The Top Ten Innovations In Podiatry
- Volume 20 - Issue 8 - August 2007
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Every year brings new advances in the podiatric profession as technologies and modalities emerge to help DPMs overcome existing clinical hurdles. This year’s crop of innovations include the possible use of marrow-derived stem cells to facilitate wound healing, a new topical agent to help treat eczematous dermatoses and fixation devices that podiatric surgeons may find useful.
Without further delay, here is what the experts had to say on the top innovations in the podiatric profession.
1. Telbermin (Genentech). Diabetic foot ulcers are a persistent challenge. However, a new recombinant human vascular endothelial growth factor (rhVEGF) in the pipeline has demonstrated efficacy in treating such ulcers.
Telbermin has already undergone a phase I randomized, double-blind, placebo-controlled trial for the treatment of diabetic foot ulcers. Researchers evaluated 55 patients with 29 receiving telbermin and the rest of the patients receiving a placebo. Patients received telbermin up to three times a week for up to six weeks along with good wound care, according to an abstract presented at the Symposium on Advanced Wound Care.
In the telbermin group, 41.4 percent of the patients achieved complete healing in six weeks in comparison to 29.6 percent of placebo patients who achieved complete healing in six weeks, according to the study. Researchers also say the average time it took to achieve complete healing was 87 percent faster for patients in the telbermin group. The abstract authors conclude that telbermin has potential in treating diabetic foot ulcers although further studies are necessary.
David G. Armstrong, DPM, says telbermin likely has “a novel mode of action that can stimulate angiogenesis in a way that few other cytokines can.” While more research is needed, Dr. Armstrong says telbermin has promise.
“A new cytokine, particularly one as critical to the wound healing process as VEGF, is welcome in this area,” says Dr. Armstrong, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine in Chicago.
Can These Biologic Scaffolds Facilitate Improved Surgical Outcomes?
2. OsteoCure™ Wedges (Nexa Orthopedics). An innovative resorbable scaffold may enhance bone growth. OsteoCure Wedges are porous and utilize PolyGraft® material technology, according to the manufacturer Nexa Orthopedics. The company adds that the scaffolds are made of polylactide-co-glycolide (PLG) copolymer, which facilitates structure and calcium sulfate for the enhancement of bone growth.
In addition, the company says polyglycolide (PGA) fibers add strength and surfactant permits the easy absorption of fluids into the scaffolds. The porous scaffold has a mean pore size of 500 to 600 µm and has 75 percent total porosity for tissue ingrowth. The architecture of the scaffold mimics natural bone, according to Nexa.
Nexa notes that the copolymer is amorphous (noncrystalline) and resorbs in four to eight months. The company says the hydrophilic properties of the wedges absorb blood, marrow, cells and proteins.
Patrick DeHeer, DPM, says OsteoCure Wedges work well. In the last two or three years, Dr. DeHeer has used them for pediatric surgery, including the Cotton osteotomy for pediatric flatfoot.
How do the wedges compare to other modalities? Dr. DeHeer, a Fellow of the American College of Foot and Ankle Surgeons, notes they are pre-cut in specific sizes and wedge shapes. The sizers and templates make usage “much easier intraoperatively,” explains Dr. DeHeer, a Diplomate of the American Board of Podiatric Surgery.
3. OrthAdapt™ Bioimplant (Pegasus Biologics). Another biological scaffold, the OrthAdapt Bioimplant, allows DPMs to repair and reinforce soft tissues such as tendons and ligaments, according to the manufacturer Pegasus Biologics.
The company says the product is indicated for the repair, reconstruction, augmentation and reinforcement of soft tissue in many orthopedic, sports medicine and foot and ankle procedures.