Taking a STRIDE to improve wounds through a novel care pathway

Introduction: Over the past decade, wound care has significantly advanced with new materials, technologies, and surgical techniques, though progress has lagged behind fields like surgery and cardiology. The focus has shifted from topical therapies to a holistic, multidisciplinary approach, emphasizing chronic wound management. Despite improvements, further innovation is needed, particularly in diagnostics and advanced treatments, to address gaps in chronic wound care.Methods:STRIDE (Surgical Treatments for Reconstruction & Innovative Deformity Elimination) is a novel, aggressive surgical approach aimed at sustained wound closure. It integrates advanced wound care with surgical intervention, addressing the multiple co-morbidities of diabetic ulcers. STRIDE focuses on infection management, biomechanical issues through offloading, and long-term solutions for wound closure. As ulcers progress, infection risk increases, often leading to bone infection and the need for aggressive antimicrobial therapies or amputation. To address this, we propose using a novel antibiotic-loaded flowable cement injected directly into the bone. This cement offers high antimicrobial effectiveness and represents a new surgical approach to osteomyelitis. Importantly, this can be an independent procedure or combined with oral or IV antibiotics as needed. The second step involves optimizing the wound bed through novel antimicrobial washes, synthetic skin substitutes, and real-time optical imaging to ensure a physiological environment conducive to healing. The third and most crucial step is proper offloading, addressing biomechanical deformities through reconstructive surgery rather than traditional devices. Surgeries range from endoscopic gastrocnemius recession to complex Charcot foot reconstructions. Noteworthy, early surgical intervention may be necessary when wounds cannot be closed due to location, patient compliance, or offloading issues.Results:Initial results from our center show great promise for the sustained closure of wounds using the STRIDE pathway, with a 50% reduction in our historical amputation rate, over 90% rate of wound closure of Wagner 3/4 ulcers by 20 weeks, and less than 5% recurrence rate, typically not at the same site.Discussion: The STRIDE pathway aims to enhance wound healing and minimize recurrent ulceration. Incorporating novel technologies, this approach has shown great success in achieving sustained wound closure and addressing the challenges of chronic wound healing.References: