The NHS performs more than 8000 foot and foot bone mutations each year as a result of a single disease: diabetes.
And the figure is rising due to an increase in type 2 diabetes, a lifestyle-related disease, the cases of which have doubled since the mid-1990s.
But now a breakthrough in wound care technology could stop this escalation in its wake.
Scientists have a transparent & # 39; patch & # 39; developed from patients' blood, which could help to heal the problem ulcers that lead to foot or leg amputations.
Fact: Recent figures from Public Health England show that between 2015 and 2018 the NHS performed more than 27,000 toe, foot and lower leg amputations due to diabetes
The treatment, called LeucoPatch, has been tried in more than 200 hospitals in Europe, including some in the UK, and involves taking about half a cup of blood from a patient's arm.
The blood is put in a container in a machine that turns it hundreds of times per minute. During this process (also called centrifugation) the more dense red blood cells sink to the bottom, while the less dense white blood cells rise to the top.
Centrifugation also secretes fibrin, an even less dense protein that forms a gauze-like substance that acts as a scaffold in wounds. Blood can clot on this to form a healing scab and healthy new skin cells can begin to grow.
After the spinning process, the fibrin is removed and pressed into a semi-solid round patch – about the size of a 50p piece – that also contains leukocytes, white blood cells that help kill bacteria and viruses, and platelets, tiny disc-shaped cells that help blood clot.
Designed to treat foot ulcers, the patch is placed on the wound and covered with a loose patch.
After a week it starts to break down and is replaced by another patch – made in exactly the same way. This process is repeated until the wound heals.
It can take approximately 20 weeks to completely heal a foot ulcer, a common and serious complication of diabetes that develops because the disease damages nerves and blood vessels to the extremities.
Risk: people with diabetes are much more likely to be amputated on their toes or feet because their injuries do not heal normally. High blood sugar levels can cause nerve damage, which means that patients cannot feel their skin so well and may not know when they have a wound
Recent figures from Public Health England show that between 2015 and 2018 the NHS performed more than 27,000 toe, foot and lower leg amputations due to diabetes.
An increase in type 2 diabetes is believed to be the cause.
Most diabetic foot ulcers are treated with a combination of debridement (the removal of dead tissue), antibiotics (to fight infection) and protective dressings. But in many cases the wound fails to heal due to a lack of blood flow through the damaged blood vessels.
The results of the LeucoPatch study were recently presented in a major study published in the journal The Lancet Diabetes & Endocrinology.
The study included more than 260 patients with diabetic foot ulcers that were difficult to cure. Half were treated with the new LeucoPatch and half received standard treatment, such as debridement and standard dressings. Each patient was followed for six months.
In the LeucoPatch group, 34 percent saw wounds fully healed, compared to just 22 percent in the control group.
HOW CAN DIABETES LEAD TO FOOT AMPUTS?
People with diabetes are much more likely to amputate their toes or feet because their injuries do not heal normally.
A high blood sugar level can cause nerve damage, which means that patients cannot feel their skin well and may not know when they have a wound or feel how serious it is.
And diabetes restricts blood circulation in the legs, which slows healing because oxygen and nutrients are scarce.
The combination of these two factors means that it can take longer for people to get over injuries and the healing period means there is more chance that it will be infected or that meat will die from gangrene.
If an injury becomes too infected or untreatable, the affected part of the body may need to be cut off.
Moreover, they healed faster, with more LeucoPatch patients without ulcers after just three months of treatment.
The patch is thought to work by stimulating the release of growth factors that promote tissue repair and the formation of healthy blood vessels to fill the wound with oxygen-rich blood, vital for healing.
Philip Herberts, 54, from Pontefract, Yorkshire, was one of the first in the UK to benefit from treatment – avoiding amputation of his lower leg.
The father of one was diagnosed with type 2 diabetes in 2007 after being immobilized by an enclosed nerve and his weight inflated to 22st.
A few years ago he developed peripheral neuropathy, a complication of diabetes in which nerves in the limbs are damaged and cause numbness in the leg and foot. This means that injuries such as cuts and blisters can go unnoticed and cannot heal properly.
& # 39; I was on vacation when I saw a blister larger than a £ 2 coin at the bottom of my foot, just behind my toes & # 39 ;, says Philip. & # 39; It grew bigger in the next 12 months despite my nurse's efforts. & # 39;
Doctors warned Philip to undergo an amputation unless the ulcer started to heal. & # 39; I was shocked & # 39 ;, he says.
& # 39; I am an independent mechanic and driver, so losing part of a leg would have had a huge effect on my life. & # 39;
Then his team at Wakefield Hospital, part of the NHS Trust in Mid Yorkshire Hospitals, asked Philip if he wanted to participate in the LeucoPatch study.
After only eight treatment sessions, Philip's ulcer was completely healed.
& # 39; It just disappeared & # 39 ;, he says. & # 39; It was great. It gave me back my mobility and I lost the 5th. & # 39;
LeucoPatch is only available in clinical studies in the UK, but if they are successful (and depending on the costs that are currently unknown), it may become available in the NHS.
Dan Howarth, head of care at the Diabetes UK charity, says: “More than 160 diabetes-related amputations happen every week in the UK, so anything that has the potential to reduce this shocking number is welcome. & # 39;
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