Abstract: The clinical management of venous ulcers is debatable; however, a better understanding of the physiology has led to development of new treatment modalities. At the authors’ center, bilayered extracellular matrix (ECM) technology (OASIS® Wound Matrix, Healthpoint, Ltd., Fort Worth, Tex) has been used to treat various lower-extremity wounds. In this retrospective study, the authors attempted to determine if ECM with a classic Unna boot method of compression was more effective at healing venous stasis ulcers than traditional Unna compression dressing supplemented by a wound drainage controlling agent alone. Thirty-three randomized outpatients diagnosed with venous insufficiency and venous leg ulcers were recruited to the study. The patients were divided into 2 groups based on type of dressing applied. Group A was treated with the commercially available ECM and application of a classic Unna boot method of compression. Group B was treated with the classic Unna boot method. The com

Abstract: Background: Much is written regarding risk factors precipitating amputation in patients with diabetes. Two such factors are neuropathy and peripheral vascular disease (PVD). However, many patients with diabetes and these risk factors do not succumb to amputation. Factors that differentiate patients proceeding to amputation and those not, despite having the same risk factors, are unclear. Therefore, this investigation examined the quality of medical care and patient compliance in patients with diabetes and neuropathy and/or PVD. Methods: Retrospective exploratory data analyses of 50 patients with diabetes and neuropathy and/or PVD who succumbed to amputation and 30 patients with diabetes and the same risk factors but did not advance to amputation were analyzed. Two variables, Medical Care and Patient Compliance, were created and operationally defined using current guidelines for management of patients with diabetes. Results: In patients with diabetes that succumbed to amputati

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.

Abstract: The authors report a case of a 50-year-old man with bilateral, wide, crural ulcers of 1-year duration on the lower limbs. The patient experienced 3 transient ischemic attacks (TIAs), and instrumental exams revealed thrombotic events involving the kidney, lung, and central nervous system (CNS). The authors performed a thrombophilic screening, which indicated altered concentrations of C and S proteins and antithrombin III (AT III) and a single-base mutation (C677T) at the methylene tetrahydrofolate reductase gene (MTHFR). Methylene tetrahydrofolate reductase gene mutation may be associated with a coagulation system disorder. These data suggest that the MTHFR mutation may be responsible for cutaneous ulcer pathogenesis.