer and low intercellular space in the epidermal layer. Expressions of TGF-β1, PDGF-BB, and VEGF were also higher in BTESS-treated wounds, compared with MTESS-treated wounds.
CONCLUSIONS: These results indicate that BTESS is the preferred treatment for irradiated wound ulcers.