A New Bag Of Innovations

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The Promogran Matrix Wound Dressing was recently granted FDA approval for the treatment of exuding wounds, including diabetic, venous and pressure ulcers.
Dermagraft, which received FDA approval late last year, facilitates a rapid decrease in wound depth, according to Dr. Armstrong.
A 76-year-old insulin-dependent male with diabetes presented with an ulceration under his big toe (see above photo).  He has a long-term history of peripheral vascular desease and previously had an amputation of the fifth toe on the same foot.
Here we see the same ulcer two weeks after it was treated with debridement, Hyalofill, Aquacel and offloading via a Camwalker boot.
With the Pressure Specified Sensory Device (shown above), you can perform quantitative assessments of isolated peripheral nerves.
Cleveland Smith, DPM, says the DBX6 orthotic “gives you the best of flexibility and durability in the same compound.”
By Jeff Hall, Editor-in-Chief

What products are facilitating quicker wound healing? What are some of the cutting-edge devices that are generating interest among podiatrists? What antibiotics are getting results? Are there new innovations that can provide adjunctive relief in diabetic foot wounds? In an attempt to answer some of these questions, we talked to leading podiatrists in the field. Without further delay, here’s what they had to say.
1. Promogran Matrix Wound Dressing. This chronic wound dressing was recently granted FDA approval for the treatment of exuding wounds, including diabetic, venous and pressure ulcers. David Armstrong, DPM, says Promogran’s combination of 45 percent oxidized regenerated cellulose (ORC) and 55 percent collagen may help facilitate improved healing in difficult wounds.

“(Promogran) appears to have a strong affinity to bind excess proteases in the wound,” points out Dr. Armstrong, the Director of Research and Education within the Department of Surgery, Podiatry Section at the Southern Arizona Veterans Affairs Medical Center. “When you combine this with its capacity to ionically bind and preserve endogenous and potentially exogenous growth factors, (Promogran) may help us move out of that chronically destructive inflammatory phase that is so deleterious to wound healing.”
Dr. Armstrong has had clinical experience with Promogran in the United Kingdom and has been evaluating results of the product over the last year. He is “encouraged” by the adjunctive potential of Promogran, saying that it may be particularly impactful when you combine it with other advanced wound healing modalities.
“I think (Promogran) could potentially be a powerful combination with other products such as currently available growth factors, hyaluronan, bioengineered tissue and even VAC therapy,” claims Dr. Armstrong.

2. Dermagraft. This human fibroblast-derived dermal substitute received FDA approval late last year for treating chronic, full-thickness diabetic foot ulcers of greater than six weeks duration. According to the manufacturer Smith and Nephew, you should not use Dermagraft over exposed tendon, capsule or bone.
Dr. Armstrong says Dermagraft has a number of key benefits, including:
• easy application;
• a superstructure of healthy, normal collagen; and
• facilitates a rapid decrease in wound depth.
When the modality received FDA approval, Dr. Armstrong predicted that Dermagraft would be a major advance in wound healing (see pg. 12, “News And Trends,” November 2001 issue).
“I believe strongly that if this modality is used as an adjunct to aggressive debridement, offloading, infection control and vascular intervention, where warranted, we will see not only widespread acceptance, but faster healing and ultimately, a reduction in the prevalence of lower extremity amputation,” noted Dr. Armstrong, who is also a Visiting Senior Lecturer of Medicine within the Department of Medicine at the Manchester Royal Infirmary at the University of Manchester in the United Kingdom.

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