Healing Foot Ulcers
The Archives of Surgery 2000;135:627-634 has an article titled Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent by Brem, H, MD et al. The researchers wanted to prove that early intervention with biological therapy will either halt progression or result in rapid healing of chronic wounds in diabetics with foot ulcers and ulcers. In a prospective nonrandomized case series, 23 consecutive patients, with a total of 41 wounds, were treated with human skin equivalent (HSE) after excisional debridement of wounds. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses.
The researchers concluded that in diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in traditional skin graft is successful in producing healing. The high success rate with complete closure in these wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. The researchers found that if a wound did not fully heal after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is likely the cause. The writer conclude that all non-ischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.