Literature Review

Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Evolving negative pressure wound therapy (NPWT) technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. In diabetic foot management, NPWT has had a significant impact on limb salvage. However, it is important to emphasize that diabetic foot management is a multidisciplinary effort, and NPWT is only one of the essential tools in overall management. Successful outcome is heavily dependent on all treatment modalities, including adequate wound debridement, appropriate antibiotic therapy, optimization of healing markers, and meticulous wound monitoring.

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Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Diabetes mellitus is frequently associated with chronic non-healing wounds, many of which result in amputation. The combination of peripheral vascular disease, neuropathy, and impaired immune function contributes to a higher risk of injury and deficiency in healing. Wound healing is a complex process comprising eight important factors: (1) collagen synthesis, (2) cell migration, (3) cell cycle and differentiation, (4) angiogenesis and growth hormone, (5) blood clotting, (6) extracellular matrix and focal adhesion, (7) calcium ion signaling, and (8) immune and inflammatory response. In the diabetic cell, all these processes malfunction, with the exception of collagen synthesis, cell migration, and cell cycle or differentiation.

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Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

An important factor in wound healing is adequate blood flow; thus patients with critical limb ischemia (CLI) and complex wounds are poor healers. Primary treatment for CLI is revascularization. Wound healing can be prolonged as a consequence of cyclical protease production by necrotic tissue during the inflammatory phase of healing. Debridement of necrotic tissue is therefore necessary to reduce inflammation and progress the healing cycle, as well as to promote epithelialization and reduce risk of infection. Conventional debridement therapy can be difficult in patients with CLI because of limitations in visualizing wound margins and time effectiveness. Maggot debridement therapy (MDT) is a traditional debridement therapy using live, sterilized fly larvae. This study investigated MDT in patients with CLI after midfoot amputation following revascularization by endovascular therapy. The outcomes of wound bed preparation were compared with the outcomes in patients receiving conventional therapy.

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Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.

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Temple University School of Podiatric Medicine's picture

Staphylococcus aureus is a primary cause of post-operative surgical site infection. S. aureus produces hyaluronidase, which degrades hyaluronic acid (HA). HA is important in wound healing because it prevents bacterial proliferation and provides anti-inflammatory properties. Although early bactericidal antibiotic treatment is important for wound infection, systemic antibiotics often do not prove to be entirely beneficial for wound penetration. Therefore, newer treatment methods that are not at risk of antibiotic resistance are necessary.

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Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Within the last decade, the rise of diabetes in the U.S. population has been matched with a rise in diabetic foot ulcers requiring amputations. Because many of these diabetic foot ulcers develop secondary to poor wound healing and susceptibility to infection after surgery, some important risk factors have been evaluated. Stress, among other factors, has been shown not only to affect the psychological state of a patient, but also biologically to impair immunity and induce an inflammatory microenvironment within patients.

Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Twenty-five percent of all diabetic patients will develop a diabetic foot ulcer (DFU), the major reason for hospitalizations in diabetic patients. The current standard of care (SOC) for DFUs consists of debridement, glycemic control, antimicrobial therapy, and imaging. DFUs often become infected, and with improper healing they require more advanced care and possibly lower extremity amputation. This study evaluated the usefulness of a perfusion-decellularized porcine hepatic-derived wound matrix (PDPHD-WM) in treating difficult-to-heal ulcers, or DFUs of greater than three months’ duration that had been treated with at least one other advanced method.

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Temple University School of Podiatric Medicine's picture

Wounds with exposed bone and tendon are a major concern for physicians due to the significant morbidity that they can cause. The primary focus of this study is to determine the efficacy and safety of a biologically active, cryopreserved human skin allograft for the treatment of wounds of this nature.

Aletha Tippett MD's picture
study on statins

by Aletha Tippett MD

Oh, what a shock to see a study published on atorvastatin treatment in the adult patients at risk of diabetic foot infection in a recent issue of Wounds.1 The conclusion of this study was that taking atorvastatin for at least three months reduced the risk of diabetic foot infections (DFI). The authors also theorized that statins could prevent infection in patients with diabetes.

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