Cath Lab Digest

The Centers for Disease Control and Prevention recently announced that diabetes now affects nearly 24 million people in the United States. Foot ulcers will affect up to 25 percent of people with diabetes during their lifetime.¹ People with diabetes have a 30-fold higher lifetime risk of undergoing a lower extremity amputation in comparison to those without diabetes.² A foot ulcer precedes a lower extremity amputation 85 percent of the time.³
Diabetic foot problems are a major burden to society and come at great costs to the healthcare system. Prevention of foot ulcers is key. However, when a patient presents with an open wound, appropriate management is necessary to prevent lower extremity amputation.

The foundation of treatment includes the “VIPs” of diabetic wound healing. The VIPs stand for Vascular (ensuring adequate limb perfusion), Infection (controlling infection) and Pressure (mitigation of plantar pressures through proper offloading). Until one addresses all three of these factors, the wound will persist.
The treatment plan should progress through three key phases. The first of these phases is debridement, the second is promotion of granulation tissue and third is wound closure. Accordingly, let us take a closer look at the use of orthobiologic scaffolds in attaining wound closure.
Sheehan, et al., conducted a prospective, controlled trial of diabetic foot ulcers that were not complicated by ischemia or infection. After providing good clinical care, the researchers found that wound area changes over a four-week period can strongly predict complete wound healing over a 12-week period.⁴ Therefore, when patients receive good fundamental wound care and the ulcer size fails to reduce by half over the first four weeks of treatment, they are unlikely to achieve wound healing over a reasonable period, and require more aggressive and “advanced” therapies.⁴
There have been some exciting advances in wound healing and orthobiologics specifically. If the wound remains stagnant after addressing the VIPs, then one should consider more advanced therapy.

A Primer On Adjunctive Advances In Wound Care
Over the past decade, many new treatment technologies have emerged and researchers have shown that they increase the probability of wound closure in difficult-to-heal foot ulcerations in patients with diabetes. The use of negative pressure wound therapy (NPWT) via VAC therapy (KCI) helps promote granulation tissue formation so the wound size becomes more manageable.⁵