The Center for Podiatric Care and Sports Medicine

New Approaches to Healing Diabetic Foot Ulcers Show Promise in Clinical Trials

Posted by on Thursday, December 26th, 2013

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Photos published in the New England Journal of Medicine highlight just how gruesome — and fast-spreading — diabetic foot ulcers can be. The patient, a 50-year-old obese man from Switzerland, apparently had no idea he was suffering from diabetes — even though his blood glucose level was 10.5% (far above the 6.5% norm) and even though he had neuropathy in his feet.

He didn’t have a fever or high white blood cell count, which normally accompany infection, but his foot had taken a bad turn. What started off as a mild brush burn from a new shoe had begun to blister by day three and turned into full-blown necrosis requiring surgery by day 10.

The man’s case was not a unique example of the danger in undiagnosed diabetes. Unfortunately, diabetic foot ulcers affect up to 15% of the diabetic population. Due to the danger of diabetic foot ulcers, many researchers are currently working on new ways to catch patients early and improve standard wound care.

diabetic wound care
Many exciting changes are taking places within the realm of diabetic wound care.
Image Source: Vimeo.com

Standard Diabetic Wound Care

The standard care for a diabetes foot ulcer involves:

– Debridement: The removal of dead skin and tissue from the wound to reduce the spread of infection.

– Dressing: Proper wrapping of the wound should help absorb fluid and protect the wound from infection. There are hydrogels, foams, and absorbent polymers. Sometimes the wraps are soaked with human growth factor and skin cells to promote faster healing.

– Offloading: The affected limb should not bear body weight to enable faster healing. 

– Infection control: Pathogens like methicillin-resistant staphylococcus aureus (MRSA) and pseudomonas aeruginosa can be particularly nasty and difficult to treat. Yet, there are several different methods to reduce the risk of serious, widespreading infection — which we’ll discuss next.

How Are Diabetic Ulcer Infections Controlled?

There are several promising methods that can treat diabetic foot ulcers with some degree of success:

– Negative wound therapy: Using a vacuum, surgeons removes fluid and necrotic tissue during the debridement procedure to ensure that all infectious materials are drawn out of the area.

– Stem cell therapy: While still in its early stages, clinical trials have been promising. One study by Osiris Therapeutics found that 80% of the diabetics whose wounds hadn’t healed after 12 weeks of standard care received complete closure when treated with stem cell therapy.

– Vascular surgery: In rare cases of chronic ulceration, minor bypass surgeries can create detours to improve circulation to the region and promote prompt healing.

– Oxygen therapy: It is believed that increased oxygen concentration can improve cell division and reduce the risk of bacterial infection. However, Hyper-Baric Oxygen Therapy (HBOT) has its critics, as it is very expensive and perhaps not necessary for most patients. More clinical studies are needed before the industry accepts HBOT as standard practice.

What’s New In Diabetic Foot Ulcers Care?

A new system called the VHT® Wound Treatment System, developed and marketed by Cure Care, Inc. was recently promoted in Diabetes Health as a portable unit that combines all the most effective elements of diabetic wound care: antibiotics, moisture, and oxygen. Essentially, Vaporous Hyperoxia Therapy delivers a high concentration of oxygen, water vapor, and antibiotics into a closed chamber.

A small clinical trial of 26 diabetic patients and 32 diabetic foot ulcers was conducted to demonstrate the efficiency of the new system. The patients were an average age of 61, with ulcers averaging 1130 mm³ in size. They  had unsuccessfully undergone standard wound care for time spans ranging from three months to eight years. After cleaning and debridement, VHT was administered for one hour with four cycles of mist, antibiotics, and oxygen, and was repeated twice weekly until the wounds closed. Twelve sessions seemed to be the magic number for most patients.

The results were impressive:

– At 12 weeks, 76.7% of VHT patients were healed, compared to 24.2% of standard wound care patients.

– At 20 weeks, 90.7% of VHT patients were healed, compared to 30.9% of standard wound care patients.

– No adverse events were reported during the study and no patients suffered a worsening of condition.

– All but two of the patients (needing skin grafts) achieved total wound closure by the end of the study.

Meanwhile, several other studies are testing spray-on skin solutions that could be “game-changers” in the world of diabetic foot ulcer care.

Here at our New York Center for Podiatric Care and Sports Medicine, we are keeping a close eye on exciting new developments to offer you the very best in new technology that address diabetic foot issues.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.