The COVID-19 pandemic is driving significant change in the healthcare system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, ER visits, hospitalizations, length-of-stay, and costs. But podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the COVID-19 risk. The goal of podiatrists during the pandemic is to reduce the burden on the healthcare system by keeping diabetic foot and wound patients safe, functional, and at home.
Background: Ultraviolet-A therapy is a simple, inexpensive, and effective modality for wound healing with tremendous potential to improve healing and reduce clinical infections in several clinical settings. To date, application of UV-A relies on bulky and hard to dose lamps that provide inconsistent therapy, thus making it difficult to apply therapy that is appropriate for the patient. Methods: This study was designed to test the effectiveness of a novel wound therapy device that combines UV-A with traditional negative pressure wound therapy to promote wound healing. Further, we tested the ability of fiber optic UV-A delivery to inhibit bacterial proliferation. Finally, we assayed the level of DNA damage that results from UV-A as compared to established UV-C therapies. Wound healing studies were performed in a porcine model using an articulated therapy arm that allows for continued therapy administration over an extended time course. Negative pressure wound therapy was administered alone or with ultraviolet-A fiber optic therapy for 2 weeks. Dressings were changed twice a week at which time wound area was assessed. Results: Data demonstrate that UV-A with NPWT treatment of wounds results in greater healing than NPWT alone. Using the same therapy device, we demonstrate that exposure of Staphylococcus aureus and Pseudomonas aeruginosa to fiber optic UV-A results in decreased colony area and number of both bacterial strains. Finally, we show that UV-A induces minimal DNA damage in human fibroblasts and no more DNA damage in wound tissue as compare to intact skin. Conclusions: These data demonstrate that UV-A can decrease bacterial proliferation and promote wound healing when coupled with NPWT.
The publication of the Global Vascular Guidelines in 2019 provide evidence-based, best practice recommendations on the diagnosis and treatment of chronic limb-threatening ischemia (CLTI). Certainly, the multidisciplinary team, and more specifically one with collaborating podiatrists and vascular specialists, has been shown to be highly effective at improving the outcomes of limbs at risk for amputation. This article uses the Guidelines to answer key questions for podiatrists who are caring for the patient with CLTI.
Background: To evaluate clinicians' compliance to follow national guidelines for tetanus vaccination prophylaxis in high-risk foot patients. Methods: We retrospectively evaluated 114 consecutive patients between June 2011 and March 2019 who presented with a foot infection resulting from a puncture injury through the emergency department. Eighty-three patients had diabetes mellitus and 31 patients did not have diabetes mellitus. Electronic medical records were used to collect a broad range of study data on patient demographics, previous medical history, previous tetanus immunization history and tetanus status upon presentation to the emergency department (ED), peripheral arterial disease, sensory neuropathy, laboratory values, and clinical / surgical outcomes. Results: 46.5% of the patients who presented to the ED with a puncture wound did not have up-to-date tetanus immunization. Of those patients, 79.2% received a tetanus-containing vaccine booster, 3.8% received intramuscular tetanus immunoglobulins (TIG), 3.8% received both tetanus-containing vaccine booster and TIG, and 20.8% received no form of tetanus prophylaxis. When comparing data between patients with and without diabetes, there were no statistical significant differences in tetanus prophylaxis. Conclusion: Guidelines for tetanus prophylaxis amongst high-risk foot patients in this study center are not followed in all patients. Patients with DM are at high risks of exposure to tetanus, we recommend physicians to take a detailed tetanus immunization history and vaccinate them if tetanus history is unclear.
ObjectiveTo compare pathogens involved in skin and soft tissue infection (SSTI) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. MethodsWe evaluated 113 consecutive patients between June 2011 and March 2019 with foot infection (SSTI and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes (DM) and 30 did not (NDM). We evaluated the bacterial pathogens in patients with skin and soft tissue infections (SSTI) and pedal osteomyelitis (OM). ResultsPolymicrobial infection were more common in patients with diabetes mellitus (83.1% vs 53.3%, p=.001). The most common pathogen for SSTI and OM in DM was s. aureus (SSTI 50.7%, OM 32.3%), whereas in NDM patients it was Pseudomonas (25%) for SSTI. Anaerobes (9.4%) and fungal (3.1%) infection were uncommon. Pseudomonas aeruginosa was only identified in 5.8% of people with diabetes. ConclusionsThe most common bacterial pathogen in both SSTIs and pedal OM was staphylococcus aureus in patients with DM. Pseudomonas spp., was the most common pathogen in people without diabetes with SSTIs.