DOI: http://dx.doi.org/10.18203/2349-2902.isj20172396

A prospective study on effectiveness of use of papain urea based preparation in dressings compared with regular conventional dressings in diabetic foot ulcers

Balasubrahmanya K. S., Praveen M. Pawar, Srinidhi M., Shruthi S., Jinumon K. V., Rahul D. Kunju

Abstract


Background: Diabetic foot ulcer is a very common condition encountered in surgical practise. Wound management pose a good challenge for a treating surgeon due to its physical, mental and social implications. The devitalised necrotic tissue present in ulcer does not favour the wound healing as it increases the chance of infection and delays appearance of granulation tissue. Hence debriding of devitalised tissue plays a key role in wound care. In present study ,we used papain urea based preparation in dressings which is a autolytic agent. This study was conducted to evaluate the effectiveness of use of papain urea based preparations compared with regular conventional dressing in diabetic foot ulcer management.

Methods: This was a prospective study conducted in K. R. Hospital, Mysore, Karnataka, India. 60 eligible subjects with diabetic foot ulcers were selected and subjects were randomly allocated into two groups Group A and Group B with 30 subjects in each group. Subjects in Group A underwent dressing with papain urea based preparation and in Group B underwent regular conventional dressing. Results were assessed with respect to percentage decrease in necrotic tissue, incidence of infection, appearance of granulation and hospital stay.

Results: Among Group A subjects percentage reduction of necrotic tissue was more, granulation appeared early and the hospital stay was less compared to Group B subjects which were statistically significant. However, there was no significant difference with respect to incidence of infection in both groups.

Conclusions: Papain urea based preparation is effective in diabetic foot ulcer care.


Keywords


Autolytic, Debridement, Papain urea

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References


Neto RM, Ansalid MA, Eduarda SM, Oliveira S, Luz VH. A case report of a multidrug resistant bacterial infection in a diabetic patient treated in northeastern Brazil. Diabetic Foot and Ankle 2012;3:186-96.

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719-24.

Clark RA. Cutaneous tissue repair: basic biologic considerations. I. J Am Acad Dermatol. 1985;13(5):701-25.

Rodheaver G, Baharestani MM, Brabec ME. Wound healing and wound management: Focus on debridement. Adv Wound Care. 1994;7:22.

Hellgren L, Vincent J. Debridement: An essential step in wound healing. In: Westerhoff W (ed). Leg ulcers: Diagnosis and Treatment. Amsterdam, Netherlands: Elsevier Science,1993:305-312.

Cohen IK. How Do the Methods and Timing of Debridement Affect the Quality of Repair?. J Trauma Acute Care Surg. 1984;24(9):S25-55.

Haury B, Rodeheaver G, Vensko J. Debridement: An essential component of traumatic wound care. Am J Surg. 1978;135:238.

Fowler E, van Rijswijk L. Using wound debridement to help achieve the goals of care. Ost/Wound Manag. 1995;41:23S.

Berger MM. Enzyme debriding preparations. Ost/Wound Manag. 1992;38(8):26.

Alvarez OM. Pressure ulcers: Critical consideration in prevention and management. Clin Mater. 1991;8:209.

Brett DW. Chlorophyllin- a healer? A hypothesis for its activity. Wounds. 2005;17(7):190-5.

Shapira E. Giladi A. Neuman Z. Use of water insoluble papain (WIP) for debridement of burn eschar and necrotic tissue. Preliminary report. Plast Reconstr Surg. 1973;52(3):279-81.

Ayello EA, Cuddigan JE. Debridement: controlling the necrotic/cellular burden. Adv Skin Wound Care. 2004;17(2):66-76.

McCallon S. Enzymes for wound debridement and healing. ECPN. 2007;120(6):30-5.

Hebda PA, Flynn KJ, Dohar JE. Evaluation of efficacy of enzymatic debriding agents for removal of necrotic tissue and promotion of healing in porcine skin wounds. Wounds. 1998;10(3):83-96.

Hobson D, White E, Anderson L, Lira L. Development and use of quantitative method to evaluate the action of enzymatic wound debriding agents in vitro. Wounds. 1998;10(4):105-10.

Levenson SM, Gruber DK, Gruber C, Lent R, Seifter E. Chemical debridement of burns: Mercaptans. J Trauma. 1981;21(8):632-44.