Proactive Wound Care

Chapter
First Online:
Part of the Contemporary Diabetes book series (CDI)

Abstract

In June, 2003, a paper by Sheehan et al. (Diabetes Care 26:1879–82, 2003) caused many physicians to think about the need for proactive wound care. In this paper, the authors demonstrated a pattern of healing in diabetic foot ulcers in which wounds that did not show a significant decrease in size within 4 weeks of standard treatment, had less than a 10% chance of being closed by week 12. As a result, a benchmark was established, whereby one could say with reasonable certainty that in the absence of at least 50% closure after 4 weeks of standard care, a new approach was needed. When wounds fail to close from initial treatments, it is prudent to reassess the wound environment, the condition of the patient, adjust the treatment, and take proactive steps to enhance and stimulate the healing process.

Proactive wound care involves a series of steps to stimulate the wound to progress towards closure. These steps should be broad in their scope, and should focus on the shortcomings of the wound, and on the barriers to healing. Once potentially problematic issues are identified, the wound care specialist should consider the options that they have to gain control and improve the wound environment.

Keywords

Decellularized collagen Extracellular matrix ECM Bioengineered skin substitutes Dermagraft Diabetic foot ulcers Apligraf Clinical application Proactive wound care modalities 
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References

  1. 1.
    Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26:1879–82.PubMedCrossRefGoogle Scholar
  2. 2.
    Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV, American College of Foot and Ankle Surgeons. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006;45:S1–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Landsman A, Roukis TS, DeFronzo DJ, Agnew P, Petranto RD, Surprenant S. Living cells or collagen matrix: which is more beneficial in the treatment of diabetic foot ulcers? Wounds. 2008;20(5):111–6.Google Scholar
  4. 4.
    Eckes B, Nischt R, Krieg T. Cell-matrix interactions in dermal repair and scarring. Fibrogenesis Tissue Repair. 2010;3:4.PubMedCrossRefGoogle Scholar
  5. 5.
    Cornwell K, Landsman A, James KS. Extracellular matrix biomaterials for soft tissue repair. Clin Podiatr Med Surg. 2009;26:507–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Badylak S, Kokini K, Tullius B, et al. Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res. 2001;99(2):282–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Hwang K, Hwang JH, Park JH, et al. Experimental study of autologous cartilage, acellular cadaveric dermis, lyophilized bovine pericardium, and irradiated bovine tendon: applicability to nasal tip plasty. J Craniofac Surg. 2007;18(3):551–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Schultz GS, Wysocki A. Interactions between extracellular matrix and growth factors in wound healing. Wound Repair Regen. 2009;17:153–62.PubMedCrossRefGoogle Scholar
  9. 9.
    Knox SM, Whitelock JM. Perlecan: how does one molecule do so many things? Cell Mol Life Sci. 2006;63:2435–45.PubMedCrossRefGoogle Scholar
  10. 10.
    Hallman R, Horn N, Selg M, et al. Expression and function of laminins in the embryonic and mature vasculature. Physiol Rev. 2005;85:979–1000.CrossRefGoogle Scholar
  11. 11.
    Jiang WG, Harding KG. Enhancement of wound tissue expansion and angiogenesis by matrix-embedded fibroblasts (Dermagraft), a role of hepatocyte growth factor/scatter factor. Int J Mol Med. 1998;2:203–10.PubMedGoogle Scholar
  12. 12.
    Mansbridge J, Liu K, Patch R, Symons K, Pinney E. Three-dimensional fibroblast culture implant for the treatment of diabetic foot ulcers: metabolic activity and therapeutic range. Tissue Eng. 1998;4(4):403–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Gentzkow GD, Iwasaki SD, Hershon KS, et al. Use of dermagraft, a cultured human dermis, to treat diabetic foot ulcers. Diabetes Care. 1996;19(4):350–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Pollak RA, Edington H, Jensen JL, Kroeker RO, Gentzkow GD, Dermagraft Diabetic Ulcer Study Group. A human dermal replacement for the treatment of diabetic foot ulcers. Wounds. 1997;9:175–8.Google Scholar
  15. 15.
    Naughton G, Mansbridge J, Gentzkow G. A metabolically active human dermal replacement for the ­treatment of diabetic foot ulcers. Artif Organs. 1997;21(11):1203–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Bowering CK. The use of Dermagraft in the treatment of diabetic foot ulcers. Today’s Ther Trends. 1998;16:87–96.Google Scholar
  17. 17.
    Marston MA, Hanft J, Norwood P, Pollack R. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care. 2003;26(6):1701–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Veves A, Falanga V, Armstrong DG, Sabolinski ML. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers. Diabetes Care. 2001;24:290–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Brem H, Blledux J, Bloom T, Kerstein MD, Holllier L. Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent. Arch Surg. 2000;135:627–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Steinberg JS, Edmonds M, Hurley DP, King WN. Confirmatory data from EU study supports Apligraf for the treatment of neuropathic diabetic foot ulcers. J Am Podiatr Med Assoc. 2010;100(1):73–7.PubMedGoogle Scholar
  21. 21.
    Sabolinski ML, Alvarez O, Auletta M, et al. Cultured skin as a “smart material” for healing wounds: experience in venous ulcers. Biomaterials. 1996;17:311–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Eaglstein WH, Falanga V. Tissue engineering for skin; an update. J Am Acad Dermatol. 1998;39:1007–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Phillips TJ, Manzoor J, Rojas A, Isaacs C, Carson P, Sabolinski M, Young J, Falanga V. The longevity of a bilayered skin substitute after application to venous ulcers. Arch Dermatol. 2002;138(8):1079–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Newton DJ, Khan F, Belch JJF, Mitchell MR, Leese GP. J Foot Ankle Surg. 2002;41:233–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Falanga V, Margolis D, Alverez O, et al. Healing of venous ulcer and lack of clinical rejection with an allogenic cultured human skin equivalent. Arch Dermatol. 1998;134:293–300.PubMedCrossRefGoogle Scholar
  26. 26.
    Gentzkow GD, Jensen JL, Pollak RA, et al. Improved healing of diabetic foot ulcers after grafting with a ­living human dermal replacement. Wounds. 1999;11:77–84.Google Scholar
  27. 27.
    Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21(5):822–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Landsman AS, Cook J, Cook E, et al. A retrospective clinical study of 188 consecutive patients to examine the effectiveness of a biologically active, cryopreserved human skin allograft (TheraSkin) on the treatment of diabetic foot ulcers and venous leg ulcers. Foot Ankle Spec. 2011;4(1):29–41.PubMedCrossRefGoogle Scholar
  29. 29.
    Abstract presented by A. Landsman et al. for the Symposium on advanced wound care, April 2010; Study conducted by the University of Maryland, Institute of Human Virology, Baltimore, MD, Feb 2010.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Podiatric Surgery, Department of SurgeryCambridge HospitalCambridgeUSA
  2. 2.Department of SurgeryHarvard Medical SchoolBostonUSA
  3. 3.Department of ResearchCalifornia School of Podiatric Medicine at Samuel Merritt UniversityOaklandUSA
  4. 4.Division of Podiatry, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA

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