Combination of Subatmospheric Pressure Dressing and Gravity Feed Antibiotic Instillation in the Treatment of Post-Surgical Diabetic Foot Wounds: A Case Series?Part 2.
Case study 1: diabetic foot ulcer with osteitis of the fifth metatarsal head. Negative pressure wound therapy with instillation was utilized in conjunction with intravenous antibiotics from the fourth through sixth inpatient day. Case study 2: diabetic foot ulcer with osteomyelitis.
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Football Dressing for Neuropathic Forefoot Ulcerations
Abstract: In response to the need for a dressing technique that interrupts the causal pathway of trauma in the healing of chronic diabetic neuropathic forefoot ulcerations, the authors devised a dressing with supplies that are widely available, inexpensive, and reliably applied with little additional training. A prospective analysis of the proposed ?football? dressing is presented. Results are compared to literature employing total contact casting and instant total contact casting. Fifteen subjects are included. A t test was used to evaluate the role of infection in the wounds. Infection in the wound was not found to be a statistically significant factor in healing with the football dressing (P = 0.2). Total weeks for complete epithelization of forefoot ulcers was 3.80 ± 2.60 (range 1?10 weeks). Healing rates comparable to total contact casting are noted with the football dressing on these forefoot wounds. This fact coupled with the low cost and ease of application make this dressing technique worthy of further study, as it appears to be an efficacious treatment option.
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Combination of Subatmospheric Pressure Dressing and Gravity Feed Antibiotic Instillation in the Treatment of Post-Surgical Diabetic Foot Wounds: A Case Series?Part 1
Abstract: A new negative pressure wound therapy (NPWT) device with solution instillation capability (V.A.C.® Instill?, KCI, San Antonio, Tex) will be discussed. Historical delivery methods for local antibiotic levels directly to the post-surgical field are antibiotic-laced beads, Kritter-type instillation catheters, and closed suction irrigation. These devices will be reviewed and contrasted with both traditional NPWT as well as the new NPWT with instillation. The authors present 5 diabetic foot surgical case studies highlighting the use of NPWT with instillation followed by a discussion of the reduced length of stay demonstrated in the case studies. The basis of both moist wound healing and wound irrigation will be discussed. The pros and cons of various topical solution choices will be reviewed. The authors will also present a list of scenarios in which the new NPWT with instillation option should be considered.
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A Novel Regenerative Tissue Matrix (RTM) Technology for Connective Tissue Reconstruction
Abstract: The restoration of structure, function, and physiology to damaged or missing tissue through the use of a regenerative tissue matrix (RTM) leads to regenerative healing rather than reparative scarring. While many processes exist to transform biologic materials into an extracellular matrix (ECM), only those that maintain the required structural and biochemical properties necessary to capture the intrinsic regenerative abilities of the body are suitable to produce an RTM. Histological examination using differential staining with hematoxylin and eosin stain or Verhoeff von Geisen stain of human biopsies of RTM obtained from 2 different abdominal surgery patients taken at 8- and 12 months were consistent with RTM remodeling into fascia-like tissue. A synopsis of recent studies on the use of the RTM GraftJacket® (Wright Medical Technologies, Memphis, Tenn) in successful closure of diabetic foot wounds is presented. Collectively, these reports indicate that LifeCell produced ECMs exemplified by GraftJacket exhibit the required clinical outcomes associated with an RTM.
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An Institutional Analysis of Risk Factors in Pectoralis Advancement Flap Reconstruction
Abstract: The restoration of structure, function, and physiology to damaged or missing tissue through the use of a regenerative tissue matrix (RTM) leads to regenerative healing rather than reparative scarring. While many processes exist to transform biologic materials into an extracellular matrix (ECM), only those that maintain the required structural and biochemical properties necessary to capture the intrinsic regenerative abilities of the body are suitable to produce an RTM. Histological examination using differential staining with hematoxylin and eosin stain or Verhoeff von Geisen stain of human biopsies of RTM obtained from 2 different abdominal surgery patients taken at 8- and 12 months were consistent with RTM remodeling into fascia-like tissue. A synopsis of recent studies on the use of the RTM GraftJacket® (Wright Medical Technologies, Memphis, Tenn) in successful closure of diabetic foot wounds is presented. Collectively, these reports indicate that LifeCell produced ECMs exemplified by GraftJacket exhibit the required clinical outcomes associated with an RTM.
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April 2002
April 2002 Industry News: April 2002 - biolitec Clinical Study: Wound Healing by Laser Light biolitec, Inc. is currently seeking investigators and subjects for a new clinical study to assess the efficacy of laser light at the 980 nm wavelength in healing all diabetic foot wounds. When wound warming was combined with offloading, wound healing rates improved to a statistically significant level (p = While the study pointed out that Warm-Up therapy alone is not the answer to diabetic foot ...
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The Use of Negative Pressure Wound Therapy on Diabetic Foot Ulcers: A Preliminary Controlled Trial
Negative pressure wound therapy (NPWT) was developed by Argenta and Morkywas to promote healing of open wounds. The diabetic foot ulcers were surgically debrided prior to initiation of NPWT or moist gauze dressing. In the treatment of diabetic ulcer wounds, NPWT provided a faster wound resolution compared to saline-moistened gauze.
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Nonhealing Ulcer in a Diabetic Foot
Abstract: We present a case of a patient with a nonhealing plantar ulcer of about 15+ years duration resulting from a scald injury. We report on the interdisciplinary approach that led to the diagnosis of squamous cell carcinoma (Marjolin?s ulcer). Metastatic evaluation was negative. The condition and treatment course are discussed.
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Predicting Patient Outcome
Laura L. Bolton, PhD Department Editor Percent Change in Diabetic Foot Ulcer Area Over Four Weeks of Care Predicts 12-Week Healing Reference: Sheehan P, Jones P, Caselli A, Giurini J, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Objective: This study assessed the capacity of diabetic foot ulcer four-week healing rates to predict complete healing over a 12-week period. Debridement ...
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The Effect of the Scotchcast Boot and the Aircast Device on Foot Pressures of the Contralateral Foot
Abstract: Offloading the diabetic foot ulcer is a key element to successful wound healing. The aim of the current study was to determine whether offloading devices affect foot pressures on the contralateral foot. Foot pressures were measured in 22 diabetic patients wearing three different types of footwear on the foot with an active or recently healed ulcer, as follows: the post-op sandal (SAN) (Benefoot UK Ltd, Prestwich, United Kingdom), the Scotchcast boot (SCB), and the Aircast device (AIR) (Aircast, Inc., Lincolnshire, United Kingdom). The SAN was worn on the contralateral foot during all foot pressure measurements. The results showed that foot pressures in the contralateral foot were not different between the three different footwear conditions. There was also no difference in peak pressure time integral in the contralateral foot between the three different footwear conditions. However, an insignificant trend was noted for a longer contact time for the contralateral foot compared to the offloadeded foot for the SAN, SCB, and AIR (p=0.3, p=0.15, and p=0.05, respectively). Although there was only a small difference in contact time, this can lead to an asymmetric gait pattern and could potentially lead to overloading of the contralateral foot and/or to difficulties with maintaining balance while walking. In conclusion, although offloading devices do not seem to alter foot pressures on the contralateral foot, monitoring the contralateral foot is of paramount importance. Asymmetric gait pattern and/or difficulties with balance are essential factors to keep in mind when describing offloading devices to patients with peripheral neuropathy.
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