Treating Painful Diabetic Wounds and Ulcers
“This young man had a problem where he – he has diabetes and he stepped on a nail and he got a very serious infection. He got an ulcer on the bottom of his foot and it was down here underneath the second metatarsal and then it got an infection and it dissected up here and went all the way across his foot and up through his foot. There was a hole all the way through the foot when we first cleaned this out. It was badly infected. He’s been on this thing called a wound vac, which is a negative pressure wound therapy machine for about five weeks and he’s improved a lot in those five weeks. In the next couple of weeks we hope to get him back to work and on with his life. He’s a great American, he works hard, takes care of his family, and does the right thing. So we’re trying to get this guy back on his feet.This just shows a lot of different principles of taking care of a diabetic foot, and I’ll talk to you a little bit about those. The first one is, this probably could have been prevented with appropriate preventative measures like a good insole or a custom made device inside the shoe to take pressure off these areas. Once he did get an ulcer, that could have been treated with offloading with maybe a total contact cast. By some misfortune, he ended up getting a really bad infection. Now we’re stuck dealing with a lot of tissue loss, and he’s doing pretty well with that. Once we get him back up on his feet, there are some things we can do to prevent this from ever happening again.
What we’re going to apply now is collagen. What collagen is is the building block – it’s sort of like a scaffold for tissue to grow into. That’s one of the reasons we’ve been able to get this patient to heal so rapidly. He had a lot of tissue loss with a big defect and he’s all filled in now because we’ve been using this collagen material.
Collagen is just a white powdery substance and you just put it on the wound, put it about a quarter thickness. We’re going to put this sponge on. What this sponge does is the sponge is an open cell foam, which means it all communicates with itself. Let’s say you were to put one half of the sponge in the water and suck on it, the water would come all the way up through the sponge, if it was all sealed, because that’s what open cell foam means – it means that it’s open all the way down. This is open cell foam and that’s kind of how it works.
Now you can see this sponge, it’s all nice and puffy, it’s not squeezed down at all. We cut a hole in this sealer that we’ve wrapped around his foot, attach the part that goes to the suction canister, plug that in. What this thing does is it maintains the pressure of negative 125 milliliters of mercury continuously, or you can set it up for alternating pressure. Basically, the principle of it is that it increases circulation in the area of the wound by about anywhere from 25-40%, depending on the study that you read. What this does is it dramatically increases the rate of healing that occurs inside this foot. This thing cuts the healing time probably – with a wound like the one that you had it would probably have taken 2-3 months to heal and this has been about a month. With collagen and the wound vac, we’ve really dramatically decreased his healing time so he can get back to work and normal lifestyle. We’ll see you soon, maybe about 4-5 days, ok?”