This is the case of a patient with extensive forefoot gangrene, extending almost till the ankle. Patient was a known diabetic and hypertensive. Complete occlusion of below knee vessels was there. Rheologic agents, silver dressing & HBOT were used to treat this patient resulting in complete closure of the wounds and salvage of the foot
Diabetic Foot Ulcers & Growth Factors…
What are growth factors and are they useful in diabetic foot ulcers? Let us try to answer it in non medical lingo.
What are Growth Factors?
Growth factors are substances released by the body to help in wound healing. They get released from various cells once an injury occurs. They help the body to heal a wound. The action of growth factors starts almost from the time you get a wound or injury. Various types of cells release different growth factors based on the type of wound, the duration of the wound etc.
What kind of growth factors are there?
Various growth factors are present in the body like Platelet derived growth factor(PDGF), epidermal growth factor(EGF), Vascular endothelial growth factor, keratinocyte growth factor, transforming growth factors(TGF) etc
Which growth factors are commercially available?
Basically only two growth factors, PDGF & EGF are available for commercial use in the treatment of diabetic foot wounds. Other growth factors are still in the research phase for wound healing.
Can growth factors be applied at anytime to the wound?
No. Growth factors should be used only after thorough cleaning/debridement of the wound has been carried out. If the wound still has pus, dead tissue or gangrenous tissue, the growth factor will not be useful. Therefore cleaning of the wound is of utmost importance before using a growth factor. Growth factors cannot be expected to improve wound healing unless comprehensive wound care is carried out, which addresses the underlying problem of these wounds. Therefore the infection, underlying circulatory problem, blood sugar levels all need to be treated before growth factors will show any improvement in the healing of the wound.
How should growth factors be applied?
Growth factors must be applied as per manufacturer instructions. We prefer to apply them twice daily to a wound. Once growth factor application starts we monitor the wound for progress. If within 15 days of starting the application we find either no difference in the wound or we find that there is less than 50% reduction in wound size, we investigate further as to what is preventing the wound from healing or then we might change the treatment modalities.
Diabetic Foot Problems : Control your sugars…most important. No rise in sugars means no foot problems.
- Inspect your feet daily for blisters, bleeding, and lesions between your toes.
- Use a mirror to see the bottom of your foot and heel.
- Do not soak your feet unless the temperature of the water is lukewarm, not as hot as you can stand it. (95°-100° Fahrenheit).
- Avoid temperature extremes – do not use hot water bottles or heating pads on your feet.
- Wash your feet daily with warm, soapy water and dry them well, especially between the toes.
- Use a moisturizing cream or lotion daily, but avoid getting it between the toes.
- Do not use acids or chemical corn removers.
- Do not perform “bathroom surgery” on corns, calluses, or ingrown toenails.
- Trim your toenails carefully and file them gently. Cut your nails straight across . Have a podiatrist treat you regularly if you cannot trim them yourself without difficulty.
- Contact your podiatric surgeon immediately if your foot becomes swollen or is painful, or if redness occurs.
- Do not smoke.
- Learn all you can about diabetes and how it can affect your feet.
- Have regular foot examinations by your podiatric surgeon.