The effect of hyaluronic acid on the changes in Matrix Metalloproteinase-1 (MMP-1), leukocytes level, and bacteriocide effects among patients with Wagner 3 and 4 diabetic foot ulcer

Ida Bagus Anangga Kharisma, I Nyoman Semadi, I Gede Raka Widiana

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Background: Diabetes Mellitus (DM) has become a major public health problem. A significant complication of Diabetes Mellitus is the emergence of diabetic foot ulcers that require special treatment in healing. Hyaluronic Acid plays a role in cell proliferation and cell movement and is needed in the process of wound healing. The main goal of treatment of diabetic ulcers in the foot is to achieve wound closure as quickly as possible, prevent recurrence and amputation.

Methods: A true experimental study with pre and post-test design has been conducted among 32 diabetic foot patients at Sanglah General Hospital which divided into 2 groups: Hyaluronic acid and NaCl 0.9% using consecutive techniques. The hyaluronic acid compared to NaCl 0.9% on MMP-1, leukocyte levels, and bacteriocide effects in patients with Wagner's diabetic foot 3 and 4 were assessed. Data were analyzed using SPSS version 20 software for Windows.

Results: The results showed that Hyaluronic Acid increased MMP-1 levels while NaCl 0.9% reduced MMP-1 levels significantly (P<0.05). Hyaluronic Acid was able to reduce leukocyte level significantly compared to NaCl 0.9% (P=0.006). A positive bacterial culture was also found markedly lesser in Hyaluronic Acid groups compared with NaCl 0.9% (P<0.001). Multivariate analysis using logistic and linear regression also showed significant differences in the MMP-1 and leukocyte level (P<0.001) and positive culture results using hyaluronic acids (OR: 0.020; 95% CI 0.003-0.166; P<0.001)

Conclusion: These results suggest that MMP-1 levels and leukocyte levels differed significantly between Hyaluronic Acid and NaCl 0.9% used. Hyaluronic Acid can increase MMP-1 levels in Wagner 3 and 4 diabetic care. The results of positive culture with Hyaluronic Acid used are less than NaCl 0.9%.

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One stage release of circumferential constriction band in upper limb with multiple Z-plasty technique: a case report

I Gusti Putu Hendra Sanjaya, Agus Roy Rusli Hariantana Hamid, Gede Wara Samsarga

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INTRODUCTION: 

Congenital constriction band is an uncommon congenital abnormality with multiple disfiguring and disabling manifestations. The widely known management for the correction of congenital constriction band especially in circumferential constriction band is done in a multistage release of constriction band to eluding vascular and lymphatic embarrassment. The purpose of this case report was to present the outcome of one-stage release in terms of safety and aesthetic appearance.

 

CASE DESCRIPTION:

Women 28 year old came to outpatient plastic surgery clinic presented with circumferential constriction with no functional disability in her right arm since birth. Excision based on design of multiple Z-Plasty is started 2 cm proximal and distal from constricted band. The multiple Z- Plasty flaps are transposed around each other, changing the direction of the constriction band.  Postoperatively, the extremity circulation was normal, and no edema was observed. The range of motion is within normal limits and aesthetically acceptable for the patient.

 

DISCUSSION: Patterson classified constriction ring syndrome into four types, and type II is the most common. In type II Paterson , there are normal full-layer skin structures and no important nerve or blood vessel was affected so an incision completely encircling an extremity would not interfere with distal circulation and provided strong evidence that one-stage resection of constriction band could be performed. Using multiple Z-Plasty for constriction band release leads to improvement of functional and cosmetic appearance of the defect.

 

CONCLUSION: A one-stage release of circumferential constriction band in the upper limb using multiple Z-Plasty is considered as a safe treatment with an aesthetically acceptable result for the patient

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