THE DIABETIC FOOT - GENERAL-CONSIDERATIONS AND PROPOSAL OF A NEW THERAPEUTIC AND PREVENTIVE APPROACH

The treatment of the diabetic foot is a common and sometimes difficult problem. The treatment of the characteristic lesions of the diabetic foot involves many forms of therapy: these include contact dressings a nd topical treatments. The different therapies that have been applied do not often give satisfactory results. Therefore, for this purpose, w e have studied the effect of biostimulation of wound-healing by utilis ing the CO2 laser together with the action of the KTP laser on 25 pati ents (11 females and 14 males), all suffering from diabetes mellitus w ith polyneuropatic ulcers of the foot. Low out-put laser irradiation m ay stimulate granulation tissue and collagen production in fibroblasts . Many studies observed a regeneration of microcirculation in the ulce r and a regeneration of lymphatic circulation. The laser irradiation m ethod produces a sterilizing effect from bacteria that over-infect the diabetic ulcer too. Each patient underwent a surgical treatment of th e edges of the ulcers with CO2 and KTP laser (wavelength 532 nm) focus ed, and a combined phototherapy (CO2 laser and afterwards KTP laser, d efocused). The irradiation was carried out through laser beam (by opti c fiber for KTP) manually directed, until all of the ulcer surface bec ame irradiated. On the skin around the ulcer, an omental derived cream (fractionated porcine omental lipid extracts) was daily applied, inde pendently from the laser treatment, to evaluate the angiogenic effect of this substance. The results are reported in this paper. This sugges ts that the therapeutical effect of irradiation with CO2 and the KTP l aser might favour a recovery of the polyneuropathic ulcer in shorter t imes against traditional therapies and might decrease the peripheral s ymptoms of the polyneuropathy. The combination of this treatment toget her with the application of a topic based on purified lipid of the ome nt reacts with neoangiogenesis of the dermal capillaries, as well as r estoration of the optimal perilesional skin conditions.