Emphasizing The Need For Accelerated Wound Healing

   The importance of resolving infections and facilitating quicker wound healing is commonly understood when it comes to managing lower extremity ulcerations in patients with diabetes. Indeed, a recent study in Diabetes Care emphasizes just how important those treatment goals are in the diabetic population.    According to the study, those who have a diabetic foot infection have over a 150 times greater risk of amputation and a 55.7 times increased risk of hospitalization than those without infection (see page 10, “News and Trends”).    In light of these staggering and grave statistics, we present our Sixth Annual Wound Care Theme Issue.    In the aforementioned news article by Senior Editor Brian McCurdy, Lawrence Lavery, DPM, and Benjamin Lipsky, MD, co-authors of the Diabetes Care study, emphasize key preventive steps, wound care principles and proper use of antimicrobial therapy for infected wounds.    Exploring such issues further, Guy Pupp, DPM, and Chad Westphal, DPM, offer their perspectives in the feature “How To Choose Appropriate Antibiotics For Diabetic Foot Infections” (see page 56). Drs. Pupp and Westphal review key signs and symptoms to look for in the clinical exam of patients with possible diabetic foot infections. They also discuss key parameters for culturing of these wounds. The authors offer insights on common organisms associated with acute and chronic infections, and other considerations in selecting appropriate therapy.    In keeping with the theme of improved wound healing, Paul J. Kim, DPM, Karolina S. Dybowski, BS, and John S. Steinberg, DPM, offer “A Closer Look At Bioengineered Alternative Tissues” for this month’s cover story (see page 38). While terms like “skin substitutes,” “bioengineered skin equivalents” and “biological skin substitutes” get thrown around a bit, the authors propose the new terminology of “bioengineered alternative tissues.” Then they offer a thorough primer of currently available and emerging modalities in this arena. They discuss what these products are comprised of and also review the available literature (noting the lack thereof in certain cases) in regard to the efficacy of these modalities.    Dr. Steinberg pulls double duty in this issue as he co-authors a second feature, “Is There A Role For ESWT In Wound Care?,” with Lt. Col. Alexander Stojadinovic, MD, LCDR, Eric Elster, MD, Lt. Col. (P) George Peoples, MD, and Chris E. Attinger, MD (see page 62).    While the title of the article might cause a few double takes, the authors review pertinent studies in this area and discuss the different mechanisms of extracorporeal shockwave therapy (ESWT). They also note that preliminary clinical trials are under way to further define whether ESWT has a place in the armamentarium of clinicians who manage lower extremity wounds.    Following in the multidisciplinary mode, Martin Wendelken, DPM, RN, Oscar Alvarez, PhD, Lee Markowitz, DPM, Christopher Comfort, MD, and Linda Waltrous, RN, offer “Key Insights On Mapping Wounds With Ultrasound” (see page 70). Discussing the combination of photo planimetry and wound mapping assessment via ultrasound, these authors cite potential benefits including improved accuracy of wound measurements and the ability to document the progress (or lack thereof) of wound treatment regimens.    Hopefully, the collective insights from these authors on wound healing principles and emerging modalities for assessment and treatment will be beneficial. In particular, given the significantly elevated risks of amputation and hospitalization among high-risk patients with diabetic foot infections, a firm grasp of key principles and thorough consideration of the tools in one’s armamentarium seem to be an essential combination in accelerating wound healing.