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The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.
Maggot debridement therapy is rapidly increasing in popularity at major diabetic foot and wound care centers worldwide. However, we are unaware of specific guidelines on the short-term storage of larvae. We sought to evaluate differences in maggot motility over time in larvae refrigerated versus those stored at room temperature. We also introduce a simple surrogate method for evaluating maggot vitality that may be useful for in vivo studies if validated in future works. We randomly selected ten larvae from the same shipment at ten different times in 9 days. Larvae were placed on a translucent acetate grid, and their total excursion in 30 sec was measured. This was converted into a Maggot Motility Index. In the refrigerated group, the index remained at or above 40 mm/min for approximately 60 hours from baseline, when there was a significant decrease. This same phenomenon occurred during the first 12 hours in the nonrefrigerated group. There were significant differences in motility between refrigerated and nonrefrigerated larvae immediately after baseline until day 8. Larvae are more practical for repeated clinical use if kept refrigerated between applications. (J Am Podiatr Med Assoc 94(4): 353–355, 2004)
INTRODUCTION AND OBJECTIVES: The benefits of using amniotic tissue in skin regeneration are well documented. Today, cryopreservation technology allows for better availability and maintenance of mesenchymal stem cells. This is of particular interest in treating the diabetic foot ulcer as this population has fewer mesenchymal stem cells. The objective of this case series investigation was to compare the efficacy of cryopreserved human amniotic stem cells in treating foot wounds of different etiologies. We will present data and case photos for a diabetic foot ulcer, venous leg ulcer, arterial ankle ulcer, and a pyoderma gangrenosum ulcer
METHODS: Cryopreserved human amniotic stem cell grafts were applied to patients with chronic ulcers of different etiologies that had been subjected to at least 4 weeks of standard wound care and did not show adequate clinical progress. Wound area was recorded and photographed on weekly basis. Area reduction was charted over time and the results of each individual case were compared to one another.
RESULTS: All ulcers displayed results that well exceeded the established parameters of weekly healing rates for effective wound treatment modalities.
• Pyoderma gangrenosum displayed the poorest response to treatment. However, it is worth noting that the patient was not compliant in the prescribed adjunctive treatment regimen but managed to achieve 64% wound reduction.
• All ulcers showed the largest appreciable amount of healing in both total area reduction and week-to- week closure percentage after the first application.
CONCLUSIONS: Cryopreserved human amniotic stem cell grafts can aid in the decreasing the time to closure of various types of lower extremity ulcerations. The therapy is a clinically viable option for physicians to consider when formulating a treatment plan for a patient with an ulcer.
Letters to the Editor
Negative-Pressure Wound Therapy and Diabetic Foot Amputations: A Retrospective Study of Payer Claims Data
Interprofessionalism
A Cornerstone of Innovation and Medical Education at Scholl College of Podiatric Medicine
In 1912, the Illinois College of Chiropody and Orthopedics was founded, and is today known as the Dr. William M. Scholl College of Podiatric Medicine. It has been an integral part of Rosalind Franklin University of Medicine and Science in North Chicago, Illinois since 2001. Through the ensuing decades, Scholl College alumni have been instrumental in moving the profession forward.
Neuropathic foot ulcers are a common complication in patients with diabetes. These ulcers are often slow to heal and can lead to infection, further tissue destruction, osteomyelitis, and amputation. These patients pose a challenge to clinicians who must determine the best treatment options while balancing the risks, benefits, and costs. Conservative therapies often present disappointing results, and a number of newer “biologic bandages” have been developed to better assist the healing process. We describe results from diabetic patients with neuropathic foot ulcers treated with a new amniotic membrane–based allograft.
