A COMPARATIVE STUDY OF USEFULNESS OF TOPICAL PLACENTAL EXTRACT VERSUS TOPICAL COLLOIDAL SILVER IN THE MANAGEMENT OF DIABETIC FOOT ULCER

Abstract

Background: Diabetes Mellitus is defined by World Health Organisation as a metabolic disorder characterized by chronic hyperglycaemia resulting from defects in Insulin secretion, Insulin action or both. WHO has estimated at least 171 million people with diabetes worldwide with figures doubling by 2030. Diabetic foot is defined as a group of syndromes in which neuropathy, ischemia and infection leads to breakage of tissue with further morbidity and possible amputation. 88% of all lower limb amputation secondary complications of DFU. Diabetic foot ulcer (DFU) is a major complication of Diabetes mellitus accounting to 15%. The management of DFU is a multidisciplinary approach which includes strict control of blood glucose, prevention through education and regular dressings. Conventional treatment lack in providing necessary growth factors and augment healing process.The aqueous form of placental extract contains numerous growth factors with anti-inflammatory anti-platelets action augmenting tissue regeneration. The nano particles in the colloidal silver acts at the enzymatic levels thus rendering antimicrobial action on the ulcer. Objectives: 1. To evaluate the usefulness of topical placental extract in management of diabetic foot ulcers 2. To evaluate the usefulness of topical colloidal silver in management of diabetic foot ulcers 3. To compare the effectiveness of both in terms of decrease in the size of ulcer and duration of ulcer healing in the management of diabetic foot ulcers. xii Methodology: The study is a randomized prospective study conducted in R.L.J.H & RC attached to SDUMC included 60 patients divided by even and odd method from December 2018 to December 2020. Patient with DFU satisfying inclusion criteria were included in the study and a detailed history as per proforma was obtained and were initially stabilized with wound debridement. Placental extract of 0.25% concentration topical application for group A and colloidal silver of 0.002% concentration of topical application for group B patient were applied with dressing being changed daily. The ulcer was observed weekly in term of reduction in size, appearance of granulation tissue and clearance of necrotic tissue and was measured and recorded. Results: DFU was most commonly seen in patients during the 5th and 6th decade and males were more commonly affected. The common mode of onset being spontaneous and dorsal aspect of the foot being the most common site. Placental extract shows better healing rates in term of reduction in size, appearance of granulation tissue and reduction of necrotic tissue than colloidal silver. Conclusion:  The use of placental extract showed better response in terms of reduction in size of the ulcer.  Granulation tissue and epithelisation appeared faster in placental extract group which further facilitates ulcer healing.  Necrotic tissue was considerably reduced on usage of placental extract thus decreasing infection and fastening healing process xiii  The subjects in 5-6th decade were the most vulnerable with male predominance  The diabetic foot ulcers were more common due to spontaneous onset than due to trauma.  HbA1c has a linear association in healing. We conclude that placental extract was a better agent in treatment of diabetic foot ulcer in terms of ulcer size reduction, appearance of granulation tissue and clearance of necrotic tissue.