الفهرس 
Pathophysiology of the diabetic footOnly 14 pages are availabe for public view
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Abstract
Diabetic foot ulcers are the most common and devastating chronic complications of diabetes mellitus. Due to impaired immunity, malnourishment, simultaneous multi system involvement by diabetes, the management of diabetic foot is a challenging problem for clinicians.
There are many factors that can affect wound healing which interfere with one or more phases in this process, thus causing improper or impaired tissue repair. Wounds that exhibit impaired healing, including delayed acute wounds and chronic wounds, generally have failed to progress through the normal stages of healing. Such wounds frequently enter a state of pathologic inflammation due to a postponed, incomplete, or uncoordinated healing process.
Negative-pressure wound therapy is a recently developed wound treatment modality based on vacuum-sealing drainage and vacuum-assisted closure to create a localized controlled negative-pressure environment
Vacuum-assisted closure (V.A.C.) therapy involves the controlled uniform application of continuous or intermittent negative pressure to the wound bed transferred via open-pore foam.
The following mechanisms have been attributed to VAC therapy: creates a moist environment, reduces edema, increases local blood flow, stimulates angiogenesis and formation of healthy granulation tissue, stimulates cell proliferation, reduces size and complexity of the wound, removes soluble healing inhibitors from the wound, and reduces bacterial load.
The aim of our study to assess the role of the vacuum assisted closure (VAC) therapy in the management of diabetic foot ulcers.
The study was conducted for fifty patients with diabetic foot ulcers admitted to the Menoufia university hospital (Shebin El Kom) & Damanhour medical national institute (El Beheira).
The ages of the 50 patients ranged from 37 years and 68 years with a median age of 50.5. The mean age of the cases was 50.52. Thirty two patients (64.0 %) were males while eighteen (36.0 %) were females. The male to female ratio was 1.7: 1. The highest incidence (44.0%) was among patients with an age range from 41 years to 50 years, while the lowest incidence (10.0%) was in patients with an age of 40 years or less.
All patients were subjected to full history taking, clinical examination, routine laboratory investigations and informed written consent before application of VAC.
The results of the current study revealed that among the 50 patients, the most common anatomical site of the ulcers was at the heel then around medial maleolus. The longest diameter of the wounds ranged from 3 cm to 14 cm with mean diameter of 8.5 cm. The reduction in the wound size ranged from 10% to complete healing with mean reduction of 44.0 %. The number of VAC dressings ranged from 2 to 14 times, with mean number of 6.2 dressings. The duration of these dressings took from 2 to 7 weeks with mean duration of 2.9 weeks.