wound

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.

 

Healing Diabetic Foot Ulcerations Part 3: Lonnie Kaplan DPM

Finally, the last of the four major areas that can be preventing ulcerations from healing. Just a recap, the other three areas are bacterial count, amount of blood flow and offloading of the wound. The last will be discussed below:

  1. Nutrition: Adequate nutrition is paramount for wound healing. Not only can poor nutrition lead to obesity, diabetes and heart disease to name a few, it can also slow down the progression of wounds. Protein, vitamins (especially A and C) and zinc are key factors for healing. There are multiple ways that your podiatrist can evaluate your nutritional status. Most of these are through a simple blood test. Albumin, pre-albumin and lymphocyte count are some tests that can be ordered that primarily look at protein levels necessary for good healing. Sometimes albumin levels come back normal although patient has recently had a decrease in protein in diet because it takes 2-3 weeks for albumin levels to catch up with protein loss. Pre-albumin shows a much quicker decrease with poor nutrition. It is also important to screen patients for alcoholism as this leads to malnutrition commonly. Your podiatrist will commonly refer you to a nutritionist and take a multidisciplinary team based approach to get you best results. Nutritional supplements may be prescribed for patients as well without adequate nutritional status to allow for best chance for healing of 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.

Healing Diabetic Foot Ulcerations Part 2: Lonnie Kaplan DPM

Like I discussed in the previous blog, there are 4 major areas that can be preventing ulcerations from healing. The first two are blood flow and offloading the wound. The next one will be discussed below:

  1. Bacterial Count: It is important to remember that bacteria is all over your body. It is also important to realize that there is both good and bad bacteria. Normal skin has bacteria on it which does not cause any harm to the body as does the GI tract. Ulcerations can either be infected or colonized. Infection is best defined as a multiplication of bacteria, viruses, or fungi that causes symptoms. Symptoms of infection include redness, warmth, swelling, increased drainage and pus to name a few. Colonization is a step below infection where there is multiplication of the bacteria, virus or fungus but minimal symptoms. When treating a foot ulceration that does not appear to be healing, your podiatrist may take a culture swab of the wound to be sure there is no resistant organisms.  Organisms such as methicillin resistant Staph aureus (MRSA) and vanocymin resistant enterococcus (VRE) are becoming more and more prevalent in  the world. (no longer just in hospitalized patients) Sometimes wounds can be colonized with these organisms and culture based treatment with either topical or oral antimicrobial agent can lead to quicker healing.

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.

Stay tuned to learn about the last major factor that can slow ulceration healing in my next post!

Healing Diabetic Foot Ulcerations- Lonnie Kaplan DPM

Like we discussed earlier, foot ulcerations can frequently take a long time to heal and become frustrating to the patient. Once you develop a foot ulceration, the most important thing to think about is how it can get healed as quickly as possible. To do this, you need to determine the underlying causes for non-healing. There are 4 major areas that us as podiatrists think about that can be preventing ulcerations from healing. We will discuss two of them in this blog and the remaining two in upcoming blogs.

  1. Blood Flow: Just like any other injury in the body, blood flow is needed for ulcerations to heal. An ulceration that is starved of blood may start looking black and discolored. Normal ulcerations should have a red base. Diabetes predisposes patients to vascular disease. A simple noninvasive test can be done in the office to look for adequate circulation. If poor blood flow is found, you may be referred to a vascular specialist for evaluation.
  2. Offloading: Think about it: you are constantly putting all of your body weight on your poor feet. Patients with diabetes and a multitude of other diseases have neuropathy and thus have minimal or no sensation in their feet. Many times patients can step on nails, needles or tacks without feeling anything. In a sensate patient, the pain you have with an ulceration would prevent you from bearing weight on the affected area hence offloading the area. Patients with neuropathy don’t have this luxury and need to be offloaded through other means. Examples of offloading methods include special inserts for shoes, boots, or different types of casts.

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.

Stay tuned for more blogs on this topic including other things we look at for healing as well as other treatment options for diabetic foot ulcerations that we are using in the office today!

Diabetic Foot Ulceration

One of the major complications of diabetes that is seen in the lower extremity is diabetic foot ulceration/ wounds. There are many risk factors for ulceration in diabetics—the biggest risk being a lack of sensation in the bottom of the feet that can be experienced by diabetic patients (Neuropathy). Peripheral vascular disease is another major risk factor for the development of ulcerations.

Unfortunately, diabetic foot ulceration are one of the leading causes of non-traumatic amputations in the U.S.  Early recognition is key in preventing this dreaded complication. Diabetic patients should check their feet daily and use a mirror to inspect the bottom of their feet.  If areas with increased redness or areas of high pressure are seen, it should be evaluated immediately by a podiatrist. Another thing to keep an eye out for is cuts/scrapes that are not healing.  Many times what appears to be a simple cut on the foot, can turn into a major problem without appropriate treatment. Diabetic patients should never walk barefoot, as they may not be able to feel it if they step on something that cuts the bottom of their foot.

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.

Stay tuned for more blogs on this topic including treatment options for diabetic foot ulceration that we are using in the office today!