foot ulceration

VACUUM to Heal Wounds?? Lonnie Kaplan DPM

Sometimes foot ulcerations still do not heal despite all of the previous discussed options and your podiatrist needs to discuss other possible treatment options. For very deep wounds and wounds with ligaments, tendons and muscle exposed, negative pressure wound therapy (NPWT) is an excellent modality. It is commonly used on wound after amputations where the skin is not stitched closed due to infection etc. Negative pressure wound therapy is a vacuum system (yes you read this correct) that creates negative pressure within the wound to remove fluids, drainage, allow for a moist healing environment, and remove infectious materials in order to help in the healing of the wound. The vac can also help the wound edges pull together.

The application of the wound vacuum starts with a foam dressing over the wound followed by an adhesive dressing that forms a seal around the periphery of the wound. At this point a small hole is made in the adhesive dressing and a drainage tube is placed which is connected to a vacuum suction. The vacuum can either be on continuous (constantly on) or intermittent (turns on and off at set increments) There are both portable wound vacs as well as larger wound vacs that are kept at bedside in home bound patients. The portable ones have an arm strap and they are worn similarly to a shoulder bag and of course have a canister that collects the drainage. The podiatrist will usually change the foam dressing three to four times a week depending on the amount of drainage in the canister. One major goal of the wound vac system is to fill in the wound enough to apply a skin substitute. This treatment option has become more and more popular over the last 5-10 years due to its efficacy in helping to resolve difficult to heal wounds.

Call Quality Foot Care Today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.

Skin Substitutes for Diabetic Ulcerations: Lonnie Kaplan DPM

As you now know from my previous posts, diabetes is a common cause of foot ulcerations. If the ulceration is not colonized/infected, nutrition and blood supply are adequate, and there is adequate offloading you may be thinking, what is the next step if a wound still will not heal. A treatment that can be used are skin substitutes. These products can be used when there is less than 50% improvement in size of wound in a 30 day period using standard of care. Some of these products contain stem cells which allow tissue to differentiate into cells that allow for better healing of wounds. (most of this is taken from placental tissue) Others are just made up of an extracellular matrix with different growth factors that aid in the healing process. There have been many studies recently including head to head comparisons of different products showing excellent results. It is important to differentiate these products from split thickness/full thickness skin grafts which are harvested from another part of the patient’s body in an operating room setting.

Application of these products are completed either in the office or in a wound care center. Most of the time, the product is applied and adhered either with steri-strips (form of tape) or with stitches or staples. Normally after applied, a large sterile dressing is applied to the patient’s foot. The patient will usually keep the area clean and dry for a week after which they will be seen back in the podiatrist’s office or wound care center where new measurements will be taken and reapplication will occur. Good improvement/ healing has been seen in very difficult to heal wounds using the above skin substitutes.

Call Quality Foot Care today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.