ASSESSMENT OF A TREATMENT FOR NEUROPATHIC ULCERS IN DIABETIC PATIENTS USING CELLULOSIC

MEMBRANE
By: Sasajima, E.K., Magalhes, A.A.C., Gamba, M.A.
ABSTRACT
The authors above undertook this study to assess the
properties of the bacterial cellulosic membrane in
treating diabetic patients neuropathic ulcers located on
the plantar area. 30 patients under treatment at the
UNIFESP-EPM Insensitive Foot Rehab Center were
included, divided in Groups A and B. The results
obtained (graphs 1 and 2) led us to the conclusion that
the bacterial cellulosic membrane presents properties
that facilitate the healing process where indicated.
Remember that it is counter-indicated in the presence of
necrosis and infection or when there is attrition when
walking.
INTRODUCTION
Diabetes mellitus is a chronic disease acknowledged as
a major public health issue, with high social, economic
and human costs. It is often associated with both acute
and chronic complications, and it may lead to
permanent physical disability due to blindness or
amputation.
For most diabetic patients, amputations are preceded by
foot ulcers.
The diabetic foot has been widely discussed lately by
many organizations and institutions around the world,
with special attention to changes in the approach and
treatment, with the purpose of reducing the number of
amputations in up to 50%.
In the last 30 years, dressing technology has evolved
greatly, from obscure methods to the application of
interactive and bioactive materials.
The cellulosic membrane is a new dressing product
developed by Acetobacter xylium bacteria and it has
been used as substitute skin in the treatment of both
acute and chronic wounds.

ulcers classified as degree I or II (depth) and

Degree A (vascularization) according to
Brodsky classification.

Exclusion criteria:
uncontrolled diabetes mellitus;
infected wounds presenting cellulites, abscess
and purulent secretion;
osteomyelitis verified through radiological
exam;
presence of necrotic tissue;
non-use of adequate ulcer healing orthosis.
RESULTS
As shown in Table 1, with reference to gender, we have
observed that there is a prevalence of male patients in
both groups: Group A (73%) and Group B (86%).
Table 2 shows that 80% of Group B and 53 % of Group
A had their wounds healed. 47% of the patients in
Group A were not successful in healing their wounds.

healed not others

(Graph 1: Number of patients in Group A and B

according to gender.)
(Graph 2: Number of patients who had their wounds
healed, according to Groups A and B.)
Figure 1 shows the evolution in the healing of the
wound of a male patient using the cellulosic membrane.
The wound healed in 06 weeks.

OBJECTIVES
To assess the properties of the cellulosic membrane on
neuropathic ulcers located on the plantar region of
diabetic feet.
METHODOLOGY
Randomized clinic study with 30 patients that were
being seen at the Insensitive Foot Rehab Center of the
School of Medicine of the Federal University of So
Paulo (Lar Escola So Francisco UNIFESP-EPM),
which were included according to the following criteria:
suffering from diabetes mellitus;
age between 40 and 75, both male and
female;
with neuropathic ulcers located on the plantar
area;
ulcers existing for over 6 months;

(Fig. 1: Patient VC, male, 60 years old.)

COMPLICATION
The condition of the wound worsened in one week,
after using the cellulosic membrane.

(Fig. 2: Patient FAF, male, 65 years old.)

DISCUSSION
The treatment of diabetic feet ulcers is complex:
requires a team approach
reduced strain on adjacent areas
infection control
diabetes control
local treatment of wounds
Around 80% of the patients that used the cellulosic
membrane had their wounds healed in approx. 11
weeks, the recommended period for cicatrisation.

The membrane acts as a protecting barrier against

microorganisms due to its small pores, and it also
allows the passing of steam, keeping the bed of the
wound moist.
It is easy to handle, because its flexible. Its semitransparency allows for a better wound control.
CONCLUSION
The bacterial cellulose membrane is a dressing method
that adds to the improvement of the diabetic foot ulcer
treatment, where indicated. Remember that it is
counter-indicated in the presence of necrosis and
infection or when there is attrition when walking.

REFERENCES
1. Magnocavallo C., Baratti C, Lavazzari M, Pamparana F, Pellegrini C. Use of synthetic film (bioprocess) in abrasions
and second degree burns. Preliminary study in emergency room. Minerva Chir. 1993 48 (13-14); 773-8
2. Meteos SB Pele descartvel (Disposable skin). Ind.Bras. 2004: 30-40. http://www.cni.org.br
3. Pitanguy I, Salgado F, Maracaj PF. Use of cellulose film (biofill) as a biologic dressing. Rev. Bras. Cir. 1988 vol 78
(5) 1-13
4. Jorge BH, Borges MF, Brito VN, Santos TGM, Thirone AP. Anlise clnica e evoluo de 70 casos de leses podais
infectadas em pacientes diabticos (Clinical analysis and evolution of 70 cases of feet infected lesions in diabetic
patients). Arq. Bras. Endocrinol. Metab. 1999 43 (5) 366-372
5. Gamb MA, Gotlieb SLD. Mellitus: estudo caso-controle (Mellitus: control case study). Sade Pblica 2004; 38(3):
399-404. Bergamaschi DP, Amaral ACV, Amputaes de extremidades inferiores por diabetes (Lower extremities
amputation due to diabetes).
6. Brodsky I. Mtodo aperfeioado para o estagiamento e a classificao das leses dos ps nos pacientes diabticos
(Improved method for determining the stage and classification of diabetic foot lesions). In Levin ME, ONeal LW. P
Diabtico (Diabetic foot) 6th ed. Dilivros 2002, p. 275-84
7. Nures MAF, Resende KF, Castro AA, Pitta GBB, Figueiredo LFP, Miranda JL Fatores predisponentes para amputao
de membro inferior em pacientes diabticos internados com ps ulcerados no estado de Sergipe (Predisposing factors
leading to amputation of lower limbs in diabetic patients admitted to the hospital with ulcerated feet in the Sergipe state).
J Vasc Brs 2006; 5(2) 123-130
8. Georg AE, Duncan BB, Toscano CM, Schmidt M, Mengue S, Duarte C, et al. Anlise econmica de programa para
rastreamento do diabetes mellitus no Brasil (Economic analysis of a diabetes mellitus tracking program in Brazil). Ver
Sade Pblica 2005; 39(03)\; 452-560
9. Dirio Oficial da Unio Poder Executivo (Federal Administration Official Gazette) January 9, 2006
10. Conselho Nacional de Sade. Resoluo (National Health Council Resolution) N. 196 of October 10, 1996. Diretrizes
e Normas Regulamentadoras de pesquisa envolvendo seres humanos. (Directives and Norms regulating research involving
human beings). Biotica, Braslia, v. 4, n.2 (suppl): 15-25.