A Unique, Definitive And Durable Solution To The Chronic Diabetic Foot Ulcer
Lewis Freed, Todd Haddon.
OrthoArizona, Mesa, AZ, USA.
BACKGROUND: In spite of considerable effort and investment, definitive treatment for the chronic refractory diabetic foot ulcer is lacking and if complete healing is achieved, recurrence is expected in many if not most instances. A novel treatment has been applied to this condition which employs ultrasonic energy to address the major pathophysiologic features of the condition.
METHODS: An ultrasonic probe demonstrated to be effective in removing diseased tendon was applied to the pathologic features of the diabetic foot ulcer. Using 2-4 puncture sites the ultrasonic probe is first used to remove the thickened scar tissue that surrounds the non-healing wound crater. The probe is then introduced into the osseous prominence which is also removed using the ultrasonic probe. The scar and bone are aspirated through the hollow probe and removed from the field. The initial experience is limited to MW class 1-3 ulcers. From 2014 - June 2019, 79 ulcers were managed in this manner. The chronicity varied from a minimum of 3 months, to over 3 years (mean = 15 months). All patients had unsuccessfully undergone numerous traditional treatment modalities. The mean ulcer size was 20 mm and the men treatment time was 4.5 minutes. Patients were followed at weekly intervals until healed and at 3 month intervals subsequent to healing.
RESULTS: At a mean time of 3.5 weeks (range 7- 42 days) 75/79 ulcers completely healed. During subsequent surveillance, 5 of the 75 developed a recurrence from 14 - 33 months. One patient developed a bacteremia and one a local cellulitis, both responding to antibiotics.
CONCLUSIONS: Treatment with the ultrasonic probe in the manner described has demonstrated a high rate of complete healing with a low recurrence and complication rate. The procedure is relatively inexpensive and easily learned by those experienced in managing this condition.
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