Efficacy of Polyurethane Foam Dressing in Debrided Diabetic Lower Limb Wounds

Ajit Kumar Varma, MS; Arun Bal, MS, PhD; Harish Kumar, MRCP; Rajesh Kesav, MS; Sandhya Nair

Currently in India, there are 30 million people with diabetes and an estimated 40,000 amputations occurring annually due to diabetes-related foot problems. The most common cause is the infected neuropathic foot, which is potentially preventable.1 Few organized diabetic foot screening programs exist in India. Podiatric services are available only in major centers in India, and a multidisciplinary team approach is mostly lacking. Proper orthotics for patients with diabetes are not readily available. Socio-economic factors, such as barefoot walking, inappropriate footwear usage, lack of awareness of the seriousness of diabetic foot problems among doctors and patients, and hence, late referrals to specialty centers, are a matter of concern. Seventy percent of India’s population lives in the rural area and 40% stay in 1-room tenements. Inadequate sanitation, improper foot offloading due to lack of facilities, poor socio-economic conditions, and inadequate awareness about the seriousness of diabetic foot problems are common. Rat and insect bites, vigorous massage, thermal injuries due to hot fomentation, injuries due to improper footwear, and fungal infections of intertriginous skin cause a significant number of diabetes-related foot injuries in India.2 These cause extensive necrotizing fasciitis and other soft tissue and bone infections of the lower limb, which can be limb and life threatening.3 In India, few patients are insured, and the vast majority of patients with diabetes and foot problems have to pay for the cost of medical care. Hence, the cost of treatment and consumables used assumes much greater significance in such circumstances.
In the proliferative phase of wound healing, which lasts from 5 days to 3 weeks after injury or trauma, fibroblasts migrate in the wound depths. These fibroblasts synthesize and secrete collagen. Their migration is self-powered and limited by contact inhibition. Fibroblasts do not contain fibrinolytic enzymes, and the fibrin, dead cells, and tissues in a wound can inhibit their migration. Polyurethane foam dressings facilitate faster removal of slough and dead tissue and assist in this stage of wound healing and in epidermal migration. Polyurethane foam dressings loosen slough by creating a moist wound environment, assist in proper wound bed preparation, and promote this phase of wound healing.4 Slough is a complex mixture of deoxyribonucleic proteins, fibrin, bacteria, leukocytes, and serous exudate. Slough is not dead tissue. Wound exudate can be classified by quantity as mild (0.25 g/cm2/24 hours), moderate (0.5 g/cm2/24 hours), and heavy (1.0 g/cm2/24 hours).5 Medicated polyurethane foam impregnated with silver, iodine, alginate, and various other substances is widely used in the management of diabetic wounds.5 Few studies regarding the efficacy of non-medicated polyurethane foam dressings have been conducted. Polyurethane foam dressings retain moisture, maintaining a moist wound environment, which is important for proper wound healing. They also absorb excessive exudate thereby preventing tissue maceration, facilitating removal of slough, and promoting the proliferative stages of wound healing.6 Medicated polyurethane foam dressings, though effective, are costly. Non-medicated polyurethane foam is inexpensive, readily available, and sterilizable, making it a cost-effective dressing material. It gives sufficient mechanical protection to the wound, is nonadherent and nonallergenic, and does not shed loose material into the wound. Moreover, it conforms to anatomical contours and has a long shelf life.7


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