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Treating Foot Ulcers
How a Wound Care Center Can Help

by William J. Ennis, DO, MBA, and Patricio Meneses, PhD

Advanced therapies
If, after the first four weeks of treatment, there is no significant improvement in a person’s wound, the wound care clinician may recommend an advanced wound healing therapy. Over the past 10 years, there has been an explosion of new wound-healing technologies introduced into the marketplace. Some of the more common treatments are the following:

Surgical debridement. It has been shown that diabetic foot ulcers heal faster when surgical, or sharp, debridement is performed on an initial and routine basis. In this procedure, the clinician uses an array of sharp instruments such as scalpels, curettes, or scissors to remove debris from the wound bed. Most people with diabetes, because of their sensory neuropathy, do not have any discomfort with this procedure. Advanced wound care dressings that provide a moist environment are used in conjunction with surgical debridements.

Enzymatic debriding agents. Enzymatic debriding agents can be thought of as “scalpel blades in a tube.” These enzyme-containing ointments chemically disrupt or digest nonviable tissue in the wound and promote healing. Usually applied once a day at home, these ointments can be very effective in the removal of dead or diseased tissue, but the process is much slower than surgical debridement. Sometimes the two treatments are used in conjunction with one another.

Energy therapies. Sometimes a wound can “stagnate” or become “stunned,” and at this point a wound care technique that imparts energy into the wound bed may be useful to kick-start the healing process. Therapies such as electrical stimulation (in which a high-voltage, pulsed current is applied to the wound), ultrasound (in which high-energy sound waves penetrate tissues to speed healing), and most recently, the MIST Therapy System (which uses an ultrasound-created mist to promote wound healing) have been used with success to treat people with stubborn diabetic foot ulcers. The use of these therapies requires the person being treated to come to the wound care center at least three times a week in addition to his regular appointments. These treatments are usually used for two to four weeks or until the ulcer begins healing again.

Pulse lavage therapy. Historically, whirlpool was a very popular technique for treating diabetic foot ulcers. Recently, however, this technique has been replaced with pulse lavage therapy. Pulse lavage is performed with a water-gun–like device coupled with a suction device to clean and debride the wound at the same time. Pulse lavage is usually only used for a few treatments at the beginning of the wound treatment process.

Bioengineered tissue treatment. Over the past several years, bioengineered tissues have become available for use in people with diabetic foot ulcers. These tissues can be made from living human cells or can be composed of a collagen lattice that acts as scaffolding within which the body’s own cells can migrate and begin the healing process. Some of these products are applied once and followed with secondary dressing changes over four weeks, while others require weekly applications. Most, if not all, of the work can be done in an outpatient setting.

Oxygen therapies. Hyperbaric oxygen therapy, a therapeutic option for selected people with diabetic foot ulcers, requires the person being treated to lie inside an acrylic tube that is filled with 100% oxygen under two to three times the normal atmospheric pressure. This therapy works by increasing the amount of oxygen in the blood and available to the body’s tissues. A person can usually watch TV, listen to music, or engage in conversation or relaxation techniques during the therapy sessions, which typically last 1.5–2 hours and take place daily for, on average, 20–30 treatments. It is important to know that inhaling oxygen under pressure is the only type of oxygen therapy approved by Medicare. Topical oxygen therapy (when the affected area of the body is placed in a tent filled with oxygen) has been shown to have some positive clinical effects, but is not yet covered by Medicare.

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