Unveiling The Top Ten Innovations
Intriguing new treatments and devices abound in this yearly review. We take a closer look at promising therapies for diabetic neuropathy and osteoarthritis of the ankle. Wound care specialists weigh in on new approaches to optimizing wound beds and closing stubborn wounds. Podiatric surgeons discuss time-saving devices for facilitating tendon transfers and leading voices in biomechanics offer their respective takes on a helpful orthotic modification, a re-emerging pediatric orthotic and a new athletic shoe that is generating a lot of buzz.
Without further delay, here is what the experts had to say …
1. Ruboxistaurin mesylate (Eli Lilly). Could a newly emerging medication reverse the damage of diabetic peripheral neuropathy? Ruboxistaurin mesylate, which has been the subject of worldwide studies on diabetic neuropathy as well as diabetic retinopathy, has shown early promise, according to various researchers.
The drug is an inhibitor of protein kinase C (PKC) Beta II, which has been shown to be “overactive in the tissues targeted by diabetes and responsible for impairment of microvascular function,” explains Aaron I. Vinik, MD, a Professor of Internal Medicine at Eastern Virginia Medical School in Norfolk, Va.
In these cases of impaired microvascular function, the nerves are vulnerable to compromised blood supply, which can lead to initial nerve dysfunction and subsequent irreversible nerve damage, according to Dr. Vinik.
However, he notes that as an inhibitor of PKC Beta II, ruboxistaurin mesylate has “the capability of reversing or preventing the biologic abnormalities in diabetes” as opposed to just treating a symptom of diabetes such as hyperglycemia.
Dr. Vinik emphasizes that this medication, which is currently in Phase III development, could have a major impact in the podiatric diabetic population.
“There are 85,000 amputations each year in the United States alone,” points out Dr. Vinik. “Eighty-seven percent of the time, the main predisposing factor is neuropathy, which leads to foot ulcers, infections, osteomyelitis and neurodegenerative arthropathy (Charcot). (With the use of ruboxistaurin mesylate), I think the podiatric diabetic population may be relieved of a considerable proportion of this morbidity and potential for the loss of quality of life and premature death.”
Bring In The Wound Closers
2. Graftjacket and Graftjacket Xpress (Wright Medical). Earlier in the year, researchers published a study in Orthopedics that examined the use of Graftjacket Regenerative Tissue Matrix on full-thickness wounds in patients with diabetes (see page 13, “News And Trends,” March issue). In the 40-patient study, the authors found that those treated with the Graftjacket had an 89.1 percent reduction in wound depth after a month whereas the control group had a 25 percent reduction within the same time period.
David G. Armstrong, DPM, says he has also had favorable results with the modality.
“The Graftjacket seems to be very useful as a durable, predictable scaffold for wounds of moderate depth,” says Dr. Armstrong, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine in Chicago.
Dr. Armstrong, a member of the National Board of Directors of the American Diabetes Association, has also been impressed with the Graftjacket Xpress Flowable Soft Tissue Scaffold. He says he has found it useful for tunneling wounds.
According to the manufacturer, the Graftjacket Xpress is an injectable treatment that is mixed with sterile saline. The company says one would apply Graftjacket Xpress to deep crevicing wounds via a syringe through a small catheter. It emphasizes that the product reduces the risk of infection and facilitates the rapid formation of granulation tissue.
Dr. Armstrong has found both modalities to be “very promising,” noting that he has seen a synergy of the two products in deep, complex wounds with elements of undermining.