Abstract:

Recent innovations in the field of wound healing have created numerous advanced therapies from which clinicians may now choose. The challenge for the reconstructive surgeon is to ensure that these adjunct technologies are used according to an evidence-based protocol to ensure optimal healing. Critical to successful outcomes is that new modes of therapy do not supplant, but are used in tandem with, core principles of wound management: establishing a correct diagnosis, ensuring a good local blood supply, debriding the wound to a clean base, correcting the biomechanical abnormality, and nurturing the wound until it shows signs of healing. Debridement should be performed as often as necessary until the wound is deemed clean and ready for reconstruction. Useful adjuncts in debridement include hydrotherapy and ultrasonic therapy. The majority of reconstructions are accomplished through simple techniques. If a wound is not meeting the expected healing trajectory, management adjuncts such as negative pressure wound therapy, growth factor, cultured skin, and hyperbaric oxygen can then reactivate or expedite the process toward achieving a healed wound.

Authors:

Mark W. Clemens, MD, Justin M. Broyles, BS, Phi-Nga Jeannie Le, MD, Christopher E. Attinger, MD

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Abstract:

Wound infection is common and delays wound healing. Validated signs included in the mnemonic NERDS and STONEES can be used to identify whether bacterial damage is superficial or deep, respectively. Clinicians must discern when bacterial damage has occurred on a timely basis and what treatment strategies to institute. A variety of topical antimicrobial agents have been developed incorporating iodine, chlorhexidine, silver, honey, topical oxygen, and topical antibiotics. Selection of appropriate strategies should be based on three key factors: healability (healable versus nonhealable), bacterial burden (colonization versus deep infection), and host risk factors. This article reviews and offers succinct recommendations pertaining to the management of wound infection in clinical practice.

Authors:

Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA

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Abstract:

Diabetic foot ulcers are a common problem in clinical practice and one of the most common complications in diabetic patients, often leading to amputation and hospitalization. Although there are a number of options for coadjuvant therapy for diabetic foot ulcers, a considerable number of patients remain unhealed after 12 weeks of treatment and, in general, rates of healing remain low. For these reasons, as well as the rising costs of associated complications of nonhealing diabetic foot ulcers, there is an impetus for the research community to develop more sophisticated ways to manage this condition. We reviewed ongoing clinical trials (clinicaltrials.gov) testing new therapies for foot ulcers and searched the basic science literature for preclinical background of these products. We focused our review on new therapies that include topicals, skin substitutes, bioengineered skin, cellular therapy growth factors, devices, and herbal medications. All of these options are analyzed and presented in this review as promising new options for the treatment of diabetic foot ulcers.

Authors:

Alejandra Vivas, MD, Julia Escandon, MD, Elizabeth Lebrun, BS, Sonal Choudhary, MD, Jennifer Tang, BS, Robert S. Kirsner, MD, PhD

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Abstract:

Diabetic foot ulcers are a marker of far more serious underlying co-morbidities that often represent a precursor to infection, amputation, and death. The treatment of diabetic foot ulcers is marked by many options that represent both potential opportunity and hindrance. Thousands of products are available to the provider, yet confusion often exists as to the indications, as well as when and how to use such modalities. Increased availability of treatment modalities can be overwhelming to providers, and as such, can lead to reliance on outdated and unproven methods. Current diabetic foot ulcer treatment options are often based on clinical and anecdotal findings. Evidence-based treatment options are limited. An overview of diabetic foot ulcer management is presented in an organized manner to assist providers in their decision making in treating diabetic foot ulcers, with a goal of improving clinical outcomes and reducing amputations.

Authors:

Desmond P. Bell, Jr., DPM, CWS

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