N. V. Ramanaiah 1 , Saikrishna 2 , Chandrasekhar 3 , Vamshidhar 4 , G. V. Ramanaiah 5 , K. Lokesh 6
Diabetes is the highest risk factors associated with limb threatening ischemia. Foot ulceration and infection are the major causes of hospitalization in people with diabetes. Signs of infections in these lesions are likely to be masked as people with diabetes may not show typical inflammatory response to infection. Despite this inherent difficulty, diagnosis of infection is essentially clinical. In addition infection of diabetic foot often involves superficial and deep tissues, including bone. Dressings have a part to play in the management of wounds. They traditionally provide a moist wound environment, handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Nano-technology makes it possible to expand the surface area of Silver particles markedly to Nano scale. They markedly expand the surface area of silver particles, increasing their contact with bacteria or fungi, and vastly improving its bactericidal and fungicidal effectiveness. AIMS AND OBJECTIVES: 1. To study the efficacy of Nano crystalline silver in the management of diabetic foot ulcer. 2. To compare time required for healing of diabetic foot ulcer with Nano crystalline silver against conventional dressing. 3. Number of Nano crystalline silver dressing required in comparison with conventional dressing. STUDY DESIGN: Prospective and observational study. SAMPLE SIZE: 100 cases were studied prospectively. INCLUSION CRITERIA: Patients aged more than 20years with diabetic foot ulcer, Ulcers of size less than 10×10 cm. EXCLUSION CRITERIA: Clinical signs of infection, cellulites; X-ray showing Osteomyelitis. Doppler showing atherosclerosis and varicosities. Uncontrolled diabetes, significant medical diseases. Patients on steroids, immunosuppressive agents, radiation, or chemotherapy. STUDY SETTING: S. V. R. R. G. G. Hospital, Tirupati. STUDY PERIOD: From Jan 2013 till November 2014. STUDY METHODS: Patient fulfilling the inclusion and exclusion criteria is selected. Consent is taken. Patients are randomly selected into two groups. Cases in the test group will be treated with topical Nano crystalline silver dressings with bedside surgical debridement will be done whenever indicated. The control group will be treated with conventional topical dressings and bedside debridement. The patients will be followed up for 7 weeks and ulcer status will be noted using visual score. CONCLUSION: Nano silver dressings are safe, effective, with a slight beneficial edge to the conventional dressing with solutions like betadine in terms of promoting wound healing, and are more patient compliant in view of Less pain while changing the dressing, Less number of dressings required, Less duration of hospital stay. This indicate that Nano silver dressings may be used as an adjunct in management of diabetic foot ulcer and seems to be more efficient than conventional dressings in this regard.
