A case series of autologous platelet-rich plasma injection in treating chronic ulcers conducted in Saudi Arabia.

Objective: This is a case series study of 14 cases of chronic unhealed ulcers involving patients of 19-85 years, aimed to demonstrate the positive therapeutic outcomes of using autologous platelet rich plasma (PRP) in diabetic foot ulcer (DFU) and other chronic wound healing. Methods: This is a formal consecutive clinical case series. Patients with chronic unhealed ulcers were enrolled from the amputation prevention clinic by an interdisciplinary team includes podiatrist, general surgeon, orthopedic, vascular surgeon, and wound care nurses at Kahel Specialized Centre, a specialized center for managing foot and ankle diseases, located in Riyadh, Saudi Arabia. Those patients who presented with chronic wounds and showed no significant wound reduction despite following the standard wound care protocol were included in the study. There were no specific predetermined exclusion criteria when considering patients for treatment with this modality. Results: In this case series, majority (80%) of the patients were above 50 years of age, and 10 (66.7%) patients were male and 5 (33.3%) were female. Of all the cases presented to the amputation prevention clinic, majority (73.3%) reported suffering from type 2 diabetes mellitus (DM) and also, one reported type 1 DM [6.7%]). All the cases of DFU received a combination of hydrogel and autologous PRP treatment and were put of suitable offloading devices, except one case received a combination of Cadexomer iodine, hydrogel and PRP treatment. In the present case series involving 3-14 weeks of the treatment duration, only 2-3 doses of autologous PRP provided complete healing and or maximum wound closure. Conclusion: Autologous PRP therapy is efficacious in facilitating, enhancing wound healing and aids in complete wound closure. This case series was limited in term of the sample size which is the number patients enrolled for the study, hence, the study finding remain inconclusive to some extent and hence, further study is required with greater number of sample size. The strength of this study is that it is the first study in Saudi Arabia and gulf region, to report the beneficial effect of PRP in chronic unhealed ulcers including diabetic ulcers.

Management of Diabetic Foot Ulcers Using Topical Oxygen Therapy: A Case Series.

BACKGROUND AND AIM: Surgical and endovascular revascularization procedures along with hyperbaric oxygen therapy (HBOT) and topical oxygen therapy (TOT) for chronic oxygen-deprived wounds are standard care treatment protocols for diabetic foot ulcer (DFU). Topical developments in the delivery of topical oxygen therapy have made this a more feasible treatment in practice. The present case series highlights the efficacy of NATROX therapy as TOT in wound healing and the impact of increased oxygenation on ulcer healing in patients with diabetic foot ulcers. METHODS: The TOT was evaluated in 6 patients with DFU who have applied NATROX topical oxygen delivery system for a period ranging from 6 weeks to 24 weeks at Kahel Specialized Centre, located in Olaya, Riyadh, Saudi Arabia. RESULTS: The administration of TOT demonstrated complete wound healing in all the six patients who either had ulcers with minor amputation of toes/heel or had ulcers with other comorbidities in a range from 3 to 8 weeks. CONCLUSION: NATROX therapy is an advanced topical oxygen delivery system compared to other conventional oxygen delivery systems; however, the study warrants further research to assess its potential applicability in DFU wound healing in large sample size and across the races.

The Frequency and Risk Factors of Diabetic Foot Ulcer Recurrence Among Jordanian Patients with Diabetes.

BACKGROUND: Diabetic foot is a major public health problem and their complications are an imperative cause of morbidity and mortality in diabetes. OBJECTIVE: To evaluate the rate of recurrence of foot ulcers post two years of follow-up, including the associated risk factors in the patients attending the diabetic foot clinic at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG), Amman, Jordan. METHODS: A historical cohort design was adopted for the patients who presented for the first time to the diabetic foot clinic at the NCDEG. Every patient who came to the clinic was reviewed by using his or her medical files with respect to diabetic foot-related complaints. Patients were classified under four categories: (1) Recurrent foot ulcers (2) chronic foot ulcer (3) free of recurrence, and (4) no foot ulcers. Among the four groups, group 1 (recurrent foot ulcers, n=76) and group 3 (free of recurrence, n=54) were included for the analysis. RESULTS: Among the 141 patients who presented to the diabetic foot clinic during the two-year study period, 76 (53.9%) of them experienced ulcer recurrences, 54 (38.3%) were recurrence-free, and 11 (7.8%) had chronic ulceration. The two-year recurrence rate was 58.5%. The presence of deformity and osteomyelitis were the statistically significant independent risk factors for recurrent foot ulceration. CONCLUSION: This study of recurrences was clearly related to the type and complications of the ulcers rather than to the other variables. Recurrent foot ulceration is linked to the presence of osteomyelitis and/or deformities.