DOI: http://dx.doi.org/10.18203/2349-2902.isj20202851

Studying the impact of the cost-effective Suvidha off-loading dressing in healing neuropathic ulcers in diabetic foot: a case series of 83 cases from South India

Sunay N. Bhat, D. Vinoth

Abstract


Neuropathic ulcers pose a global burden carrying a risk of amputation of 15-46 times especially in developing countries. These ulcers are mainly managed with offloading techniques. In this study we share our experience of using an easy to use, cost effective method the Suvidha offloading dressings in terms of its acceptability and effectiveness in managing these cases. A prospective case series of 83 patients with mean age 58 years, managed with Suvidha offloading dressing in our institution from 2016 till 2019, excluding patients with ABI less than 0.4 and Wagner 4 and 5. They were reviewed after 6 months/SOS. Ulcer measured 1×1 to 4×4 cm, was present most commonly in the mid foot and least commonly in the lateral aspect of the foot. 53 cases were Wagner grade 2 and 9 cases Wagner grade 3. Forty cases were initially infected, 29 cases had a deformed foot, 5 cases needed interval wound debridement. The duration of ulcer healing was 2 weeks for 1×1 cm great toe ulcer, to 12 weeks for the 4×4 cm mid foot ulcer. All 83 patients were followed up for 6 months. 5 ulcers recurred. The patient satisfaction was measured by a 5-points Likert scale with a mean value of 17.4 out of 20. The Suvidha offloading footwear is a cost effective, easily replicable and efficient dressing requiring only the readily available dressing materials, with good healing rates, good patient satisfaction and adapted for developing countries. The results are comparable with other methods of offloading practiced worldwide. 


Keywords


Suvidha, Offloading, Diabetes, Ulcer, DFUs

Full Text:

PDF

References


Nick JM, London, Donnelly R. Ulcerated lower limb. BMJ. 2000;320(7249):1589-91.

American Diabetes Association. Consensus development conference on diabetic foot wound care. 7-8 April 1999, Boston, Mass Adv Wound Care. 1999;12:353-61.

Zhang P, Lu J, Jing Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49:106-16.

Flahr D. The effect of no weight-bearing exercise and protocol adherence on diabetic foot ulcer healing a pilot study. J Wound Management. 2010;56(10):40-50.

Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361:1545-51.

Spencer S. Pressure relieving interventions for preventing and treating diabetic foot ulcers (Cochrane review). Cochrane Database Syst Rev. 2000;3:CD002302.

Marrigje. Total Contact Casting of the Diabetic Foot in Daily Practice. Diabetes Care. 2005;28(2):243-7.

Armstrong DG, Nguyen HC, Lavery LA, Schie VCH, Boulton AJ, Harkless LB. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24:1019-22.

Armstrong DG, Lavery LA. Evidence-based options for off-loading diabetic wounds. Clin Podiatr Med Surg. 1998;15:95-104.

Caravaggi C, Faglia E, Giglio DR, Mantero M, Quarantiello A, Sommariva E, et al. Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study. Diabetes Care. 2000;23:1746-51.

Priyanka Saikia. Effective and Economic Offloading of Diabetic Foot Ulcers in India with the Bohler Iron Plaster Cast. Indian J Surg. 2016;78(2):105-11.

Bus SA. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review. Diabetes Metabolism Res Reviews. 2016:99-118.

Oyibo SO. A Comparison of Two Diabetic Foot Ulcer Classification Systems - The Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24(1):84-8.

Younis BB, Shahid A, Arshad R. Frequency of foot ulcers in people with type 2 diabetes, presenting to specialist diabetes clinic at a Tertiary Care Hospital, Lahore, Pakistan. BMC Endocr Disord. 2018;18:53.

Strong K, Bergin S, Raspovic A. Patient satisfaction: Total-contact casting versus felt padding; Diabetes. Available at https://www.diabetesonthenet.com/resources/details/patient-satisfaction-total-contact-casting-versus-felt-padding. Accessed on 24 April 2020.