Background Diabetic foot (DF) is a serious complication of diabetes. Most diabetic foot wounds are chronic and difficult to heal. Negative pressure wound therapy (NPWT) has achieved good clinical efficacy in the treatment of diabetic foot, chronic wound and ulcer, and the external treatment of traditional Chinese medicine has a long history of inhibiting bacterial growth and transforming saprophytic muscle on chronic infection wound. The synergistic effect of traditional Chinese medicine combined with negative pressure wound therapy on chronic wound of diabetic foot needs clinical observation.
Objective To investigate the application of Chinese herbal medicine washing (CHMW) combined with negative pressure wound therapy (NPWT) in debridement and treatment of bacterial biofilm of diabetic foot wounds, and evaluate the synergistic effect of CHMW and sNPWT compared with standard single therapy, so as to provide a new treatment of diabetic foot in clinic therapeutics.
Methods From July 2018 to December 2020, 150 diabetic foot ulcer patients (Wagner Grade 2-4) were diagnosed in the Emergency Department of the Second Affiliated Hospital of Chongqing Medical University. They were randomly divided into five groups (group A with conventional treatment, group B: NPWT, group C: Phellodendron amurense washing combined with NPWT, group D: Honeysuckle washing combined with NPWT, and group E: Phellodendron amurense + Honeysuckle washing combined with NPWT, 30 cases in each group). The pathological changes, characteristics of BBF wound, ulcer wound healing, treatment efficiency, and the change of inflammatory factors such as C reactive protein (CRP), interleukin-6 (IL-6), Procalcitonin (PCT), antioxidant function malondialdehyde (MDA), superoxide dismutase (SOD) and endothelial function as nitric oxide (NO) activity, endothelin (ET) after using five different treatments were evaluated and compared.
Results We found that all wounds showed squamous epithelial collagen fiber hyperplasia, interstitial inflammation, and skin appendages before treatment. After six weeks of treatment, the squamous epithelial fibrous epithelial and the mesenchymal response generally decreased, with visible appendages, and the symptoms improved successively from group A to group E. Before treatment, there was no difference in CRP, IL-6, PCT, MDA, SOD, ET or NO between the five groups (P > 0.05). After six weeks of treatment, the BBF clearance rate increased, while ulcer area and healing time decreased successively from group A to group E, and serum CRP, IL-6, PCT, MDA, and ET concentrations also decreased. SOD and NO concentration increased successively from group A to group E (P < 0.05). The wound size, ulcer area, healing time, and the concentration of CRP, IL-6, PCT, MDA, SOD-1, ET and NO between group C and group D showed no statistically significant difference (P > 0.05). The wound healing rate of five groups of patients was as follows: group E > group D ≈ group C > group B > group A (P < 0.05).
Conclusion The traditional Chinese herbal medicine including Phellodendron amurense and Honeysuckle washing combined with NPWT can promote healing of diabetic foot wounds with a synergistic effect, which can be promoted and applied in clinical practice.
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