Many patients with non-healing ulcers are already in significant pain prior to surgery. Many of these patients will require escalating doses of pain medications following surgical debridement and grafting. Some will already have developed tolerances to pain medications. So, what do we prescribe to control their pain? More importantly, what can we prescribe and still maintain a level of comfort... Read More.
Even if a wound appears to be benign, one must obviously be vigilant against the possibility of malignancy. These expert panelists discuss identifying malignant wounds, taking biopsies and when one might consider an amputation.
Q: What clinical insights lead you to suspect that a lower extremity wound may have an underlying malignancy?
A: M. Joel Morse, DPM, suspects malignancy if a wound does... Read More.
Patients with venous ulcers can face daunting complications. Accordingly, our expert panelists provide pertinent pearls on diagnosis, compression therapy, debridement and how their patients have fared with vascular surgery procedures.
Q: How do you approach/work up the patient with a chronic venous ankle ulcer? Is there any need for venous ultrasound studies?
A: Kazu Suzuki, DPM, CWS, says many... Read More.
While there is not an overwhelming amount of literature on hyperbaric oxygen therapy (HBO), the recent decision by the Centers for Medicare and Medicaid Services (CMS) to cover the use of HBO in treating diabetic foot wounds has fueled new discussions on the potential efficacy of the modality. With this in mind, our panelists discuss their experiences in using HBO, the current literature on the... Read More.
Plastic and reconstructive surgery techniques can be a significant adjunct for podiatric surgeons in managing diabetic foot wounds and tissue loss. With this in mind, the panelists discuss a variety of techniques (including split-thickness skin grafting and muscle flaps) and indications for chronic ulcers, the neuropathic foot and pressure-induced heel ulcerations.
Q: When do you consider... Read More.
Neuropathic ulcers can be extremely problematic for diabetes patients and podiatrists alike. Exploring the ins and outs of surgical treatment, our expert panelists take a closer look at specific ulcers, helpful techniques, the merits of preoperative vascular testing and postoperative protocols.
Q: Do you perform prophylactic diabetic foot surgery? If yes, what are the common types of situations... Read More.
As Aristidis Veves, MD and Thanh Dinh, DPM, point out, it is well-known that the chronic diabetic foot ulcer is stuck in the inflammation phase of the wound healing cycle. Research studies have shown that non-healing wounds may have specific biochemical imbalances, notes Liza Ovington, PhD. In particular, non-healing wounds have been shown to have excessively high levels of proteolytic enzymes... Read More.
Ischemic wounds can be challenging for any physician. With this in mind, the panelists discuss key indicators to look for in the history and physical exam, the effectiveness of noninvasive vascular testing and parameters for performing an amputation after bypass surgery. They also explore the treatment possibilities of angioplasty/stenting and the long leg distal bypass. Without further delay,... Read More.
In a follow-up to the last Q&A column on preventing post-op wounds (see page 16, January issue), our expert panelists have reconvened to discuss the treatment of post-op wounds. They explore treatment approaches to a variety of wounds, ranging from the post-op dehiscence and infected wounds to exposed internal fixation and fracture blisters. Without further delay, here are their thoughts.
Q:... Read More.
Offloading diabetic neuropathic ulcers comes with a unique set of treatment challenges. Some consider total contact casting the gold standard but whether it’s practical in a busy practice is highly debatable. Still, how can one arrive at a solution that will enhance patient compliance? With these issues in mind, our expert panelists share their thoughts and experiences with this topic.
Q: How do... Read More.
Given the potentially serious nature of venous ulcers in the lower extremity, our expert panelists take a closer look at key risk factors and share their treatment approaches to this condition. Drawing from their experience, they also discuss topical treatments, the use of bioengineered skin substitutes and surgical procedures.
Q: What risk factors predispose patients to the development of lower... Read More.
When is advanced imaging necessary for guiding one’s decision-making on the treatment of a lower-extremity wound? How reliable are radiographs when clinicians suspect osteomyelitis? Should you employ magnetic resonance imaging? Does nuclear medicine imaging have particular value in managing wounds? Our expert panelists tackle these questions and more in the following discussion... Read More.