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STRAVIX◊ Tissue Products in the treatment of infected diabetic foot ulcers and limb preservation
A diabetic foot ulcer acts as a portal for systemic infections—infections that are especially dangerous as diabetic patients often suffer from impaired immunity which increases their risk for local and systemic infection. Debridement and antibiotic therapy should be initiated as soon as possible as well as close blood sugar monitoring and control because hyperglycemia may increase the virulence of infectious microorganisms. And even with the tightest control, surgery is often necessary—to control infection and prevent amputation.1
Two infected diabetic foot ulcer cases come to us from Dr. Harry Schneider, Assistant Professor of Surgery at Harvard Medical School and Residency Director at Cambridge Health Alliance Podiatry in Cambridge, MA.
Dr. Schneider is one of a growing number of surgeons who employ the use of STRAVIX tissue to manage diabetic foot ulcers (DFU) and prevent amputation.
Case study: infected diabetic foot ulcer #1
Diagnosis
Dr. Schneider’s first case involves a 54-year-old woman with type II diabetes who presented with an infection of the left foot with a large open wound. In addition to DM, past medical history included lymphedema. The patient had previously been treated with incision and drainage as well as negative pressure wound therapy.
Procedure
Prior to surgery, the wound was again incised ad drained with NPWT applied for two weeks. In the OR, STRAVIX Cryopreserved Umbilical Tissue was applied, and the patient transferred to a Skilled Nursing Facility where she was closely monitored and received regular dressing changes.
Outcome
Patient achieved complete wound closure.
Case study: infected diabetic foot ulcer #2
Diagnosis
Dr. Schneider’s next case involved a 52-year-old male with a diabetic foot infection who had completed initial incision and drainage procedures followed by weekly debridements. In addition to past medical history of diabetes, the patient was quite thin with a BMI of 18. He was also a one pack a day smoker.
Procedure
After the initial incision and drainage, the patient lost most of the tissue on the dorsal aspect of the foot with extensor tendons exposed and a wound between his first and second digits that went all the way up and around into his arch exposed. The patient was placed on IV antibiotics, brought in weekly, and at one week the foot was again debrided with NPWT applied.
At this point a discoloration was noted that laterally there was discoloration that appeared to be biofilm. By week 4 the arch and dorsal areas were seen to be filling in nicely. At this point Dr. Schneider fenestrated and applied STRAVIX Tissue to help cover and protect the viable tendons and promote healing. In the ensuing weeks, the STRAVIX Tissue is no longer discrete tissue, but has become integrated with surrounding tissue.
At the next week the area that had been suspected of having biofilm had a purplish discoloration indicating possible non viability, it was removed and STRAVIX Tissue inserted into the cavity. At the next week, the plantar surface had greatly improved and STRAVIX Tissue was added to the remaining tissue deficit. At this point the tendons did not appear to be progressing as hoped. Debridement with VERSJET◊ Hydrosurgery System was done followed by an application of STRAVIX Tissue.
At 8 weeks Dr. Schneider performed a final STRAVIX Tissue application.
Outcome
At 12 weeks the infection had achieved complete closure. Dr. Schneider notes that in many gangrene infections, complete healing can take up to a year. The fact that there was complete closure with exposed tendons and bone in only 12 weeks of applying Stravix Tissue is impressive and demonstrates the ability of the product to help in limb salvage cases.
Why STRAVIX Tissue Products?
The choices of skin substitutes are plentiful, but STRAVIX Tissue Products are manufactured using proprietary processes allowing the structural tissues to retain all native components including growth factors, a hyaluronic-acid rich extracellular matrix, and intact placental cells.2,3 In fact, A single STRAVIX Tissue can provide fast closure for soft tissue defects and complex wounds.4 For larger wounds surgeons can choose STRAVIX Meshed Tissue which is easily stretched to cover larger area and provides a more affordable choice.
In addition, STRAVIX PL Lyopreseved Umbilical Tissue retains all the native components of the tissue while requiring no thawing or special refrigeration for off-the-shelf, on-demand convenience.
Sign up for our webinar today and see STRAVIX Tissue for yourself.
References:
- University of California San Francisco Department of Surgery, Diabetic Foot Ulcers, Accessed September 6, 2023. https://surgery.ucsf.edu/conditions--procedures/diabetic-footulcers.aspx#:~:text=A%20diabetic%20foot%20ulcer%20acts,for%20local%20and%20systemic%20infection.
- Dhall S, Coksaygan T, Hoffman T, et al. Viable cryopreserved umbilical tissue (vCUT) reduces post-operative adhesions in a rabbit abdominal adhesion model. Bioact Mater. 2018; 4(1): 97-106
- Data on file
- McGinness K, Kurtz Phelan DH. Use of viable cryopreserved umbilical tissue for soft tissue defects in patients with gas gangrene: A case series. Wounds. 2018; 30(4): 90-95.
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www.smith-nephew.com
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