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Wound healing pharmaceuticals: an examination of the literature for evidence
182
Abstracts / The Foot 18 (2008) 181–185
Methodology
Methods
The patient was diagnosed with type II diabetes; well controlled. Patient presented with a full thickness neuropathic ulcer that had been present for longer then six months. Patient’s ulcer was debrided and measured to be 1.5 cm × 1.5 cm × .5 cm. The patient received two applications of autologous growth factors in a fibrin clot matrix and an Apligraf skin graft. Post operatively the patient was fitted with a Bledsoe boot instead of total contact plaster cast. The Patient was evaluated for 12 weeks with regular office visits and healing was evaluated qualitatively.
Patient’s blood was drawn and centrifuged with the MTF system to prepare the fibrin clot application to ulcer site located at the hallux (distal) measuring 4.2 cm × 4.4 cm × 0.7 cm and the 2nd toe (medially) 1.9 cm × 1.0 cm × 1.2 cm. The fibrin clot was initially applied to the ulcers and sutured with 4–0 vicryl. The Unite was sized to the wound and sutured. A second application of fibrin clot was applied. The patient was given a Bledsoe boot to offload.
Results Results Ten day post procedure the previous non healing ulcer showed adequate perfusion and inflammation response; the wound edges show good granulation tissue. The wound at 12 weeks shows full contractions and closure with complete epithlization over the ulcer. Conclusions Pathology of a chronic wound can be effectively reversed by the application of platelet derived growth factors and bioengineered skin graft. The Bledsoe boot offered ease to evaluate the wound during the study and allowed for proper wound care maintenance. doi:10.1016/j.foot.2008.11.004 Applications of unite skin graft substitute with MTF autologous platelet derived growth factors in treating foot ulcers Michael Moi (BS, MS), Anthony R. Iorio (DPM, MPH, FACFAOM) Purpose A case study evaluating the efficacy of applying autologous platelet derived growth factors with sterilize bioimplants skin graft to treat a 65 year old male with foot ulcers.
Introduction Unite skin graft is an allograft bilayered cultured skin which accelerates healing by controlling tissue crosslinking. MTF is a cascade autologous platelet system promoting growth factors utilizing patient’s own blood to generate crosslinked platelet-rich fibrin matrix. Combination of the two technologies suggests accelerated healing faster than single component alone.
Rapid epithelization of 2nd toe ulcer was achieved at week eight and the hallux lesion was significantly reduced by week twelve with MTF and Unite measuring at 0.5 cm × 0.5 cm.
Conclusions The adjunct of MTF with Unite offers an economical and novel strategy optimizing wound healing. Additional case studies are needed for confirmation of our outcomes. doi:10.1016/j.foot.2008.11.005 Wound healing pharmaceuticals: an examination of the literature for evidence Robert G. Smith (RPh, DPM, CPed)
Goal/Purpose To determine the availability of clinical based evidence for wound healing pharmaceuticals
Methods Evaluation of available clinical data that follow accepted established criteria is the foundation and framework for this investigation. First, to insure the data found would be proportional to this investigation primary literature was investigated using: Medline Database, Cochrane Database, InfoPOEMs, and National Guideline Clearinghouse. A search profiled was complied using the following subject terms: “Pharmaceutical Product Class, Diabetic, Foot, Ulcer, and Wound”. These key words were used to perform Boolean logic electronic searches to identify relative literature citations. The time period of the search was determined to cover those primary citations from 1967 to 2008. A further limitation was to select only those investigations that described human clinical trials, meta-analysis, or randomized control trials. A manual review of citations’ references lists and bibliographies was
Abstracts / The Foot 18 (2008) 181–185
under taken for any other information found that would have lead to further material to be used as part of this review.
Results Five hundred citations were found and evaluated as defined by the search limitations. Twenty-three percent (n = 115) citations rose to a significant level of evidence as defined by the investigation’s parameters.
Conclusions The search for evidence based medicine in wound care is still in the developmental stages. Much of the data does not rise to a significant level of evidence and is often left to interpretation by wound care teams. doi:10.1016/j.foot.2008.11.006
183
Results In healthy subjects (N = 8), the RF > 0.3 and was always positive. In preoperative Charcot patients (N = 3), the RF < 0, however, RF was increased post surgery (N = 1), indicating a transition to normal plantar distribution after Charcot reconstruction.
Conclusion In this investigation, we suggested a reliable and accurate score to demonstrate improvement in gait patterns following foot reconstruction. This score is speed independent and indicates whether the distribution of plantar pressure is close to a normal pattern. doi:10.1016/j.foot.2008.11.007 The biomechanical implications of wearing ill-fitting shoes
Initial findings in developing a novel and reliable method of differentiating pathological and healthy plantar pressure loading pre and post Charcot reconstruction
Meghan Arnold (BS)
Bijan Najafi (PhD), Ryan Crews (MS), James Wrobel (DPM, MS), David G. Armstrong (DPM, PhD)
No research has ever been performed to investigate the effects that ill-fitting shoegear have on the biomechanics of the feet. This project investigated changes in peak pressures and total contact area of the foot during walking as based on the rearfoot, midfoot, and forefoot in different shoegear conditions. Subjects were fitted with appropriately sized shoes, and either shoes that were one size too small or shoes that were one size too large. Data was collected using the Pedar© system. Our results cannot be analyzed by statistical means because of the small enrollment in our study. But, shoes are beneficial to the feet regardless of what size shoe worn, because peak pressure is decreased over all areas of the foot. However, properly fitted shoes are superior to those that are one full size smaller or larger because they have the lowest peak pressures throughout the foot. Contact area is decreased in the proper shoe size as compared to the smaller shoe size. This was determined to be beneficial because of less shoe irritation, which can lead to ulceration or deformity. In the larger shoe, contact area remained the same, determined by the constant size of the foot, whereas the size of the shoe increased. Overall, a properly fitted shoe provides the greatest advantage over ill fitting shoes.
Goal/Purpose Following surgery, patients may increase their gait speed in response to greater confidence in stability and a more efficient gait pattern. Although this increase may be practically advantageous, it may also result in increased peak pressure values, historically viewed as a negative outcome. Here, we demonstrated that the statistical distribution of the total foot pressure profile is speed independent and can reliably measure improvement post Charcot reconstruction.
Methods A time-scale normalization scheme was used to moderate the effect of gait speed across the different steps’ pressure profiles. After normalizing the time-scale, we estimated the statistical distribution of the total-foot plantar pressure profile. To examine whether this distribution is normal, a customized normal distribution curve was created for each trial utilizing the mean and standard deviation values. Then the original plantar pressure distribution was fitted to the customized normal distribution curve using a multiple linear regression approach. This technique yields a regression factor (RF), which represents the similarity of the actual pressure distribution with the normalized distribution.
Abstract
doi:10.1016/j.foot.2008.11.008 Efficacy of cryosurgery in the treatment of heel pain G.Javier Cavazos (DPM), Khurram Khan (DPM), Anthony V. D’Antoni (DC, MS, PhD), Danine Lopez (CRT, CNA, LVN)
Abstracts / The Foot 18 (2008) 181–185
Methodology
Methods
The patient was diagnosed with type II diabetes; well controlled. Patient presented with a full thickness neuropathic ulcer that had been present for longer then six months. Patient’s ulcer was debrided and measured to be 1.5 cm × 1.5 cm × .5 cm. The patient received two applications of autologous growth factors in a fibrin clot matrix and an Apligraf skin graft. Post operatively the patient was fitted with a Bledsoe boot instead of total contact plaster cast. The Patient was evaluated for 12 weeks with regular office visits and healing was evaluated qualitatively.
Patient’s blood was drawn and centrifuged with the MTF system to prepare the fibrin clot application to ulcer site located at the hallux (distal) measuring 4.2 cm × 4.4 cm × 0.7 cm and the 2nd toe (medially) 1.9 cm × 1.0 cm × 1.2 cm. The fibrin clot was initially applied to the ulcers and sutured with 4–0 vicryl. The Unite was sized to the wound and sutured. A second application of fibrin clot was applied. The patient was given a Bledsoe boot to offload.
Results Results Ten day post procedure the previous non healing ulcer showed adequate perfusion and inflammation response; the wound edges show good granulation tissue. The wound at 12 weeks shows full contractions and closure with complete epithlization over the ulcer. Conclusions Pathology of a chronic wound can be effectively reversed by the application of platelet derived growth factors and bioengineered skin graft. The Bledsoe boot offered ease to evaluate the wound during the study and allowed for proper wound care maintenance. doi:10.1016/j.foot.2008.11.004 Applications of unite skin graft substitute with MTF autologous platelet derived growth factors in treating foot ulcers Michael Moi (BS, MS), Anthony R. Iorio (DPM, MPH, FACFAOM) Purpose A case study evaluating the efficacy of applying autologous platelet derived growth factors with sterilize bioimplants skin graft to treat a 65 year old male with foot ulcers.
Introduction Unite skin graft is an allograft bilayered cultured skin which accelerates healing by controlling tissue crosslinking. MTF is a cascade autologous platelet system promoting growth factors utilizing patient’s own blood to generate crosslinked platelet-rich fibrin matrix. Combination of the two technologies suggests accelerated healing faster than single component alone.
Rapid epithelization of 2nd toe ulcer was achieved at week eight and the hallux lesion was significantly reduced by week twelve with MTF and Unite measuring at 0.5 cm × 0.5 cm.
Conclusions The adjunct of MTF with Unite offers an economical and novel strategy optimizing wound healing. Additional case studies are needed for confirmation of our outcomes. doi:10.1016/j.foot.2008.11.005 Wound healing pharmaceuticals: an examination of the literature for evidence Robert G. Smith (RPh, DPM, CPed)
Goal/Purpose To determine the availability of clinical based evidence for wound healing pharmaceuticals
Methods Evaluation of available clinical data that follow accepted established criteria is the foundation and framework for this investigation. First, to insure the data found would be proportional to this investigation primary literature was investigated using: Medline Database, Cochrane Database, InfoPOEMs, and National Guideline Clearinghouse. A search profiled was complied using the following subject terms: “Pharmaceutical Product Class, Diabetic, Foot, Ulcer, and Wound”. These key words were used to perform Boolean logic electronic searches to identify relative literature citations. The time period of the search was determined to cover those primary citations from 1967 to 2008. A further limitation was to select only those investigations that described human clinical trials, meta-analysis, or randomized control trials. A manual review of citations’ references lists and bibliographies was
Abstracts / The Foot 18 (2008) 181–185
under taken for any other information found that would have lead to further material to be used as part of this review.
Results Five hundred citations were found and evaluated as defined by the search limitations. Twenty-three percent (n = 115) citations rose to a significant level of evidence as defined by the investigation’s parameters.
Conclusions The search for evidence based medicine in wound care is still in the developmental stages. Much of the data does not rise to a significant level of evidence and is often left to interpretation by wound care teams. doi:10.1016/j.foot.2008.11.006
183
Results In healthy subjects (N = 8), the RF > 0.3 and was always positive. In preoperative Charcot patients (N = 3), the RF < 0, however, RF was increased post surgery (N = 1), indicating a transition to normal plantar distribution after Charcot reconstruction.
Conclusion In this investigation, we suggested a reliable and accurate score to demonstrate improvement in gait patterns following foot reconstruction. This score is speed independent and indicates whether the distribution of plantar pressure is close to a normal pattern. doi:10.1016/j.foot.2008.11.007 The biomechanical implications of wearing ill-fitting shoes
Initial findings in developing a novel and reliable method of differentiating pathological and healthy plantar pressure loading pre and post Charcot reconstruction
Meghan Arnold (BS)
Bijan Najafi (PhD), Ryan Crews (MS), James Wrobel (DPM, MS), David G. Armstrong (DPM, PhD)
No research has ever been performed to investigate the effects that ill-fitting shoegear have on the biomechanics of the feet. This project investigated changes in peak pressures and total contact area of the foot during walking as based on the rearfoot, midfoot, and forefoot in different shoegear conditions. Subjects were fitted with appropriately sized shoes, and either shoes that were one size too small or shoes that were one size too large. Data was collected using the Pedar© system. Our results cannot be analyzed by statistical means because of the small enrollment in our study. But, shoes are beneficial to the feet regardless of what size shoe worn, because peak pressure is decreased over all areas of the foot. However, properly fitted shoes are superior to those that are one full size smaller or larger because they have the lowest peak pressures throughout the foot. Contact area is decreased in the proper shoe size as compared to the smaller shoe size. This was determined to be beneficial because of less shoe irritation, which can lead to ulceration or deformity. In the larger shoe, contact area remained the same, determined by the constant size of the foot, whereas the size of the shoe increased. Overall, a properly fitted shoe provides the greatest advantage over ill fitting shoes.
Goal/Purpose Following surgery, patients may increase their gait speed in response to greater confidence in stability and a more efficient gait pattern. Although this increase may be practically advantageous, it may also result in increased peak pressure values, historically viewed as a negative outcome. Here, we demonstrated that the statistical distribution of the total foot pressure profile is speed independent and can reliably measure improvement post Charcot reconstruction.
Methods A time-scale normalization scheme was used to moderate the effect of gait speed across the different steps’ pressure profiles. After normalizing the time-scale, we estimated the statistical distribution of the total-foot plantar pressure profile. To examine whether this distribution is normal, a customized normal distribution curve was created for each trial utilizing the mean and standard deviation values. Then the original plantar pressure distribution was fitted to the customized normal distribution curve using a multiple linear regression approach. This technique yields a regression factor (RF), which represents the similarity of the actual pressure distribution with the normalized distribution.
Abstract
doi:10.1016/j.foot.2008.11.008 Efficacy of cryosurgery in the treatment of heel pain G.Javier Cavazos (DPM), Khurram Khan (DPM), Anthony V. D’Antoni (DC, MS, PhD), Danine Lopez (CRT, CNA, LVN)