Prof.Dr.A.R.UNDRE Prof.Dr.A.R.UNDRE Consultant Surgeon: Saifee Consultant Surgeon: Saifee Hospital, Hospital, Jaslok Hospital & Research Centre Jaslok Hospital & Research Centre Mumbai, India Mumbai, India ROLE OF CO2 LASER IN THE MANAGEMENT OF DIABETIC FOOT/ULCER
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Jaslok Hospital & Research CentreJaslok Hospital & Research CentreMumbai, IndiaMumbai, India
ROLE OF CO2 LASER IN THE MANAGEMENT OF
DIABETIC FOOT/ULCER
In a 24-hour period of time---- 4,100 people diagnosed with Diabetes, 230 amputations in people with Diabetes.
25 % of admissions in any hospital are Diabetic. Still a large number of undiagnosed cases of diabetes Today 1.8% of total population is Diabetic By 2025 one out of every 5 Indian will be a high risk case
by 2025.
19.4 million 1995 AD
INDIA - THE WORLD CAPITAL OF DIABETES
57.2 million2025 AD
- WHO ESTIMATE
140 %
IndiaWorld Diabetes Capital
2025
Diabetic FootDiabetic Foot An Overview An OverviewPeople with diabetes have a 15% lifetime
risk of developing a foot ulcerThey also have 15 to 40% higher risk of
lower extremity amputationVaried methods of treatment are available
with varying degree of success
Amputation is a Amputation is a meanmean operation operation in Diabetic Foot.in Diabetic Foot.
Amputation reduces remaining life span of the patient.
Amputation makes the person crippled, dependent & a mental wreck.
Therefore all attempts Therefore all attempts should be made to should be made to
conserve the limb in conserve the limb in Diabetic FootDiabetic Foot
Path-physiology Of Vascular Path-physiology Of Vascular Disease In A Diabetic Disease In A Diabetic
Similar to that noted in non-diabetic patients with athero-sclerotic disease except…Generally occurring at an earlier ageAffects men and women equallyInvolves more frequently the TIBIAL
Identify and treat HIGH risk patients earlyRegular blood sugar level checkAdvice on ideal foot care
Tips to keep your feet healthyTips to keep your feet healthyA) Do’sA) Do’s
Check your bottom of feet with mirror every day and consult your doctor at very first sign of redness, swelling, pain, numbness or tingling in any part.
Check inside of your shoes every day for things like gravel or a torn lining & remove dirt and dust. If shoes are torn, replace immediately.
Regular check up of your feet by doctorCont.
Tips to keep your feet healthyTips to keep your feet healthyA) Do’s (Cont.)A) Do’s (Cont.)
Choose the right shoes with a good arch support which fit properly.
Wear white socks and check for any blood or fluid from a sore on them.
Wash your feet daily in lukewarm water. Dry them well,especially between the toes with a soft towel and blot gently; don't rub.
Keep your feet skin smooth with a cream or lotion. If your feet sweat easily, keep them dry with nonmedicated
powder
Tips to keep your feet healthyTips to keep your feet healthyB) Don'tsB) Don'ts
Do not walk barefoot. Do not wear stretch socks, nylon socks, socks with
inside seams. Do not wear socks with a tight elastic band or garter
at the top. Do not put hot water, electric blanket or heating pads
on your feet. Do not use iodine, or astringents on your feet. Avoid things that are bad for you feet.
MEDICAL TREATMENTMEDICAL TREATMENT
Early and prompt control of diabetes with low threshold for use of INSULIN
Drugs to improve vascularityCorrection of anemiaAntibiotics to control infection
Treatment of Vascular Treatment of Vascular InsufficiencyInsufficiency
MAJOR vessels : a) Angioplasty b) Vascular NeurolysisMINOR vessels : Lumbar
sympathetectomy
SURGICAL TreatmentSURGICAL Treatment
Debridement
Amputation (Minimum)
LASERLASER
L ~ LIGHT A ~ AMPLIFICATION by S ~ STIMULATED E ~ EMISSION of R ~ RADIATION
BOHR’S TheoryBOHR’S Theory
Laser are produced by three basic interactions between PHOTONS and ELECTRONS
Metatarsal Ulceration – involvement of tendon sheath
Sole Ulceration-Instep regionSole Ulceration-Instep region
Near total sole affectionNear total sole affection
Charcot JointCharcot Joint
ADVANTAGESADVANTAGES
Presence of diabetic neuropathy and non-invasive nature of CO2 laser allows most cases to be done under IV sedation
Good patient compliance Early feeding so minimum fasting period Minimal need for post procedure analgesia Negligible blood loss Patient can attend procedure on OPD basis
SummarySummaryLasers are a treatment choice that appeals to
patients. Early research suggest that laser therapy may have a role to play in the treatment of:
A) Diabetic UlcerB) Non Healing woundsC) Bed Sores.
It is ideal for diabetic ulcer as the principle of conservatism is well applied. In deep ulcers like bed sores, laser therapy helps to limit destruction of surrounding tissues.
Over 100 patients have been treated Over 100 patients have been treated successfully with CO2 Laser Therapy in successfully with CO2 Laser Therapy in the last 5 years. The patients are the last 5 years. The patients are evaluated fully for anemia, diabetic evaluated fully for anemia, diabetic status, bone involvement & vascular status, bone involvement & vascular insufficiency. In case of large ulcers, the insufficiency. In case of large ulcers, the patient undergoes conventional slough patient undergoes conventional slough excision followed by CO2LaserTherapy.excision followed by CO2LaserTherapy.
This protocol helps to reduce the hospital This protocol helps to reduce the hospital stay considerably.stay considerably.