A poster,
A Novel method for reconstructing complex diabetic foot wounds using Biodegradable Temporising Matrix (BTM), was presented at the British Orthopaedic Foot and Ankle Society (BOFAS) Annual Congress held in Belfast last month.
Surgeons (Plastic Surgery, Orthopaedic Surgery) at Liverpool University Hospitals NHS Trust conducted a prospective study to evaluate the efficacy of BTM in the reconstruction of wounds after debridement for DFA (Diabetic foot attack*).
Eight patients (mean age of 60) with complex diabetic foot wounds (exposed fascia, tendons, bone), after initial debridement and application of negative pressure wound therapy, had BTM reconstruction following partial foot amputations, ray amputations and trans metatarsal amputations.
All eight patients had successful BTM integration with the tissues. Six patients achieved complete wound healing at a median time of 18 weeks. Two patients underwent a second procedure with skin graft for final wound coverage at 3 months. There were no infections or re-ulceration at a mean follow up of 10 months (2-30).
Conclusion: Our experience suggests that BTM is a safe and effective treatment for coverage of complex wounds after debridement for DFA. In larger wounds, skin graft speeds up wound coverage, while in small to moderate wounds BTM is a single stage procedure with superior aesthetic and functional outcomes.
*Diabetic Foot Attack
The commonest manifestation of foot infection in the presence of peripheral neuropathy is an infected diabetic foot ulcer. Classical symptoms and signs of infection are often delayed as their expression is dependent on an intact peripheral nervous system. However, most diabetic foot ulcers respond favourably to bedside podiatric debridement, offloading in a TCC and administration of a course of deep tissue sample, culture-specific, oral antibiotics. Occasionally, some infections progress rapidly along the tissue planes with signs of spreading cellulitis, tissue necrosis and systemic inflammatory response. Such infections can be limb-threatening without timely intervention and have been labelled as ‘diabetic foot attack’. The management of diabetic foot attack is ideally delivered by a multi-disciplinary diabetic foot team using a structured approach. The foot and ankle surgeon is expected to take the lead in the surgical component of management.
https://www.bofas.org.uk/hyperbook/systemic-disorders/diabetic-foot/acute-diabetic-foot#:~:text=Diabetic Foot Attack,-The commonest manifestation&text=Occasionally, some infections progress rapidly,as 'diabetic foot attack'.
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