Diabetic Wound Care

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Diabetic foot wounds are common with diabetic patients and pose a high risk of affecting the feet. To avoid amputations wound care management is highly recommended. Read on to learn why experienced diabetic wound care matters and the cutting-edge treatments we offer.

Diabetes is a condition that occurs when your blood sugar is too high. This happens when your body doesn’t properly process foods for use as energy. When someone develops diabetes, major body organs become at high risk for complications. These complications can include but are not limited to cardiovascular disease, nerve damage, kidney failure, vision loss, and foot damage.

If you have diabetes and begin to develop a wound on your foot, a wound care specialist can help you avoid amputations and unwanted complications.

When should I see a wound care specialist?

The first onset of a wound to the foot is the most important time to see a specialist. At Family Foot & Ankle Physicians, our specialty-trained wound care nurse and podiatrists will manage your diabetic foot and ankle wounds in an effort to reduce the risks of other complications, such as infection and amputation.

If you are self-treating your wound at home and it has not healed after 2 weeks, then please call our office or a podiatrist to start wound care management immediately. If you are diabetic, we suggest seeing our wound care nurse as soon as possible.

What are the basic steps for wound care?

When dealing with wounds, it is important to keep the wound site clean and clear of infection. Simple steps to take include the following:

1.     Wash hands to help avoid infection.

2.     Stop the bleeding with the use of gauze or bandages.

3.     Clean the wound with sterile water or normal saline.

4.     Apply an antibiotic to help fight off infection.

5.     Bandage the wound with gauze and bandages.

6.     Change the bandages every day.

7.     Watch for signs of infection.

8.     For severe wounds or if you are diabetic, call a wound care specialist.

What happens at a wound care center?

At Family Foot & Ankle Physicians, expect the following on your first visit with our podiatrist and wound care specialist in our wound care center:

·       Check for blood flow in the area of the wound

·       Measurements of the wound

·       Examine the color of the wound

·       Assessing the odor of the wound

·       Checking for drainage and what amount of drainage exists

·       Determine reasons if the wound isn’t healing

·       Use diagnostic imaging, such as x-rays or ultrasounds

Our experienced podiatrists will also manage your care with the wound care specialist. After a full examination and treatment of your wound, expect a follow-up treatment plan to continue the wound healing process. Our goals for your wound are to:

·       Heal the wound

·       Prevention of the wound getting worse

·       Preventing limb loss

·       Preventing new wounds from occurring

·       Help keep you mobile

Treatments for a wound

Debridement

Debridement is a medical procedure for treating a wound in the skin. It involves a thorough cleaning of the wound and removal of all thickened skin or callus, infected, and dead tissue, or foreign debris, and residual material from dressings.

During debridement, our wound care specialist will clean the skin around the wound, probe to see how deep the wound is, and cut away the dead tissue. Once debridement is complete, your wound will look larger from the cutting of the skin.

Wound Vac

Vacuum-assisted closure (VAC), also referred to as negative pressure wound therapy decreases air pressure around a wound to assist the healing. During a VAC procedure, our wound care specialist or podiatrist applies a foam bandage over an open wound, and a vacuum pump creates negative pressure around the wound. That pressure pulls the edges of the wound together. Wound Vac helps reduce swelling, increase blood flow to the wound, and preventing of infections. This method is preferred for deeper wounds.

Skin Grafts

Skin grafts and tissue replacement can be used to treat foot ulcers for diabetic patients by reconstructing the skin defect. Skin substitutes need to be placed on a prepared wound bed to ensure contact between the wound bed and the graft and they take on the functions of the missing skin layer.

The skin graft heals wounds 40-50% faster than the wound can heal on its own. Each patient and each wound will be different. Expect a treatment plan that involves follow up visits for additional skin grafts to improve the healing of the wound site. We use different products as listed below, which follow different protocols for additional applications. Our physicians will identify the best product application for your wound and work with you to see which product is covered by your healthcare insurance carrier.

Below is a list of skin grafts used in our office.

(Note: most of these sites are industry-facing and missing patient language, so not sure how I feel about listing, but I know blogs need external sites to boosts is searchability and credibility, so I guess we leave it).

·       Revita/Ascent – https://www.stimlabs.com/revita

Revita provides the complete intact human placental membrane that is the physiologic tissue barrier naturally found in the body. This complete barrier containing amnion, intermediate layer, and chorion retains many of the cytokines, growth factors, extracellular components, and cell communication signals the body uses to heal, protect and grow tissues.

·       Epifix – https://mimedx.com/epifix/

EpiFix is processed using Purion, a unique patented method for placental-based allografts that is in accordance with the American Association of Tissue Banks (AATB) standards. The product is derived from donated C-sections of live births in the US. The product undergoes active preservation of the extracellular matrix (ECM), regulatory proteins, and removal of blood contaminants via a proprietary cleansing process. For an additional level of safety, the product is terminally sterilized.

·       Grafix  – http://www.osiris.com/grafix/patients/

Grafix is a cryopreserved placental membrane comprised of an extracellular matrix (ECM) rich in collagen, growth factors, fibroblasts, mesenchymal stem cells (MSCs), and epithelial cells native to the tissue. Designed for application directly to acute and chronic wounds and flexible, conforming cover that adheres to complex anatomies.

·       Affinity – https://affinityfresh.com/why-choose-affinity/

As the only fresh amniotic membrane wound covering, Affinity retains native viable cells. Affinity, as a protective wound covering, has been shown to help wounds move from stalled to closed. Affinity retains viable endogenous cells, growth factor/cytokine content, and native extracellular matrix (ECM) structure—making Affinity the closest choice to a native amniotic membrane.

·       Nushield –  https://nushieldcomplete.com/convenience-without-compromise/

NuShield is an effective choice as a natural dehydrated placental allograft wound covering for a variety of partial- and full-thickness acute and chronic wounds, with a unique preservation method that analytical testing has shown retain

·       Puraply – https://puraplyam.com/puraply-am-overview/

PuraPly AM is intended for the management of wounds and as an effective barrier to resist microbial colonization within the device and reduce microbes penetrating through the device. PuraPly AM is indicated for the management of various wounds such as diabetic and venous ulcers.

·       Artacent – https://www.tidesmedical.com/products/biologics/artacent-wound/

Artacent Wound is the only wound-specific amniotic patch that can be applied with either side facing the wound. Amniotic tissues are safe, natural biologic barriers delivering essential growth factors on a structural collagen matrix. The unique design of Artacent Wound allows for easy manipulation and repositioning, making it a flexible, dependable option for a variety of wound covering applications.

·       ActiGraft – https://reddressmedical.com/actigraft/

Standard of Care topical dressings address one or two aspects of a chronic wound bed. The ActiGraft dressing contains the fibrin matrix (derived from the patient’s own blood) acting to support the body’s own wound healing processes.

·       Apligraf – https://apligraf.com/apligraf-overview/

Apligraf is a skin substitute that looks, functions, and responds like healthy skin. The living cells of Apligraf stimulate a potent healing mechanism, help restore normal healing functions, and put the wound back on track to heal

·       Dermagraft

Dermagraft helps restore the compromised DFU dermal bed to facilitate healing by building granulation tissue and stimulating the patient’s own epithelial cells to migrate and close the wound.

·       FlowerDerm – https://flowerortho.com/products/allografts-2/flowerderm/

A single application of this product is often sufficient to stimulate the wound healing process.The pliable, flexible material adheres to wound topography and maintains contact with the wound bed. It’s also durable enough to suture or staple and has a mesh construction to encourage fluid drainage.

·       Dermavest

Dermavest® is a skin replacement derived from particularized, decellularized human placental tissue extracellular matrix. Dermavest® is indicated for use on diabetic ulcers, pressure ulcers, burns, venous ulcers, and post-Mohs surgery.

In closing, we can’t stress enough just how important it is to treat wounds as soon as they are discovered for diabetic patients. If non-diabetic, treating wounds is still important, but diabetic patients have so much at risk if not being seen by a specialist. Contact our office to make an appointment if wound care treatment is needed for your healthcare.