Advanced Treatments Help Hard-to-Heal Diabetic Foot Ulcers - and Improve LivesFriday, March 30, 2012
Advanced therapies for foot wounds are saving limbs, restoring mobility, and improving the lives of many people with diabetes who suffer from non-healing foot ulcers.
"For many Americans who have diabetes, impaired healing of foot wounds can be a tremendous problem, making these advanced treatments extremely important," says Peter Blume, DPM, FACFAS, assistant clinical professor of surgery at Yale School of Medicine. Dr. Blume is discussing this topic at the Annual Scientific Conference of the American College of Foot and Ankle Surgeons.
Foot ulcers develop in about 15 percent of the 25 million Americans who have diabetes. These ulcers can lead to serious complications such as infection and amputation, and can also decrease the patient`s quality of life.
Diabetic foot ulcers are costly, too. About 20 percent of the estimated $174 million spent annually on diabetes treatment in the U.S. deals with lower extremity care. In fact, non-healing ulcers and infection in the lower extremities are the top reasons for hospitalization among people with diabetes.
Today`s advanced treatment of diabetic foot ulcers include innovative technologies that stimulate healing. These breakthroughs are critical in diabetic foot care because poor circulation, nerve damage and impaired immune responses—problems that people with diabetes are at higher risk of having—make it difficult for a patient`s foot ulcer to heal.
One groundbreaking approach that promotes healing is the use of bioengineered skin substitutes. Surgeons place these advanced biologics, which are made either from living or non-living tissue, over the wound to accelerate growth of healthy skin.
Another advanced wound-healing technology is negative pressure wound therapy (NPWT). This consists of a wound dressing, an air-tight film placed over the wound, and a drainage tube connected to a suction device that draws excess fluid. The suction enables healthy new tissue to grow.
NPWT makes it far more likely that a graft will survive. "Today, we rarely do a skin graft without using NPWT before and after the grafting procedure," says Dr. Blume.
Skin grafting for foot ulcers is also greatly improved today. Surgeons now use plastic surgery grafting techniques that were once reserved for other parts of the body, such as in facial reconstruction. Grafting involves taking healthy skin from another area of the body and placing it over the ulcer.
The success rate of all the advanced therapies for diabetic foot wounds is high, providing substantial improvement over treatments of the previous decade.
"Fifteen years ago, we would clean out the wound, apply an antiseptic and an antimicrobial agent, put a bandage on the wound, and hope for the best," says Dr. Blume.
That picture is dramatically different today, as noted for a patient with diabetes whom Dr. Blume recently treated:
"The patient, a railroad conductor in his 50s, had fallen and sustained a wound on his foot that became infected. We cleaned out the infection and then used NPWT, at his home, for about 3 weeks," says Dr. Blume. "The wound healed nicely. Next, we applied a skin graft to the wound site and used NPWT after the grafting to promote more healing. The patient is now back in a shoe and back to work—and he didn`t lose any toes." The total time from start of treatment to the patient`s return to work was 8 weeks.
This sharply contrasts with what would have occurred before the advent of advanced approaches. "The same patient probably would have been hospitalized for about 4 weeks and undergone major surgery lasting 8 hours," says Dr. Blume. "It would have been a complex process, and he probably would have been away from work for 5 or 6 months."
Time away from work, lengthy hospitalizations, and major surgery add significantly to the economic burden of diabetes. For that reason, the advantages of advanced therapies extend beyond improved medical results to include better outcomes related to work, cost, and lifestyle outcomes.
"In light of the complications of diabetic foot ulcers and the fact that the prevalence of diabetes is rapidly rising, advanced therapies for diabetic foot ulcers will play an even more important role in the future," says Dr. Blume.