The diabetic foot. General considerations and proposal of a new therapeutic and preventive approach

Abstract 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 and topical treatments. The different therapies that have been applied do not often give satisfactory results. Therefore, for this purpose, we have studied the effect of biostimulation of wound-healing by utilising the CO 2 laser together with the action of the KTP laser on 25 patients (11 females and 14 males), all suffering from diabetes mellitus with polyneuropatic ulcers of the foot. Low out-put laser irradiation may stimulate granulation tissue and collagen production in fibroblasts. Many studies observed a regeneration of microcirculation in the ulcer and a regeneration of lymphatic circulation. The laser irradiation method produces a sterilizing effect from bacteria that over-infect the diabetic ulcer too. Each patient underwent a surgical treatment of the edges of the ulcers with CO 2 and KTP laser (wavelength 532 nm) focused, and a combined phototherapy (CO 2 laser and afterwards KTP laser, defocused). The irradiation was carried out through laser beam (by optic fiber for KTP) manually directed, until all of the ulcer surface became irradiated. On the skin around the ulcer, an omental derived cream (fractionated porcine omental lipid extracts) was daily applied, independently from the laser treatment, to evaluate the angiogenic effect of this substance. The results are reported in this paper. This suggests that the therapeutical effect of irradiation with CO 2 and the KTP laser might favour a recovery of the polyneuropathic ulcer in shorter times against traditional therapies and might decrease the peripheral symptoms of the polyneuropathy. The combination of this treatment together with the application of a topic based on purified lipid of the oment reacts with neoangiogenesis of the dermal capillaries, as well as restoration of the optimal perilesional skin conditions.