Use of Topical Small Molecule Technology to Improve Patient Outcomes in the Diabetic Wound Care Setting.

Patients were chosen at random by primary investigator based upon initial presentation with dry, cracked, and/or reddened skin, with underlying complications from compromised microvasculature. Intervention was conducted by using topical products designed to utilize small molecule technologies, with a molecular weight of fewer than 500 Da, to deliver, via topical diffusion, nutrients and antioxidants through the skin layers to address issues stemming from inadequate blood flow to the dermis. An "all-in-one" moisturizing cleansing lotion was applied to the affected areas and washed gently with a warm damp cloth. After cleansing, the skin was treated with a moisturizing skin cream or a chlorhexidine-containing skin shield on areas with redness or advanced breakdown. All products contain dimethicone as an active ingredient and are classified as OTC skin protectants per approved FDA monographs. Patients were evaluated by the primary investigator for noticeable resolution or improvements in dryness, scaling, skin cracks, and erythema.

Commentary on the conversion to an advanced standard of care for the treatment of diabetic foot ulcers and other chronic wounds.

There have been notable contributions in the literature regarding the consensus for a new standard for the treatment of diabetic foot ulcers. The more recent advances in wound care therapies, modalities, and evidence-based research have demonstrated that an advanced standard of care for wound healing should exist. Failure of treatment protocols, which center on a 50% area of wound reduction within 4 weeks as a response to standard conventional care, should indicate the use of adjuvant therapies. Negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT), growth factors, human-derived bioengineered tissue, and extracellular matrix products are readily available. This commentary will explore a brief selection of the current wound care literature as it relates to the acceptance of a new advanced standard of care. Furthermore, the intention is to stimulate further discussion and thought on the relevance of this approach in the treatment of diabetic foot ulcers and chronic wounds and how it may correlate with the ultimate outcome of healing in general.

Off-loading practices for the wounded foot: concepts and choices.

A wound practitioner's best-laid plan of care and strategy for healing an ulcerated foot is doomed to fail without a properly conceived approach based on sound off-loading principles. Wound healing that has stalled despite best-practice techniques may require reevaluation of off-loading choices. This is particularly true in the patient with abnormal foot pathologies. Special considerations are certainly required with neuropathic ulcers; however, any wound on a weight-bearing surface of the foot requires proper off-loading. This discussion explores the basic biomechanical and pathomechanical concepts that modify and influence ambulation and gait patterns. Integration of these concepts into the choices for off-loading to deter pathologic influences will alert the reader of precautionary measures and other factors for consideration. The aim of this column is to provide both an adequate working knowledge of the available off-loading devices and the necessary tools and concepts needed to stimulate wise decision protocols for wound management and healing.