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What’s New in Foot Care?

by Joy Pape, RN, BSN, CDE, WOCN, CFCN

To allow you to walk with less pressure on the bottom of your foot while your wound is healing, your doctor may apply what is called a total contact cast (TCC) that redistributes your weight away from your wound. This is called offloading, and it is considered the gold standard of care as part of the treatment of foot wounds.

The TCC-EZ is a new type of total contact cast that has benefits for both you and your physician. For your doctor, it is much faster and easier to apply than a traditional TCC. After preparing your leg, your doctor simply rolls the single layer “cast sock” onto your foot and leg. Dr. Rogers calls it the “cast sock” because, he says, “It’s almost as easy as putting on a sock. There is a boot attachment that assists the patient in walking.”

The benefit for you is that it protects your wound and allows it to heal in an average of six weeks. The TCC-EZ is lighter, easier on your skin, and not as uncomfortable as a traditional cast. When applied with the outer boot, you can walk and stay active while your wound is healing. However, the cast should not be allowed to get wet.

Negative pressure wound therapy. Commonly known as Wound V.A.C., which stands for vacuum assisted closure, this tool promotes wound healing by applying suction (negative pressure) to a wound. This negative pressure changes an open wound to a “closed wound” as it removes fluid from the wound. This concept has been shown to help wounds heal by improving circulation and removing waste fluids from the wound.

Negative pressure wound therapy consists of three components that work together: a nonstick dressing, a vacuum-assisted canister and hose that provide negative pressure (like a vacuum cleaner), and a clear film dressing to seal the wound, the dressing, and a drainage tube. The frequency of dressing changes depends on the size and type of the wound, but it is usually done every 48 hours.

In the opinion of Dr. Rogers, “This is certainly the biggest advancement in wound healing.”

Dermagraft. Dermagraft is considered a skin substitute and is used to treat diabetic foot ulcers. It is made from human cells, specifically the cultured cells of baby foreskins. (Dr. Rogers says one foreskin can grow about six tennis court sizes of skin!) These cells have been placed on a dissolvable mesh material that is placed on a clean wound bed (one that has been debrided). The mesh is gradually absorbed, and the human cells grow into place, replacing the damaged skin. The living cells in the graft produce many of the same proteins and growth factors found in healthy skin, which help to rebuild the damaged tissue in an ulcer.

Dermagraft is intended to help close ulcers that have been present for more than six weeks. It should not be used on infected ulcers or those that involve tendons, muscles, joints, or bone.

Dr. Rogers said, “It has been shown in clinical trials to heal wounds much faster.”

To raise the likelihood of treatment success, the manufacturer of Dermagraft, Advanced BioHealing, supports a program called Heal2gether that pairs up people being treated with Dermagraft with a “treatment partner,” who phones weekly to remind the person about doctor appointments and also checks in to discuss the therapy and offer information and support. Advanced BioHealing also provides education and information about diabetic foot ulcers at community events such as health fairs. You can learn more about the program at www.heal2gether.org.

DermaClose. The DermaClose RC Continuous External Tissue Expander is a first-of-its-kind product that helps close wounds by expanding the skin around a wound until it is stretched enough for a doctor to stitch the wound closed or to make a smaller wound.

To stretch the skin, a surgeon staples skin anchors (clips with barbs that penetrate the skin) near the edge of the wound. A nylon line is attached to each skin anchor, and the line is gently tightened via the DermaClose RC tension controller. This gradually pulls the skin anchors and edges of the wound together. Dr. Rogers says DermaClose RC Continuous External Tissue Expander can close a wound in three to five days depending on its location.

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