Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Support Granulation using Acupuncture Method:

Diabetic Foot Ulcer Case Study
Rubiyanto Warja
Bilqiss Medika Clinic

Abstract:- I. INTRODUCTION
Introduction: Indonesia is the country with the fourth
most diabetes mellitus patient in the world after India, Diabetes mellitus is not a taboo subject in society,
China, and the United States, 12 million patient and is almost everyone knows diabetes mellitus or diabetes, which
expected to increase to 21.3 million in 2030. Diabetic foot is considered the cause of all health problems whose
ulcers (DFU) is a complication of diabetes that is hard to complications are very large, so that they will experience a
heal and can even end in amputation due to worse condition when a person with this disease pays less
infectioncauseof not handled properly. The incidence of attention to his physical condition related to lifestyle and
diabetic foot ulcers reaches 25% and the overall bad diet. Changes in people's lifestyles now because they
prevalence reaches 6.3% of all diabetes mellitus patients tend to think it's easy to get food so that it will trigger an
in each country (JWC Int, 2018). The UK reports the increase in the prevalence of diabetes mellitus. The
effect of diabetes mellitus 20% on diabetic foot ulcers organization that concentrates on the diabetes mellitus
(National Health Service Diabetes Care, 2013). The forum,The American Diabetes Association (ADA, 2017)
incidence of diabetic foot ulcers in the United States is explains that Diabetes mellitus is a group of metabolic
15% - 20%, with the risk of amputation 15-46 times diseases with characteristics of increased blood glucose
higher than non-diabetic. The concept of moist wound levels (hyperglycemia) exceeding the value of blood sugar
healingwith modern dressings has become the main levels above 180 mg/dl caused by abnormal insulin
foundation in wound care and then acupuncture support secretions, impaired insulin action or both. Data from the
therapy can be used as additional therapy to supporting World Health Organization (WHO) shows that Indonesia is
granulationin wound healing process. Acupuncture is an the country with the fourth most Diabetes Mellitus
traditional Chinese medicine therapy using needles that (DM)patient in the world after India, China and the United
are inserted into the acupoint. States, with a total of 12 million patient and is expected to
increase to 21.3 million in 2030 (Sonta Imelda, 2018). The
Methods: A case study of a 61-year-old man who had a 7th edition of the Diabetes Atlas 2015 from the IDF states
diabetic foot ulcers on the left leg of M. Gastronemius that from a record 220 countries around the world, the
lateral after surgery who had sloughly, with the concept number of people with diabetes is expected to increase from
of modern wound care dressings, he found regrowth of 415 million people in 2015 to 642 million in 2040. Almost
granulation tissue and used acupuncture method to half of this figure is in Asia, mainly in Asia. India, China,
support granulation cells to grow faster. Proliferation Pakistan and Indonesia. The terrifying fact is that 1 person
spreads towards epithelialization which is effective per 6 seconds or 10 people per minute dies from diabetes,
enough to be used as additional therapy in cases of and diabetes claimed the lives of 5 million adults in 2015.
diabetic foot ulcers.
Countries in the Asian region, more than 5% (some
Results: The effectiveness was quite visible in the repair even reach 85%) of diabetics have the same experience.
of fast-growing granulation cells, good revascularization Singapore, which has developed health services, has a
to distal wound using acupuncture methods for diabetic prevalence rate of 20%. This ignorance is caused most
foot ulcers after 2 weeks wound care in every 3 days. diabetes diseases continue without complaints for several
Conclusion: Acupuncture therapy as an additional years, after complications arise, see a doctor (Hans Tandra,
therapy in the treatment of diabetic foot ulcers is quite 2018) in other words that early examinations are rarely
effective in increasing the amount of granulation cells carried out by the community to identify health problems
towards epithelialization in the proliferative phase. that occur. In Indonesia, based on a doctor's diagnosis at
Riskesdas in 2018, the province that suffered the most DM
Keywords:- Granulation, DFU Treatment, Acupuncture. was Jakarta as many as 2.6% of the population. So many
health problems related to diabetes mellitus are found, there
is a risk of complications becoming wounds that are hard to
heal.

Along with the increase in the number of cases, it is

easy for complications to occur, that are hard to heal wounds
(WOCN, 2016). Diabetic Foot Ulcers (DFU) are reported
have 25% incidence and an overall prevalence 6.3% of
patients with diabetes mellitus in each country (JWC Int,
2018). The UK is a developed country in the European
region reporting 20% of the effects of diabetes mellitus 20%

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Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
to diabetic foot ulcers (National Health Service Diabetes A guide in helping to solve the problem of foot ulcers
care, 2013). Diabetic foot ulcers are a condition of lower leg due to diabetes mellitus, of course, there are many
wounds with complications due to diabetes (Wounds Int, multidisciplinary profesional team involved, such as
2013). internists or endocrinology, vascular surgeons, orthopedic
surgeons, diabetes nurses, wound care nurses, psychologists,
The problem of diabetes is the main concentration of nutritionists, physiotherapists, pharmacists, podiatrists
countries in the world because of its worsening effect of (EWMA, 2014). Each discipline brings guidance in the
lower leg injuries, which occurs due to neuropathy problems patient's healing process that is focused on all lines of
or loss of sense, it will cause callus on the foot skin and promotion, prevention, curative, rehabilitative. Treatment
changes in bone shape so that it will cause thin skin and program efforts after a problem occurs, for example a
blisters without realizing it. The condition continues, it will wound complication that infection occurs, it is necessary to
get worse because the wound becomes infected and wrong involve the treatment of infection with antibiotics, fluid
handling or incorrect of wound care, even worse, it over rehydration, proper nutrition, appopriate wound care,
become to limb amputation. antidiabetic drugs that are in accordance with the body's
It is reported that the incidence of diabetic foot ulcers tolerance and do not rule out the possibility of supporting
reaches 25% and the overall prevalence reaches 6.3% of all treatment actions as adjuvant therapy for diabetic foot ulcers
diabetes mellitus patients in each country (JWC Int, 2018). by acupuncture treatment.
The UK reports the effect of diabetes mellitus 20% on
diabetic foot ulcers (National Health Service Diabetes Care, Non-pharmacological treatment model of acupuncture
2013). Incidence DFU in USA 15% - 20% risk of leg is quite reliable in helping with problems in diabetic foot
amputation 15 - 46 times higher than not a diabetic patient. ulcers to stimulate the process of cell granulation in the
According to data from the Indonesian Ministry of Health, proliferative phase towards epithelialization which is quite
2018 that diabetes which will cause leg ulcers and effective. Acupuncture is a critical component in traditional
accompanied by gangrene reaches 17% - 23% while the 1- Chinese medicine that has been used since thousands of
year mortality rate after amputation is 14.8% and increases years ago by using needles for the treatment of several
to 37%. According to Sulistyowati (2015) the number of diseases including vascular problems by inserting needles
patients with diabetic foot ulcers is around 15%, patients at into the acupoints of the body to correct diabetic neuropathy
risk of amputation are 30% with a mortality rate of 32%. problems (Lee Maosheng, 2020). The journal published by
Lee et al, that acupuncture therapy is very effective for
Wound is a condition where tissue damage occurs due diabetic foot ulcers because in addition to stimulating the
to several causes including trauma, surgery, pressure, vascular system to affect the distal circulation and wound
malignancy and vascular problems, then the body will area, it can also stimulate the growth of new tissue. Another
protect itself by carrying out the wound healing process study related to acupuncture was carried out by Irma N,
(Patrakusuma. D, 2018). Wounds are abnormalities in the 2017 by modifying the acupuncture technique at the
normal structure and function of the skin and underlying soft acupoint point using laser puncture which is quite effective
tissue that occur due to pressure, infection, trauma and the in helping the healing process of diabetic foot ulcers as
surgical process (WOCN, 2016). Therefore, we cannot evidenced by the wound area of 4 cm in 2 weeks using
predict when an injury will occur, for example accidents that therapy the size is reduced to 2 cm.
are classified as acute injuries and wounds due to
complications that fail in the healing process are called II. METHOD
chronic wounds. Wounds must receive appropriate wound Case study: A 60-year-old man,ulcers on his left leg
care, both in the cleansing process and in choosing the right lateral to the lateral Gastrocnemius, size 15cm x 4.5cm After
dressing according to the condition of the wound. 10 days of surgery, the wound started with a carbuncle after
The normal stages in the wound healing process are surgical incision was made at the hospital to open the area of
hemostasis or the coagulation process, inflammation, infection. Problems occur when the wound after surgery is
proliferation or regeneration and maturation or remodeling. sloughly (necrotic yellow tissue) because the wound is
Wound care will follow the phases and the healing process covered with gauze.
so it must be done in the right way. The concept that is Wound assessment; Wound area M. Lateral
believed and recognized to follow the process in wound care Gastronemius sinistra unstegeablestage 15cm x 4.5cm
that is known today is a closed concept with modern sloughly 100%, dry, no odor, dry and inflamed skin around
dressing. This concept was put forward by experts in wound the wound, positive neuropathy test on left and right feet.
care known as moist wound healing (Schultz, 1993; WOCN,
2014, 2016) or the wound healing process with the concept Wound care management; for 1 week (3 times wound
of moisture balance. The theory first introduce by George D. care) using hydrogel dressing sloughly can evacuated and
Winter in 1962. This concept was first published in the stage 4, 100% granulation tissue, moist conditions
journal Nature as follows"When the wound condition is (sufficiently rehydrated). The 4th meeting of the
closed, the healing rate is twice faster than the open proliferative phase of wound care, after cleansing the
condition". wound, electric stimulator acupuncture therapy was added
for 20 minutes in the area around the wound to stimulate the
gastronemius muscle to contract so as to increase

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Volume 7, Issue 4, April – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
vascularization to the wound area, maximize in epithelial III. RESULTS
contraction wound edge more visible.
Acupuncture technique with electrical stimulator in
After the acupuncture procedure, the wound was assisting the process of treating diabetic foot ulcers is quite
closed with a modern moist concept of iodosorb dressing as effective in increasing the growth of granulation tissue in the
antimicrobial topical dressing, hydrofoam and cohesive proliferative phase and supporting neo-angiogenesis process.
bandage compression. The acupuncture technique was The process of improvement is evidenced by an increase in
carried out at every wound care meeting, every 3 days after the amount of granulation cells at the base of the wound and
cleansing the wound. an increasing amount of epithelialization at the edges of the
wound more visible and the growing vascularity is
stimulated by contraction of the gastronemius muscle using
an electrical stimulator so that with three times of modern
wound care dressings added acupuncture therapy is better
condition.

IV. CONCLUSION

Diabetic foot ulcers (DFUs) are a worsening

complication of health problems caused by diabetes
mellitus. Diabetic foot ulcers must of course get more
attention in the handling or management of wound care and
multidisciplinary professionals team to help the wound
healing process properly and appropriately. Management is
related to pharmacology for proper antidiabetic, good
nutrition and adequate supplements, correct wound care
Fig. 1: Pre acupuncture procedures techniques and selection of appropriate dressings with
closed concept as well as supportive therapy or adjuvant
wound healing and one that can be used is therapeutic
acupuncture.

Acupuncture therapy using an effective electrical

stimulator to help the healing process of diabetic foot ulcers
as an additional option to increase granulation cells growth
in the proliferation phase and increase vascularization to the
distal wound area and successfully lead to the
epithelialization process. The case study above shows that
by doing three times acupuncture therapy in the wound care
process there is an improvement in diabetic foot ulcers.

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