Nano silver added with gauze helps treat diabetic feet
Diabetic foot is a serious infection of the lower extremities. It is caused by diabetic neuropathy and vascular disease. It is also a major cause of disability and death in patients with severe diabetes, so prompt treatment is essential for a positive outcome. The clinical use of nanosilver dressings can be considered to further optimize the treatment process and improve the effectiveness of treatment in diabetic foot patients. Nano silver tape has a larger contact surface and stronger bactericidal effect than ordinary silver tape. Besides, it can be disinfected repeatedly to better control wound infection and promote wound healing. The present article deals with the pathogenesis of diabetic foot, treatment of diabetic foot dressing, application of nanotechnology in the treatment of diabetic foot.
Introduction
Diabetic foot is a common condition caused by foot ulcers, infection, or deep tissue damage, and is associated with distal nerve abnormalities and varying degrees of peripheral vascular injury. vi in the lower extremities. Nearly 15% of patients with diabetes are at risk of developing foot ulcers as the disease progresses. 1 According to the report, a person with diabetes suffers a diabetic foot amputation every 20 seconds worldwide, with figures showing an annual increase in mortality of 11% and 22%, respectively. According to Research, diabetic feet account for almost a third of all diabetes-related medical costs. 2Compared with other complications, evidence suggests that the incidence, mortality, disability, and cost of diabetic foot in patients with diabetes is high. Furthermore, because some diabetics do not have a typical inflammatory response to infection, signs of infection in diabetics are sometimes masked. Furthermore, diabetic foot infections are often severe due to superficial and deep tissue accumulation, even bone accumulation. 2Therefore, the symptoms of diabetic patients are noticed only after the condition worsens. Therefore, diabetic foot often requires a combination of medical and surgical treatment. In particular, surgical dressing change and dressing application play an important role in wound treatment. Surgical dressings provide a moist wound environment, treat excess secretions, facilitate drainage, reduce wound exposure to a certain extent, reduce worsening or existing infections , which helps to clean the wound and promote healing. Therefore, in addition to requiring standard medical and surgical treatment, a good dressing for adjuvant therapy is important. Nano silver has been used in another field as an antibacterial material. It plays an important role in the treatment of diabetic foot. Nanotechnology is used to create silver nanotape. In addition to the corresponding role of traditional bandages, silver nano-bands also have specific antibacterial effects, effective antibacterial effects, broad-spectrum, difficult to form drug resistance, safe, reliable, etc.3 This study summarizes the traditional treatment of diabetic foot and compares the application of different dressings in the treatment of diabetic foot by analyzing the pathogenesis of diabetic foot and its application. Silver nano-bands in diabetic foot.
Diabetic foot
Mechanism of diabetic foot
Due to the onset of developing diabetes, patients continue to eat unhealthy foods and have inappropriate lifestyle habits, and they do not receive appropriate treatment. As a result, the disease cannot be controlled for a long time and blood sugar levels are higher than normal. Diabetes is getting worse, and blood flow at the ends of the lower extremities is not circulating normally due to vascular trauma and trauma. Diabetic foot, the most serious complication of diabetes, will eventually develop. The mechanism of diabetic foot is complex. It can be caused by genetic factors, slower limb neuropathy, vascular disease, or abnormal foot pressure. Infectious factors of the foot are often secondary to neurological and vascular disease. 4In addition, the body of diabetics produces more reactive oxygen species than normal, causing oxidative stress and antioxidation to be out of balance, increasing oxidative stress and exacerbating vascular damage. and nerves. Foot pressure is also a risk factor that is strongly associated with the development of diabetic foot. Long-term mechanical stress is applied to the foot, and the constant pressure effect destroys the local tissues of the lower extremities, eventually leading to sterile enzymatic autolysis. 6 Genetic factors also play a certain role in the formation of diabetic foot, expressed mainly in the voltage-controlled potassium channel gene (KCNQ1), epigenetic factors such as methylation, etc. 3These factors develop due to hyperglycemia. Vascular and neurological disease were the main factors, while foot pressure was the trigger. Finally, the infection aggravates the pathology. 7 The above factors combine to produce severe, difficult-to-treat, easy-to-infective diabetic feet with a high incidence.
Bandage Treatment for Diabetic Feet
In general, the treatment of diabetic foot is based on blood sugar control, diagnosis of the condition, treatment based on the development of the specific condition, and treatment of the diseased tissue accordingly. Ice plays a role in vascular disease and general neurological dysfunction. Ice treatment is a key step in the treatment of diabetic foot because it is based on controlling and eliminating infectious bacteria as well as preventing the entry of other pathogens. In general clinical practice, dressing treatment is divided into two parts: evaluation and specific treatment after evaluation.
Diabetic foot injuries should be classified according to morphology based on the course of the disease for evaluation. According to the general classification system, diabetic foot formation is divided into 4 stages: black (necrosis), yellow (inflammatory exudate), red (granule formation) and pink (epithelial formation). No.8 The assessment and judgment of the wound is based on the specific characteristics of each stage of diabetic foot. Then, effective and corresponding wound treatment measures are appropriate for each stage of disease development. Specific measures include ablation treatment, dressing change, negative pressure drainage, dressing, etc. Under control of blood sugar, metabolism, and infection, palliative ablation to remove necrotic tissue can reduce the risk of infection. 9 Excision must be complete without leaving any necrotic tissue and the extent of resection should not be excessive. In general, loose deep boils can form in the area around the bump. 10In such cases, the skin at the edge of the wound grows internally and contracts, and the cord is clearly visible around the wound. Furthermore, granulation tissue inside the wound develops, exudates are reduced and a wound protective field is formed. When needed, effective sutures can reduce bead filling time, accelerate wound healing, and reduce treatment costs. When changing medications, the frequency of sterilization and drug changes should be considered. Changing medications may help reduce the occurrence of the infection to some extent. 9Adding anti-infectives to the wound along with other oral medications can significantly improve wound healing in diabetic foot. Drugs such as alkaline hydrochloride combined with gentamicin, a moisturizing cream, can inhibit the growth of bacteria and weaken the bacteria to promote the recovery of diabetics. 11 , 12 Amoxicillin clavulanate potassium, levofloxacin, clithromycin, cephalosporexin and other anti-infective drugs are suitable for the treatment of methicillin-susceptible Staphylococcus aureus infections. In severe cases, meropenem and other antibiotics may also be used. Patients treated in multiple hospitals are more likely to be infected with a resistant strain of Staphylococcus aureus, in which case oxycycline can be used, and severe cases can be treated with vancomycin and other treatments against other infections. 13 Antibiotics cannot be changed if empiric antibiotic therapy is good. Some new antibiotics also have certain effects in the treatment of diabetic foot such as linezolid, Ertapenem.
For patients with diabetes in the legs after a certain degree of evaluation, the following adjuvant treatment is key to the entire treatment. To begin with, it’s important to choose the right wound covering that can drain the disinfectant and maintain moisture in the wound while protecting it. Some traditional fabrics such as sterile gauze and Vaseline gauze are gradually being replaced by other dressings. Recently, new forms of dressings are increasingly used to treat diabetic foot, for example, some wet dressings such as hydrogel bandages, alginate bandages, bubble bandages, silver ion bandages, etc. gave promising results. Such bandages increase the cure rate significantly. No.8 Of these, silver ion has shown good efficacy as a traditional antibacterial bacterial preparation. The complex is made up of a combination of foams that play a specific role in antibacterial and leachate treatment. The basic principle is to bind to bacterial DNA, making it difficult to bind to human DNA. Resistance is difficult to develop in the case of antibacterial effects. 15 Based on long-term use of silver ions as ice. Silver nanomaterials with sizes smaller than 100 nm-nanometers are developed to optimize silver ions for the Nano processing of silver ions. Furthermore, nanosilver has highly optimized physical, biological and chemical properties. 16 It is known that nanosilver tape has more advantages in the treatment of diabetic foot (see Table 1). After the necrotic tissue is dissolved, the wound negative pressure drainage technology can effectively drain the fluid out, reducing the wound healing time and promoting the growth of granulation tissue, which is beneficial for foot treatment for diabetics.
Table 1
Comparison of Nanosilver Dressings and Other Materials for the Treatment of Diabetic Foot
| Document Years | Country | Comparison the Dressings | Nanosilver Advantages | Conclusion | Separate Application/Joint Application | References |
| 2013 | China | Sterile defat gauze | Nano-silver combines on the dressing, makes contact with the wound, and penetrates into the subcutaneous tissue due to its molecular properties. Afterward, it quickly kills the pathogenic bacteria. As a Consequently, the final recovery rate is increased to varying degrees, and its silver ions also induces pain-relieving characteristics. | Has sterile skim gauze curative effects. The treatment effect is ordinary, and simply treats local tissue ulcer; however, nano-silver dressing is beneficial on the basis of optimization. It greatly improves its cure rate, efficacy, and pain relief. However, there are limitations. In terms of single use cost, nano silver price relatively expensive, with penetration in local hospitals. | Use it alone | [33] |
| 2011 | The UK | DACC(dialkyl aminformyl chloride, a fatty acid derivative) wrapped in antibacterial dressings | DACC performs well in creating a biological barrier, manages bacterial loads, effective for chronic wounds. Nano-silver, on the other hand, accelerates healing and can be used on acute wounds. | It is used based on the course of disease. If it is a long-term chronic disease, the DACC package dressing could be prioritized for treatment. However, for acute, heavy patients, the treatment of nano-silver dressing can be given prioritized. | Use it alone | [34,38] |
| 2021 | China | Regular Vaseline dressing | Nano-silver dressing decreases the infection rate, the number of drug changes, and the healing time, which accelerates the conversion rate. | Vaseline dressing is suitable in the treatment of diabetic foot. Firstly, the use of Vaseline dressing mainly prevents foreign pathogens from invading the wound; it has limited antibacterial ability. Experiments comparing Nano-silver dressing to Vaseline dressing can be used to further study the antibacterial characteristics of nano-silver in terms of infection rate, changing times, healing time, and efficacy of improving optimization. | Use it alone | [34,41] |
| 2015 | India | Microbiology to Polyvinyl Alcohol (PVA) and Melyanformaldehyde (MFR) Resins as Film and Coating Silver Nano Composites | Microorganisms are effectively removed by the formation of PVA-MFR-Ag composites, particularly after foot infection. Especially treated nano-silver dressings improve their stability based on their bactericidal performance, without decreasing the antibacterial activity over time. | The PVA-MFR-Ag complex was made on the basis of nano silver dressing to strengthen the applicability of nano-silver dressings. Its stable chemical coating can prolong the antibacterial activity of nano- silver dressing, extend the use time of nano silver dressing, reduce the number of nano -silver dressing replacements, reduced usage costs, and further optimize diabetic foot treatment. | Joint use | [41] |
| 2013 | South Korea | Nanocrystalline silver, silver carboxymethyl cellulose silver, Sulfampyrimidine silver, Sulfampyridine, Iodine iodide | The healing degree of patients in various groups has improved to different degrees. The dressing effect with nanocrystals is more effective. | Based on the determination of the action of silver ion dressings, additional compound products of silver also have a certain cure rate. However, in the comparative effect of many experiments, the nano-silver dressing exhibits better performance. Nano-silver optimizes the treatment effect from the aspects of wound change, epithelial degree, granulation formation degree, level of necrosis, wound biopsy, and so on to improve the degree of cure. | Use it alone | [42] |
| 2020 | Ireland | The fixed dressing | Nanosilver gel is safe and effective. It works better and reacts faster than other dressings, and alleviates pain during cleaning and debridement. | In diabetic foot ulcers, nanocrystals silver dressings are better than double the prescribed dressing, with a good cure rate, pain -relieving effects. It reduces costs of replacing the dressing as well as the use of painkillers. | Use it alone | [35] |
| 2013 | Sri Lanka | General dressings | The experimental group of nano-silver gel dressing performed significantly better than the conventional dressing group in terms of pain reduction, accessory reduction, and hospitalization time. | Compared with normal dressings, using nano-silver dressing reduces the pain, the number of replacement dressing is reduced, the treatment rate is increased, and the length of hospitalization is also shortened. It can be inferred that nano-silver dressings can also save economy, manpower, and space cost on the basis of improving the individual treatment plans, etc. | Use it alone | [38] |
| 2016 | (China, India) British Journal | Honeysuckle Water Lift Green Synthetic Silver Nanoparticles (AgN Ps) | AgN Ps have significant anti-diabetic activity on diabetic key enzymes. Green synthetic nanoparticles are safer than chemical synthesis. | Nanosilver ions still have certain toxicological effects. Adopting green synthetic nanoparticles is safer in the treatment of diabetic foot because they retain their antibacterial effects. | Use it alone | [39] |
| 2016 | India | Silver Nanoparticles | Nanosilver particles are more effective antibacterial agents than commonly used antibacterial agents. | Silver nanoparticles have the greatest inhibitory effect on MDR strains and E. coli. Therefore, the antibacterial effect is more specific to the patient’s foot. However, if the colonies of the patient foot are not infected by the above-mentioned conventional bacteria, the treatment plan should be defined based on the pathological biopsy. | Ununited | [40] |
| 2016 | Australia/China | Ag+ ions and nanometer silver particles (different particle sizes) | The antibacterial activity of nanoparticles is associated with the amount ofAg(+)released. Nanoparticles have stronger antibacterial activity in a certain range (specific values are disputed), which can be based on the balance of production cost and production process, and improves treatment success rate of diabetic foot while reducing the production cost. | Nano-silver ion produces more targeted dressing types for patients with bacterial infections and acute diabetic foot. Nano-silver dressings can improve treatment efficacy and assist clinicians in achieving individualized diabetic foot treatment by effectively controlling economic costs. | Ununited | [39,44] |
| 2021 | China | Epidermal growth factor combined with nano-silver dressing, growth factor alone, nano-silver alone and control group (conventional surgical debridement) | Nano silver dressing in joint epidermal growth factor, through the relevant experiments, and found that nano silver dressing with growth factor therapy, compared with the growth of a single factor dressings, nano silver dressing and common surgical debridement, alone by bacterial culture results can be seen that the joint group has more significant bacteriostatic effect. and can effectively inhibit the growth of bacteria at the end of the body. It can also promote epidermal growth and granulation tissue formation, making wound healing effectively. | The combination therapy of nano-silver growth factor can promote the growth of granulation tissue and fiber tissue through bacteriostasis, and thus effectively promote wound healing. Nano-silver dressing can effectively inhibit the growth of bacteria through its silver ions, and then when combined with growth factors, it can make up for insufficient local growth factors to a certain extent, promote epidermal growth, form granulation tissue, shorten the time of wound healing, and improve the healing effect. | Joint use | [45] |
Nano silver
Nano silver materials in three-dimensional form with at least one dimension less than 100 nm are called nanosilver. It is a new antibacterial product developed by nanotechnology with stable physical and chemical properties. Nano silver products have a good antibacterial effect, the contact area with bacteria is larger, so it increases the antibacterial effect and safety. Besides, resistance to drugs is also less. 18 Li and colleagues studied the antibacterial effect of nano silver through practical tests nearly 40 years ago and proved that silver activated carbon has a purifying and bactericidal effect.. 19
The treatment principle of nano silver
Nano silver has been shown to act on bacterial cell membranes. Silver nanoparticles can be deposited around cell membranes, causing specific cytotoxicity. It reduces cell morphology, impairs the structural integrity of cell membranes, alters properties, and ultimately leads to cell death. 20 , 21 It is known that nanosilver can induce reactive oxygen production, 22 this is one of the main mechanisms of antibacterial inhibition of nanosilver. Active oxygen is a by-product of cellular metabolism, and its abnormal accumulation can trigger an oxidative stress response, DNA damage, and apoptosis. Nano-silver is genetically toxic, as it disrupts DNA and ultimately induces apoptosis in disease-causing cells. 22On the one hand, silver nanometers can adsorb cell membranes and induce stress responses. 22 On the other hand, it disrupts cell membranes inhibiting dehydrogenase activity and destroys the respiratory chain. The cytotoxicity of nanosilver and respiratory chain destruction can cause accumulation of active oxygen. 23 Therefore, it attacks the cell membrane and blocks the cell’s transmission system. 24 Besides, nano silver can also prevent DNA replication. 21 Moreover, nanosilver can wrinkle free DNA morphology in bacterial cytoplasm, resulting in loss of genetic information transmission and other functions. In addition, nanosilver can lead to DNA damage and may have a good bacteriostatic effect.24–26 Moreover, nanosilver destroys cellular structural components and kills bacterial cells by chemical reaction. studied with intracellular substances NH, -COOH. 27 Nano silver can also bind to cell membrane proteins and respiratory chains, affecting ATP production and consumption in bacteria, leading to bacterial death. 28 It is known that silver ions can inactivate the mercapto group with proteins. 25 Nano silver can also damage cell walls by affecting the bacterial habitat. 25 On the basis of antibacterial, nano silver also has the function of promoting the regeneration of certain epithelial cells, the function of minimizing scar formation after wound healing. 29Especially in the in situ wound test using 1.8mg/mL AgNPs solution, the wound healed in less than 25 days, 30 proving that nano silver can improve epithelial proliferation and repair ability damage in diabetic patients. Diabetics often have lower extremity neuropathy and venous vascular disease. For the above formation mechanism, nanosilver can promote regeneration through antibacterial effect and is less susceptible to antibiotic treatment than antibiotic treatment alone. In addition, peptides, nucleic acids, antibiotics and some of its unique substances and functions (antioxidant-containing polymers, natural nanostructured hydrogels and nanofiber epithelial regeneration, etc.) Silver nanoparticles provided accelerated wound healing. 31The important and crucial thing in the treatment process of silver nano-bandage is the antibacterial effect of silver ion, along with the wound-regenerating effect, the silver nano-bandage is accurate and effective in the treatment of diabetic foot. Therefore, treatment of diabetic foot with nanosilver is a holistic process (see Figure 1).
Advantages and applications of silver nano tape
Nano silver has been widely used in surgery, gynecology, gynecology, dermatology, dentistry, medical devices, medical textile protective articles and contraceptives. The application of nano silver in the treatment of diabetic feet is also becoming more popular in clinical practice. Because silver ions have anti-infective properties, silver nano-bandage is suitable for treating diabetic feet. It is released slowly and efficiently, and the negative charge on the surface of the bacteria will destroy its structure, but more scientific experiments are needed to confirm this. 32Nano silver can effectively improve clinical symptoms, control infection, reduce ulcer area, reduce number of changes, reduce amputation rate, promote patient’s wound healing, withdraw shorten the length of hospital stay and reduce the economic burden for patients with diabetes.
The comparison of the effectiveness of different materials and silver nanotape is shown in Table 1. The advantages and improvements of silver nanotape are observed through the treatment effect of the patient. When comparing the effectiveness of silver nano-bandage with conventional cotton, betadine and vaseline dressings, it can be seen that the silver nano-bandage group gives better results in terms of cure rate of the bandage group, the number of patients recovering from the disease is significantly improved. . Besides, the cure rate is higher than cotton wool and Vaseline, and the silver nano bandage has faster wound healing time, better antibacterial ability, and some degree of pain relief. 33–36 However, there are certain limitations to the use of silver nanoparticle ions. The nanoproduct of silver ions is nanosilver. Nano-silver is more effective and safe when compared to silver ions. However, it still has a certain toxic effect, especially on some organs susceptible to human chronic diseases. 37 Preferably nanosilver tape is used to treat acute and critically ill patients without regard for its long-term effects. However, some diabetic patients requiring long-term treatment may consider managing the condition with a less toxic dressing, such as DACC. 38Also, using fusion therapy with nanosilver tape helps in the chemical synthesis of nanosilver. Plant-based synthetic methods may also be considered. Honeysuckle Water Lift Green’s synthetic silver nanoparticles (AgN Ps) can also treat diabetic feet through their effects on key enzymes. It exhibits better safety performance than chemical synthesis. 39 Silver nano-bandage has an important role in the treatment of diabetic foot secondary infections. Silver nano-bands kill bacteria more effectively than traditional bandages due to the presence of silver ions. 40Silver nano-bandage is the first choice when there is no clear indication of the type of bacteria causing diabetic foot infections and in the emergency treatment of trauma. Bacterial nano-silver blend on polyvinyl alcohol (PVA) and melamine formaldehyde (MFR) resins in the form of thin films and coatings improves the duration of the bandage’s bactericidal effect, 41 further improves the anti-infective effect of nano silver excipients. To determine the advantages offered by nano-silver products over the initial effects of silver ions, nanocrystal Silver and carboxymethyl cellulose silver, Sulfonadrimine Silver, Silfonazine and Control iodide were all beneficial. 42Many comparative experiments using silver nanoparticles with different particle sizes have been conducted to further investigate silver nanoparticles, Silver ions and for different species.
43 , It can be inferred that the therapeutic effect of nano silver is the effect of silver ions. However, nanoproducts perform better than other silver compounds, possibly because of their shape and size. Comparison of the antibacterial effects of the same E. coli with different nanodiameters demonstrates that the nanoparticles are affected by their morphology and size. Different groups of experiments show that when comparing the same particle size with different strains, the silver nanoparticle size has a certain relationship with its antibacterial ability. However, the exact values are still controversial and the degree of correlation should also be discussed further. It is worth mentioning, on the basis of treatment with silver nano tape,45 Regarding the effect of epidermal growth factor, related studies have shown that cell, growth factor, surrounding matrix on Structure and function interact, their mutual influence on cell growth restoration plays a certain role, EGFR activation regulates integrin activation and cell adhesion, creating a controlled environment Control promotes cell growth and further helps with cell repair. 46Preliminary evidence suggests that nanosilver dressings, when compared with other dressings in the treatment of diabetic foot, have superiority and uniqueness, particularly some of the uses of combination therapy, which may be possible. effectively shorten the treatment time, promote wound healing and improve the treatment effect. , but about the treatment method, there are some limitations, the specific design needs to follow the principle of individual treatment, the analysis depends on the specific situation..
Application prospect of nano silver gauze bandages
Compared with other antibacterial bandages, nano silver has outstanding characteristics and advantages when treating diabetic feet, including broad spectrum of action, wide application, safety and duration of action after treatment. long value. Experimental studies have shown that silver nanometers reduce pain, as well as duration and likelihood of infection, in patients with diabetes. Moreover, if widely developed, the popularization of silver nano-bands can also reduce the economic burden for patients, reduce unnecessary pain, improve patient survival, and play an important role in the patient’s survival. specifically in the treatment of diabetic patients at high risk of foot problems. Besides improving income for diabetic foot patients, nanosilver dressings also have a role in improving efficiency in other areas of trauma. Considering the increasing number of diabetic patients in China, the application of nano silver enamel should be promoted and developed. However, the research on silver nanotape needs to be expanded; for example, future studies may look at the harmful effects of silver nanotape on aquatic life and toxic effects on the human body.16 , 47 It is known, color-synthesized nanoparticles Green substitute nanoparticles can be used to replace chemically synthesized silver nanoparticles. It can enhance the safety performance of nanoparticles. 39 Thus, it can be demonstrated that nanosilver tape has great potential in the diabetic foot dressing market. Rational use and development of silver nanomaterials combined with ongoing research can improve the performance of nanosilver in terms of its physical, chemical and biological aspects, thereby providing conditions better health for the majority of patients with diabetes.
Conclusion
Nano silver tape is a novel, safe, novel form of broad-spectrum antibacterial tape. It plays an important role in the prevention and treatment of diabetes. In addition to protecting the wound, facilitating better drainage, and improving its safe broad-spectrum anti-infective role, related studies suggest its application in the treatment of diabetic foot has advantages. Significantly, especially several comparative experiments with different dressings have shown that nano-silver dressings effectively improve the cure rate, the safety of diabetic foot patients, and reduce pain in a certain level. Improving the effectiveness of using nano silver tape on the limitations of using silver nano band and the method of use can bring practical benefits to diabetic foot patients in many aspects.
Recognition
In the process of writing this article, we are especially grateful to Weihao Li, who captured a lot of unexpected content during our collision of minds, as well as his companion and support during the process. Reply. And We are very grateful to Mr. Shen Haitao for his guidance in the illustrations of the article. Finally, we are especially grateful to China Medical University for giving us the learning opportunity and platform that allows us to explore the unknown on the shoulders of giants. Huijing Lin and ALayi BoLatai were the first co-authors of this study.
Sponsorship statement
This study was supported by the National Natural Science Foundation of China (No. 81700706), the 345 Talent Project of Shengjing Hospital, and the Clinical Research Project of the Liaoning Diabetes Medical Nutrition Association. Ning (No. LNTNBYXYYFZXH-RS01B), Science Foundation of Liaoning Department of Education (No. LK201603) and Teaching Project of Virtual Simulation Experiment of China Medical University (No. 2020-47).
Reference source:
Application Progress of Nano Silver Dressing in the Treatment of Diabetic Foot