Wound Care: Beyond the Wet to Dry dressing

Gabriel Urrea-Botero, MD Fellowship in Wound Care

The Problem Cost

In 1999, the average cost per patient for 2 years of treatment of a diabetic ulcer in the United States of America (USA) was an estimated $27,987
Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diabet 2006;24:91-3.

The Problem Cost

More recently, the cost for the treatment of a single ulcer has increased to $8000, and the cost of an infected ulcer has increased to approximately $17,000 per year.

Barone EJ, Yager DR, Pozez AL, et al. Interleukin-1 alpha and collagenase activity are elevated in chronic wounds. Plast Reconstr Surg 1998;102:1023-7.

The Problem Cost

In 1980 synthetic wound dressings were rarely sold, whereas in 1987 it was estimated that $350 million was spent on these dressings.

Eaglstein WH, Mertz PM, Falanga V. Clinical and experimental approaches to dermal and epidermal repair: Normal and chronic wounds. New York: Wiley-L% 1991: 257- 65.

Health Impact
The likelihood of a diabetic being dead five years after a amputation is nearly 68%. This is more than double the chance of death from prostate or breast cancer

Wound Care at GMG

Conventional / Gold Standard Treatments Non Conventional / The Cutting Edge Approach

Infections Skin Surgery Topical Treatments

Wound Care at GMG

Infections

Cultures Abscess Osteomyelitis

Wound Cultures
A swab culture of the surface of a DFU usually reveals at least 1 potential pathogen; such surface cultures can be difficult to use in guiding treatment because they do not distinguish a colonized ulcer from an infected one. Swab cultures of the surface of an infected DFU often fail to represent the underlying pathogen. When deep DFIs are suspected, deep cultures are most suitable for guiding antibiotic therapy.

Wound Cultures
Ideally, deep cultures should be obtained without traversing the wound bed, to avoid the potential contamination of deep tissue with surface colonizing flora. After removing overlying necrotic debris, specimens should be obtained from the wound base or deeper tissues

Wound Cultures
In most cases, cultures of DFI should be obtained before the start of treatment (although a recent study found a striking lack of association between receipt of prior antibiotics and bone culture positivity)

1. Arag on-S anchez FJ, Cabrera-Galv an JJ, Quintana-Marrero Y, et al. Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement. Diabetologia 2008;51(11): 196270

Intralesional antibiotic injection of antibiotics

Intralesional antibiotic injection of antibiotics

Intralesional antibiotic injection of antibiotics

Intralesional antibiotic injection of antibiotics

Osteomyelitis
Most series report amputation as the only possible surgical treatment

1. Karchmer AW, Gibbons GW (1994) Foot infections in diabetes. Evaluation and management. Curr Clin Top Infect Dis 14:122 2. Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, Morgan CB, Lavery LA (1997) The natural history of great toe amputations. J Foot Ankle Surg 36:204208 3. Nehler MR, Whitehill TA, Bowers SP et al (1999) Intermediateterm outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalisation and presumed adequate circulatory status. J Vasc Surg 30:509517

Osteomyelitis
Others have also suggested that antibiotic therapy combined with debridement of the infected bone can cure most cases of diabetic foot osteomyelitis.

1. Grayson ML, Gibbons GW, Habershaw GM et al (1994) Use of ampicillin/sulbactam versus imipenem/cilastatin in the treatment of limb-threatening infections in diabetic patients. Clin Infect Dis 18:683693 2. Venkatesan P, Lawn S, Macfarlane RM, Fletcher EM, Finch RG, Jeffcoate WJ (1997) Conservative management of osteomyelitis in the feet of diabetic patients. Diabet Med 14:487490

Wound Care at GMG

Skin Surgery
Woundectomy Late Closure of wounds Lattice Stitch Technique

Lattice Stitch Technique

Lattice Stitch Technique

Lattice Stitch Technique

Lattice Stitch Techinque: Early Suture Removal

2nd Degree Burns

2nd Degree Burns

Late wound closure

Late wound closure

Woundectomy

Unna boot in the hands

Unna boot in the hands

Unna boot in the hands

Unna boot in the hands

Interesting cases

Interesting cases

Interesting cases

Interesting cases

Time is over
Thanks!