The pH of Wound Fluid in Diabetic Foot Ulcers

NewsBot · Jun 12, 2014

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The pH of Wound Fluid in Diabetic Foot Ulcers- the Way Forward in Detecting Clinical Infection?
McArdle C, Lagan KM, McDowell DA.
Curr Diabetes Rev. 2014 Jun 9.

Infections within diabetic foot ulcers are often hard to detect and extremely difficult to treat. The normal signs and symptoms of infection including purulence, erythema, pain, tenderness, warmth and induration are frequently absent in such wounds necessitating exploration of other ways of rapidly and accurately detecting infection. This study considers diabetic wound fluid pH as a possible alternative means of monitoring infection status. CINAHL, Ovid SP and MEDLINE were searched for papers in English published between January 2004 to May 2014. Key search terms included wound fluid, exudate, wound, ulcer, diabetes, pH, healing, infection, bacteria. This paper considers the potential benefits of augmenting and supporting current clinical practice in the early determination of wound healing trajectory and infection status, by monitoring wound fluid pH. The evidence collected highlights the need for further research and suggests the potential of wound fluid analysis as a possible surrogate marker for detecting infection in diabetic foot ulcers.
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NewsBot · Mar 24, 2018

Monitoring of pH and temperature of neuropathic diabetic and non-diabetic foot ulcers for 12-weeks: an observational study.
Gethin G et al
Wound Repair Regen. 2018 Mar 22. doi: 10.1111/wrr.12628.

Wound bed assessment is largely reliant on subjective interpretation without recourse to objective tools or biomarkers. The identification of a point of care, reliable biomarker would enhance assessment and ultimately clinical decision-making. Two potentially emerging wound biomarkers exist: surface pH and surface temperature. To date, knowledge of their use has been predominantly in wound prevention, in vitro studies and single time measurements. Our objective was to determine surface pH, size and surface temperature in non-infected, neuropathic foot ulcers at baseline and at 12 weeks. 50 patients (68% [n=34] had diabetes) participated. Mean baseline pH of wounds was 6.95 (SD 1.01); temperature 30.91°C (SD 3.00); and size 0.82cm2 (SD0.61). After 12 weeks, 26% (n=13) were lost to follow-up, 50% (n=25) had healed. Of the remaining patients, mean pH was 6.72 (SD0.54); temperature 30.88°C (SD2.97), and size 0.13cm2 (SD0.13). We have provided baseline values for pH and temperature of non-infected, neuropathic diabetic and non-diabetic foot ulceration. Further studies in a larger cohort are warranted to determine if temperature and or pH are indicative of a healing or non-healing state.
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NewsBot · Mar 8, 2020

Relationship Between pH Shifts and Rate of Healing in Chronic Nonhealing Venous Stasis Lower-Extremity Wounds
Arthur Tarricone et al
JFAS; Articles in Press

Venous stasis ulcers represent the majority of lower-extremity ulcers and place a considerable financial burden on the American health care system. Current standard of care therapies remain sub-optimal with 50% of venous stasis ulcers remaining unhealed after 4 months. Sixteen consecutive wounds were enrolled across 8 participants at a single center and underwent pH-driven therapy in addition to standard care as dictated by physicians. Following wound debridement, the pH of the wound bed was measured using pH strips. If acidic, normal saline was used to rinse the wound at every dressing change. If alkaline, nonsterile gauze was soaked in 0.25% acetic acid and applied to the wound for a minimum of 30 seconds. Participants were followed for 4 weeks with research staff observing compliance throughout. All 16 wounds had an alkaline pH at baseline, with an average pH of 8.25 ± 0.55 (range 7.5 to 9). Average area of the wound at the time of enrollment was (mean ± standard deviation) 285.48 ± 43.68 mm2, and average age of the wound was 37.5 ± 20.3 months (range 3 to 72). A simple linear regression model found a moderate relationship between pH and the rate of healing of chronic nonhealing venous stasis lower-extremity wounds (correlation coefficient  = 0.61). For every 1-unit change in pH, we can expect to see a change in wound size of 116.05 mm2. This is the first US-based, open-label, prospective study that examined the effect of pH on the rate of healing in chronic nonhealing venous stasis ulcer lowerextremity wounds.
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NewsBot · Feb 27, 2023

Wound pH and Surface Temperature as a Predictive Biomarker of Healing in Diabetic Foot Ulcers
Bhavani Prasad Mahindrakar et al
Source

Aim
To monitor wound pH and surface temperature as predictors of wound healing in diabetic foot ulcers (DFU).
Methods
Prospective, observational, time-bound study of 18 months, enrolling patients aged 18 to 60 years with uninfected DFU. The wound was assessed at baseline and after that, every week for 4 weeks according to the leg ulcer measurement tool (LUMT). Concurrently, wound surface pH and temperature were measured. The data were analyzed using descriptive statistics, and a P-value < .05 was considered statistically significant.
Results
Fifty-four patients with DFU were included in the study with a mean age of 55 years and a male to female ratio of 1.57. The wound showed progressive improvement, a maximum mean LUMT score of 48.89 (± 2.81) at the initial evaluation and decreased progressively to the mean of 19.80 at week 4 (± 3.43), both of which were statistically significant (P-value < .001). Similarly, the median wound pH progressively reduced from 7.7 at baseline to 7.20 in the fourth week, and median wound temperature decreased from 90°F (32.22 °C) at baseline to 85°F (29.44 °C) in the fourth week, both of which were statistically significant (P-value < .001).
Conclusion
Progressive and significant change in wound pH to acidic and drop in wound surface temperature, both corresponding to improvement in the status of DFU, maximum at 4 weeks, make them valuable predictors of wound healing. However, further, more extensive studies are required to establish a concrete relationship.
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NewsBot · Feb 22, 2024

Wound pH-Modulating Strategies for Diabetic Wound Healing
Léo-Paul Tricou et al
Adv Wound Care (New Rochelle). 2024 Feb 14

Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve complete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU. Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU pathophysiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic wounds. Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile. Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.
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NewsBot · Apr 15, 2024

An observational study of the pH value during the healing process of diabetic foot ulcer
Yiru Wang et al
J Tissue Viability. 2024 Apr 2

Objective: In this study, we evaluated the pH (potential of hydrogen) value of diabetic foot ulcers and explored the relationship between the pH value and infection, sinus formation, stasis dermatitis, and the process of healing.

Methods: From October 2022 to June 2023, 99 patients with 106 diabetic foot ulcers were selected. Diabetic foot ulcers were treated in a standardized manner by a professional team. The pH value, area, PUSH (Pressure Ulcer Scale for Healing) score, and the degree of infection of the wounds were compared before and after the treatment.

Results: The baseline wound pH value in 76.4% of the patients was in the alkaline range and was closely related to the degree of infection (P < 0.05). As the ulcers healed, the pH decreased. For moderately and severely infected diabetic foot ulcers, each unit decrease in pH was associated with a decrease in the PUSH score of approximately 4.6 points (P < 0.05). The pH values of wounds with surrounding ecchymosis dermatitis were significantly higher than those of wounds without ecchymosis dermatitis (P < 0.05). The pH value of the wound with a sinus tract was higher. After treatment, there was no significant difference in pH value between the patients with and without sinus tracts (P < 0.05).

Conclusions: The measurement of pH value is efficient and simple, and the patient suffers no discomfort in the process. The change in pH helps predict the healing process of diabetic foot ulcers and quickly identify whether there are key factors such as infection and ischemia in the wound. It is suggested that dynamic pH monitoring be included in the whole course evaluation and intervention strategy development of diabetic foot.
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