When Not To Use Advanced Wound Care Modalities

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Gary M. Rothenberg, DPM, CDE, CWS

   Despite being repeatedly advised about smoking cessation, the patient failed to quit smoking, stating “My smoking has nothing to do with the healing.” Additionally, while awaiting custom shoes that had been molded and were pending fabrication, he got explicit instructions to remain in the removable cast boot. However, he presented for a follow-up visit in athletic shoes with a sock wadded up in the forefoot of the shoe.

   When questioned in the clinic, he stated, “I just wanted to wear a regular shoe. It isn’t going to be a problem.” He obviously continued to wear the inappropriate shoe and a lateral TMA wound developed. At this point, I referred the patient to orthopedics for a proximal amputation.

   Dr. Rothenberg is the Director of Resident Training and an attending podiatrist in the Miami VA Healthcare System.

1. Sheehan P, Jones P, Caselli A, et al. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003; 26(6):1879-1882.
2. Apelqvist J, Ragnarson-Tennvall G, Persson U, Larsson J. Diabetic foot ulcers in a multidisciplinary setting: an economic analysis of primary healing and healing with amputation. J Int Med. 1994; 235(5):463-471.
3.  Product insert, Apligraf. Organogenesis, Canton, MA.
4.  Product insert, Dermagraft. Shire Regenerative Medicine, La Jolla, CA.
5. Kimmel H, Regler J. An evidence based approach to treating diabetic foot ulcerations in a veteran population. J Diabetic Foot Complications. 2011; 3(3):50-54.
6. Tippett A. An introduction to palliative chronic wound care. Ostomy Wound Manage. 2012; 58(5):6-8.

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