What’s New in DFU? Insights from the Symposium on Advanced Wound Care

My name is Brian Schmidt, I'm a clinical associate professor at the University of Michigan Medical School in Ann Arbor, Michigan, and I'm a podiatrist by training.
 
In your SAWC session on diabetic foot ulcers, you discussed emerging products and technologies making waves in the wound care space. What highlights should DPMs know about?
 
I think there's a couple novel products that are really emerging in the first that I want to officially talk about without endorsing them specifically is topical oxygen. I think there's a lot of energy and some good clinical research that's been performed already, some high-level evidence that people should integrate this into their clinical practices as soon as possible really.
 
Two names that come in are the TWO2 system and that one is very reasonable. It has a CPT code associated with it and this can be easily implemented in your clinical practice.
 
What does the research reveal about these options?
 
I think what they show and one thing that you have to consider when you're looking at these products is how do they design the study? The study design is really important because the end measure can be either percent wound area reduction, which is a surrogate endpoint for eventual healing, or they can look at complete wound closure. Complete wound closure is really important because that is the FDA standard for a clinical trial and most of these novel products are using that FDA definition and giving us a more standardized approach because if you look at studies from 5, 10, 15 years ago, everybody was using different endpoints and so when you standardize the endpoints you can really see the effectiveness of that product.
 
From your perspective, what other technologies warrant further note by clinicians?  
 
In the lecture I mentioned the kind of the water jet system and again why I highlighted that was because you can do sharp debridement very well yourself, but some of these adjunctive therapies that add to it make your debridement that much better. That was a small study with a sample size, I think of a 50, but I liked it because again, it used that complete wound closure definition, and they compared it directly with standard of care, which includes sharp debridement that we are all doing. So if you can improve the quality of your debridement, you're going to see an improvement in wound healing as well. The biggest thing is that, you know, emphasize education to our colleagues across medicine, not just in wound care.
 
Obviously, we're intimately familiar with wound healing and the effects it has or it has on people's lives. But our general practitioners are cardiologists, they may not understand this. So use some of these statistics that diabetic foot ulcers are, you know, impacting people's light longevity and their quality of life. Those things need to be taught to them so that they can incorporate it into their own medicine practices.