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Diabetic Foot Ulcers Treated with Becaplermin and TheraGauze, a Moisture-Controlling Smart Dressing
A Randomized, Multicenter, Prospective Analysis
Background: It is hypothesized that moisture regulation specific to the area of contact results in local wound conditions more amenable to healing, which would result in faster and more frequent wound closure. TheraGauze is a new polymer-impregnated dressing designed to regulate moisture to a varying degree over the entire surface of a wound.
Methods: This prospective, randomized, multicenter study examined outcomes from treatment of diabetic foot ulcers with TheraGauze and TheraGauze in conjunction with becaplermin. We also compared these outcomes with historical data from the literature that used saline-moistened gauze and becaplermin.
Results: The rates of wound closure with TheraGauze and TheraGauze + becaplermin were 0.37 and 0.41 cm2/week, respectively (P = .34). The difference between these values was not statistically significant. We also observed high closure rates at 12 weeks (46.2% in both groups) and 20 weeks (61.5% with TheraGauze alone and 69.2% with TheraGauze + becaplermin). These data were also compared with historical data for closure rates (0.18 cm2/week) and percentage of wounds closed using saline-moistened gauze alone and becaplermin with saline-moistened gauze (0.24 cm2/week) from a variety of studies.
Conclusions: Wounds in which moisture content was regulated with TheraGauze showed more rapid change in wound area and a higher percentage of wounds achieving closure at 12 and 20 weeks regardless of whether becaplermin was used. (J Am Podiatr Med Assoc 100(3): 155–160, 2010)
Antibiotic Stewardship
The Lower-Extremity Physician's Prescription for Effectively Treating Infection
The discovery of antibiotic drugs was one of the most significant medical achievements of the 20th century. The improper use of antibiotic drugs to prevent and treat infections has resulted in the emergence of resistance. Antimicrobic stewardship programs are becoming a mainstay in the fight against multidrug-resistant organisms. Individual clinicians should be encouraged to adopt the principles of antibiotic stewardship when treating lower-extremity infections in their scope of practice. First, a review of the available literature outlining the concept and practice of antibiotic stewardship is offered. Second, a discussion describing how to adopt and apply these principles to the individual clinician's practice as it applies to lower-extremity infections is offered. Finally, specific antimicrobial pharmacologic spectra and antibiogram information are offered.
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.
INTRODUCTION AND OBJECTIVES: The purpose of this study was to determine whether some foot/ankle surgeries would benefit from routine use of low molecular weight heparin (LMWH) as postoperative DVT prophylaxis.
METHODS: We conducted a formal cost-effectiveness analysis using a decision analytic tree to represent the risk of complications under a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis for 4 weeks. The two scenarios were compared for five procedures: 1) Achilles tendon repair (ATR), 2) total ankle replacement (TAR), 3) hallux valgus surgery (HVS), 4) hindfoot arthrodesis (HA), and 5) ankle fracture surgery (AFS). Outcomes assessed included short and long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the health care system perspective and expressed in US dollars at a 2015 price base. In the short-term, routine prophylaxis was always associated with greater costs compared to no prophylaxis.
RESULTS: For ATR, TAR, HA and AFS prophylaxis was associated with slightly better health outcomes; however, the gain in QALYs was minimal compared to the cost of prophylaxis (ICER was well above $50,000/QALY threshold). For HVS, prophylaxis was associated with both worse health outcomes and greater costs. In the long-term, routine prophylaxis was always associated with worse health outcomes.
CONCLUSIONS: We conclude that the decision to use LMWH prophylaxis should not be based solely on the type of foot/ankle surgery planned. Patient factors also need to be carefully weighed.
