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Diabetic Wounds
Diabetes can result in the development of several complications, including diabetic foot problems that can potentially lead to lower limb amputation.
Validation of Wagner's Classification: A Literature Review
To ensure high quality care, practitioners should base their practice on sound clinical evidence. Relying on quantitative measurements when evaluating this evidence demands measurement accuracy, reliability, and validity. Current diabetic foot ulcer classification systems include: Meggitt's, Wagner's, Knighton's, Pecoraro's, University of Texas San Antonio Diabetic Wound Classification, and Size (Area and Depth), Sepsis, Arteriopathy, and Denervation. Of these, the Wagner's classification system is the most widely used to describe the natural history of the dysvascular foot, even though evidence of its validity and reliability are lacking. A review of clinimetric properties and existing validation literature of the other diabetic classification systems suggest that the University of Texas San Antonio Diabetic Wound Classification and S(AD) SAD have the potential to fill the current void, once additional studies have been conducted.
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Treating Recalcitrant Diabetic Wounds with Hyaluronic Acid: A Review of Patients
The wound healing process in the patient with diabetes can be adversely affected by many factors, including unrelieved pressure, infection, and concurrent underlying conditions. In addition, a static wound may exacerbate patient anxiety or depression and indirectly further delay the healing process while increasing the risk of complications. The polysaccharide hyaluronic acid has long been known to be an integral component of the extracellular matrix in the dermis and other tissues and is implicated in the process of wound healing and tissue repair. Research has shown the benefit of using a novel ester of hyaluronic acid to accelerate the healing process and effectively treat diabetic foot ulceration and other difficult-to-heal chronic wounds. The effects of care using hyaluronic acid on three patients with challenging wounds are presented.
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Wound Bed Preparation: Future Approaches
Cellular and Biochemical Abnormalities in Chronic Wounds One of the barriers to healing and proper wound bed preparation consists of the cellular abnormalities within the wound (see Figure 1). Figure 1Schematic representation of wound bed preparation. In the context of wound bed preparation, how senescence of cells, their possible unresponsiveness to growth factors, and impaired healing are related becomes an...
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Modifications of the Great Toe Fibular Flap for Diabetic Forefoot and Toe Reconstruction
Diabetic forefoot and toe wounds are difficult to heal in a timely fashion. Despite proper continued offloading and protective shoe-gear techniques, these wounds are frequently complicated by recurrent breakdown and adjacent toe deformities. When properly performed, pedicle flaps from the fibular border of the great toe represent viable and cost-effective means of providing early and durable soft tissue coverage and osseous reconstruction of diabetic forefoot and lesser toe wounds. Two modifications of the traditional great toe fibular flap are described: the great toe fibular adipofascio-cutaneous flap and the great toe fibular osteo-cutaneous flap, useful for providing forefoot and toe reconstruction, respectively. Understanding the surgical aspects of the treatment provides insights into overall care for these challenging wounds. Long-term outcomes studies involving these toe reconstruction techniques are needed to fully evaluate their success in preventing recurrent toe deformity and forefoot ulceration. KEYWORDS: pedicle flaps, reconstruction, diabetic wounds, lower extremity
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Combining Bioengineered Human Dermal Replacement and Multilayered Compression Dressings to Manage Ulcers in a Person with Diabetes Mellitus: A Case Study
Multiple modalities exist for the care of lower extremity ulcers associated with venous insufficiency and complications of diabetes mellitus, (eg, neuropathy). Although reports about the use of topical adjunctive treatment modalities in the treatment of foot ulcers in persons with diabetes mellitus exist, little is known about the safety of topical treatment when used in combination with compression therapy to manage venous insufficiency. A patient with diabetes mellitus, neuropathy, a 3.3 cm x 3.0 cm x 1 mm heel ulcer and a 8.1 cm x 4.9 cm x 3 mm lower leg ulcer secondary to venous insufficiency presented at the authors? clinic. After 8 weeks of therapy using a combination of bioengineered human dermal replacement and multilayered compression dressings, lower leg edema was reduced, the heel ulcer healed, and the leg ulcer continued to improve. No complications were observed. The results observed suggest that studies examining the effects of treatment regimens that address the multifactorial etiology of some lower extremity ulcers are warranted.
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February 2003 Industry News
February 2003 Industry News Industry News: February 2003 Industry News - American Urological Association launches patient information website Many questions about urologic health can be answered discreetly and with authority through a website launched by the American Urological Association. Information available on the website includes the fact that more than 15 million Americans, mostly women, suffer from ...
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Topical Hyperbaric Oxygen and Electrical Stimulation: Exploring Potential Synergy
Treatment of chronic wounds involves interventions ranging from dressings to surgery. Modalities gaining popularity in clinical settings include topical hyperbaric oxygen and electrical stimulation. A prospective, uncontrolled study was conducted to obtain preliminary observations and data about the effects of topical hyperbaric oxygen therapy and topical hyperbaric oxygen used with electrical stimulation on the healing of chronic wounds. All subjects were geriatric residents of long-term care facilities with Stage III or Stage IV pressure ulcers. Topical hyperbaric oxygen was applied daily to the wounds of eight subjects; three also received electrical stimulation. Initial wound size ranged from 87.75 cm2 to 7.04 cm2 with an average size of 30.1 +/- 28.5 (mean +/- sd) cm2. Healing times ranged from 8 to 49 weeks. After 4 weeks of treatment with topical hyperbaric oxygen, wound size decreased an average of 34.4% +/- 22.9%. Incidentally, the wounds of five of the eight subjects decreased more than 20%, for an average of 51.8% +/- 17.9%. No significant differences in healing were observed between patients receiving topical hyperbaric oxygen alone and those receiving topical hyperbaric oxygen/electrical stimulation. Preliminary data indicate that topical hyperbaric oxygen facilitates wound healing and full closure for pressure ulcers in patients with and without diabetes mellitus. A multicenter, prospective, randomized, double-blind controlled study is currently under way.
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Selected Abstracts from the SAWC: The 15th Annual Symposium on Advanced Wound Care & 12th Medical Research Forum on Wound Repair April 27 to April 30, 2002 Baltimore Convention Center Baltimore, Maryland
* Betadine Solution, The Pursue Frederick Company, Norwalk, Conn. ** Hydrogen Peroxide Solution 3%, Bergen Brunswing Drug Company, Orange, Calif. *** Hibiclens, Zeneca Pharmaceuticals, Wilmington, Del. References 1. Bello YM, Falabella AF, Cazzaniga AL, Harrison-Balestra C, Mertz PM. * Profore, Smith and Nephew Inc, Largo, Fla...
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October 2002 Industry News
For more information please call 215-369-9812 or email: info@strategic-sales-solutions.com. - OWM National coverage for hyperbaric oxygen therapy The Centers for Medicare and Medicaid (CMS) have issued an intent to issue a formal National Coverage Determination pertaining to diabetic wounds of the lower extremity. For information, please visit www.dorland.com. - OWM ...
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The 20th Annual Symposium on Advanced Wound Care and the Wound Healing Society Meeting April 28 ? May 1, 2007 Tampa Convention Center Tampa, Florida
This year, more than 390 abstracts were accepted for presentation at the SAWC/WHS in Tampa. Of those, 30 were accepted for oral presentation. The abstracts featured here will be presented during sessions 12, 17, 23, 37, and 59. The accepted poster presentations may be viewed throughout the entire meeting and during the scheduled poster sessions, which will be held Sunday, April 29, 7:00 a.m. ? 8:30 a.m. and Monday, April 30, 7:00 a.m. ? 8:30 a.m. To access the entire SAWC brochure, including session titles, faculty, and abstracts, visit www.sawc.net.
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