Vacuum-assisted closure therapy. Recent studies have demonstrated benefit in healing foot ulcers and wounds in people with diabetes with the use of negative-pressure therapy known as vacuum-assisted closure, or VAC, therapy. This technology consists of a polyurethane sponge that is placed on the wound bed and attached to a plastic tube, which is then attached to a pump that creates a negative suction force that helps drain the wound and influences the growth of surface tissue. The negative force can be applied continuously or intermittently. This therapy can be used 24 hours a day, but with the advent of newer, portable devices, it is possible to undergo outpatient therapy. The portable device attaches to a person’s belt and can be worn throughout the day without interrupting normal activities.
Growth factor treatment. Human growth factors are hormones that are normally involved in the healing process, and engineered versions of these hormones are now being used in the treatment of diabetic foot ulcers to stimulate healing. Since achieving FDA approval as the first engineered growth factor for topical wound use, a gel containing recombinant human platelet-derived growth factor (rhPDGF) has been used to treat diabetic foot ulcers. In clinical trials, rhPDGF has been shown to help heal diabetic foot ulcers and prevent amputation better than standard or placebo therapy. The gel is applied to the wound daily at home, and weekly visits are made to the wound care center to monitor progress.
After a person’s wound has healed, there is still more work to be done. People with a history of prior diabetic wounds are at high risk for developing subsequent ulcers and therefore a constant diligence is required to prevent recurrences. Special shoe inserts generally need to be changed every three to four months, though the life expectancy of the inserts depends on the material they are made from, the wearer’s weight, and how much walking the wearer does. Customized shoes should be evaluated by a professional at least annually. At all visits to your primary-care physician, you should remove your shoes and socks before the doctor comes into the exam room. This will prompt the doctor to evaluate your feet for deformities, new ulcers, and callus formation (which can lead to ulcers), and to monitor your sensory status.
Diabetic foot ulceration is a major health-care problem with both high monetary and quality-of-life costs. If you develop an ulcer, seeking treatment from a well-staffed, multidisciplinary wound care team can significantly improve your chances for a successful outcome. Another thing you can do to improve your outcome is to become an active participant in the process. Gather all of your pertinent medical records and lab tests and bring copies with you to your first clinic visit. Read up on recent updates and advances for diabetic foot care on the Internet or at the library. Don’t hesitate to ask questions, because the more you learn, the more you can participate in the wound care team. These measures, combined with the advent of new products and methods of treatment, should put you well on your way to healing.