Introduction: The healing of venous ulcers is difficult, and several sources indicate a multidisc... more Introduction: The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Materials and methods: Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results: Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduction in wound size and, more commonly, complete wound closure. Conclusion: Adding venous evaluation referral to wound center protocol in patients with suspected venous disease improved healing outcomes, thus improving quality of life.
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had recalcitrant ulcers requiring further therapy. Our findings in 127 patients with neuropathic diabetic foot ulcers add further credence to the growing evidence that percutaneous complete tenotomy of the Achilles tendon is a viable approach to treat Wagner Grade 1 to 4 foot ulcers.
Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, c... more Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, cortical bone is relatively avascular and provides a poor base for wound healing and skin grafting. It has been shown that cortical bone fenestration and decortication can expedite wound healing in exposed calvarial bone. We present a case study where cortical bone fenestration and the subsequent application of human skin equivalent were used to heal a chronic wound of the lower extremity. We propose that this technique can facilitate the production of granulation tissue, and can aid the healing of chronic wounds of the lower extremities associated with exposed bone.
Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as... more Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple co-morbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm 2 (0.4-73.95 cm 2). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not lost to follow up, 26 achieved complete healing with an average time to healing of 16 weeks and an average of 1.24 applications of cUC. The results suggest that cUC used as an adjunctive tissue therapy in conjunction with surgical debridement, resection of infected bone, open cortex and antibiotic treatment may be an effective overall treatment strategy to promote wound healing of complex foot ulcers associated with osteomyelitis. The preliminary results are encouraging and warrant further randomized control studies to determine whether cUC might help address such an unmet medical need.
High bacterial loads within chronic wounds increase the risk of infection and complication. Detec... more High bacterial loads within chronic wounds increase the risk of infection and complication. Detection and localization of bacterial loads through point‐of‐care fluorescence (FL) imaging can objectively inform and support bacterial treatment decisions. This single time‐point, retrospective analysis describes the treatment decisions made on 1000 chronic wounds (DFUs, VLUs, PIs, surgical wounds, burns, and others) at 211 wound‐care facilities across 36 US states. Clinical assessment findings and treatment plans derived from them, as well as subsequent FL‐imaging (MolecuLight®) findings and any associated treatment plan changes, were recorded for analysis. FL signals indicating elevated bacterial loads were observed in 701 wounds (70.8%), while only 293 (29.6%) showed signs/symptoms of infection. After FL‐imaging, treatment plans changed in 528 wounds as follows: more extensive debridement (18.7%), more extensive hygiene (17.2%), FL‐targeted debridement (17.2%), new topical therapies (1...
Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many ... more Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many of these cases, surgical intervention is the best option. This article will review the risk factors for foot wounds in people with diabetes, discuss preventative and surgical strategies, and present surgical management techniques to treat ulceration and chronic infection in these wounds..
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an imme... more The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an immense impact on the ability of medical staff to perform their daily activities. Thus, we sought to direct patients who had gram-positive Acute Bacterial Skin and Skin Structure Infections (ABSSSI) to our Outpatient Department/Wound Care Center for treatment. We met the challenge of the pandemic by shifting care in the treatment of ABSSSI using a new antibiotic delivery system. We examined the use and cost-effectiveness of Dalbavancin, a unique long-acting lipoglycopeptide antibiotic that is used in the treatment of acute bacterial skin and skin structure infections, during the COVID-19 pandemic. A total of 631 patients were treated in the Outpatient Department/Wound Care Center, with re-evaluation at the Wound Care Center on Day 3 post-infusion. The primary test of cure or major improvement was based on a 4- to 6-week re-assessment by the Wound Care Center Faculty (i.e., Podiatric, Vascula...
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society, Jan 16, 2016
Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as... more Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple co-morbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm(2) (0.4 - 73.95 cm(2) ). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not...
Wounds : a compendium of clinical research and practice, 2008
Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many ... more Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many of these cases, surgical intervention is the best option. This article will review the risk factors for foot wounds in people with diabetes, discuss preventative and surgical strategies, and present surgical management techniques to treat ulceration and chronic infection in these wounds..
Soft tissue and bone infections of the lower limb continue to be a frequent and serious complicat... more Soft tissue and bone infections of the lower limb continue to be a frequent and serious complication in patients with diabetes mellitus. The best choice of antimicrobial for the empiric treatment of moderate to severe diabetic foot infections has not been established clearly. We conducted a prospective, randomized, open-label, multicenter trial comparing piperacillin/tazobactam (P/T) (4 g/0.5 g q8h) and ampicillin/sulbactam (A/S) (2 g/1 g q6h) as a parenteral treatment for 314 adult patients with moderate-to-severe infected diabetic foot ulcers. Patients with polymicrobial infections involving methicillin-resistant Staphylococcus aureus also received vancomycin 1 g q12h. Clinical efficacy rates (cure or improvement) were statistically equivalent overall (81% for P/T vs. 83.1% for A/S), and median duration of treatment was similar in the clinically evaluable populations (nine days for P/T, 10 days for A/S). Drug-related adverse events for both study drugs were comparable in frequency and type. Although both study drugs provide safe and effective empiric treatment for moderate-to-severe infected diabetic foot ulcers, piperacillin/tazobactam has the advantage of covering Pseudomonas aeruginosa (bacteriologic success rate of 85.7%), the most commonly isolated gram-negative pathogen in this study.
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had re...
The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan ... more The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduc...
INTRODUCTION The healing of venous ulcers is difficult, and several sources indicate a multidisci... more INTRODUCTION The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. MATERIALS AND METHODS Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. RESULTS Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patient...
The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan ... more The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduc...
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had re...
Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, c... more Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, cortical bone is relatively avascular and provides a poor base for wound healing and skin grafting. It has been shown that cortical bone fenestration and decortication can expedite wound healing in exposed calvarial bone. We present a case study where cortical bone fenestration and the subsequent application of human skin equivalent were used to heal a chronic wound of the lower extremity. We propose that this technique can facilitate the production of granulation tissue, and can aid the healing of chronic wounds of the lower extremities associated with exposed bone.
Debridement of devitalised tissue is an essential component of the effective treatment of chronic... more Debridement of devitalised tissue is an essential component of the effective treatment of chronic wounds. The Versajet™ Hydrosurgery System is a new technology that simultaneously cuts and aspirates soft tissue. In this study we compared Versajet with ...
Soft tissue and bone infections of the lower limb continue to be a frequent and serious complicat... more Soft tissue and bone infections of the lower limb continue to be a frequent and serious complication in patients with diabetes mellitus. The best choice of antimicrobial for the empiric treatment of moderate to severe diabetic foot infections has not been established clearly. We conducted a prospective, randomized, open-label, multicenter trial comparing piperacillin/tazobactam (P/T) (4 g/0.5 g q8h) and ampicillin/sulbactam (A/S) (2 g/1 g q6h) as a parenteral treatment for 314 adult patients with moderate-to-severe infected diabetic foot ulcers. Patients with polymicrobial infections involving methicillin-resistant Staphylococcus aureus also received vancomycin 1 g q12h. Clinical efficacy rates (cure or improvement) were statistically equivalent overall (81% for P/T vs. 83.1% for A/S), and median duration of treatment was similar in the clinically evaluable populations (nine days for P/T, 10 days for A/S). Drug-related adverse events for both study drugs were comparable in frequency and type. Although both study drugs provide safe and effective empiric treatment for moderate-to-severe infected diabetic foot ulcers, piperacillin/tazobactam has the advantage of covering Pseudomonas aeruginosa (bacteriologic success rate of 85.7%), the most commonly isolated gram-negative pathogen in this study.
Introduction: The healing of venous ulcers is difficult, and several sources indicate a multidisc... more Introduction: The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Materials and methods: Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results: Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduction in wound size and, more commonly, complete wound closure. Conclusion: Adding venous evaluation referral to wound center protocol in patients with suspected venous disease improved healing outcomes, thus improving quality of life.
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had recalcitrant ulcers requiring further therapy. Our findings in 127 patients with neuropathic diabetic foot ulcers add further credence to the growing evidence that percutaneous complete tenotomy of the Achilles tendon is a viable approach to treat Wagner Grade 1 to 4 foot ulcers.
Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, c... more Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, cortical bone is relatively avascular and provides a poor base for wound healing and skin grafting. It has been shown that cortical bone fenestration and decortication can expedite wound healing in exposed calvarial bone. We present a case study where cortical bone fenestration and the subsequent application of human skin equivalent were used to heal a chronic wound of the lower extremity. We propose that this technique can facilitate the production of granulation tissue, and can aid the healing of chronic wounds of the lower extremities associated with exposed bone.
Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as... more Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple co-morbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm 2 (0.4-73.95 cm 2). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not lost to follow up, 26 achieved complete healing with an average time to healing of 16 weeks and an average of 1.24 applications of cUC. The results suggest that cUC used as an adjunctive tissue therapy in conjunction with surgical debridement, resection of infected bone, open cortex and antibiotic treatment may be an effective overall treatment strategy to promote wound healing of complex foot ulcers associated with osteomyelitis. The preliminary results are encouraging and warrant further randomized control studies to determine whether cUC might help address such an unmet medical need.
High bacterial loads within chronic wounds increase the risk of infection and complication. Detec... more High bacterial loads within chronic wounds increase the risk of infection and complication. Detection and localization of bacterial loads through point‐of‐care fluorescence (FL) imaging can objectively inform and support bacterial treatment decisions. This single time‐point, retrospective analysis describes the treatment decisions made on 1000 chronic wounds (DFUs, VLUs, PIs, surgical wounds, burns, and others) at 211 wound‐care facilities across 36 US states. Clinical assessment findings and treatment plans derived from them, as well as subsequent FL‐imaging (MolecuLight®) findings and any associated treatment plan changes, were recorded for analysis. FL signals indicating elevated bacterial loads were observed in 701 wounds (70.8%), while only 293 (29.6%) showed signs/symptoms of infection. After FL‐imaging, treatment plans changed in 528 wounds as follows: more extensive debridement (18.7%), more extensive hygiene (17.2%), FL‐targeted debridement (17.2%), new topical therapies (1...
Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many ... more Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many of these cases, surgical intervention is the best option. This article will review the risk factors for foot wounds in people with diabetes, discuss preventative and surgical strategies, and present surgical management techniques to treat ulceration and chronic infection in these wounds..
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an imme... more The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an immense impact on the ability of medical staff to perform their daily activities. Thus, we sought to direct patients who had gram-positive Acute Bacterial Skin and Skin Structure Infections (ABSSSI) to our Outpatient Department/Wound Care Center for treatment. We met the challenge of the pandemic by shifting care in the treatment of ABSSSI using a new antibiotic delivery system. We examined the use and cost-effectiveness of Dalbavancin, a unique long-acting lipoglycopeptide antibiotic that is used in the treatment of acute bacterial skin and skin structure infections, during the COVID-19 pandemic. A total of 631 patients were treated in the Outpatient Department/Wound Care Center, with re-evaluation at the Wound Care Center on Day 3 post-infusion. The primary test of cure or major improvement was based on a 4- to 6-week re-assessment by the Wound Care Center Faculty (i.e., Podiatric, Vascula...
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society, Jan 16, 2016
Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as... more Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple co-morbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm(2) (0.4 - 73.95 cm(2) ). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not...
Wounds : a compendium of clinical research and practice, 2008
Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many ... more Wounds of the foot are the most common reason for diabetes-related hospital admissions. In many of these cases, surgical intervention is the best option. This article will review the risk factors for foot wounds in people with diabetes, discuss preventative and surgical strategies, and present surgical management techniques to treat ulceration and chronic infection in these wounds..
Soft tissue and bone infections of the lower limb continue to be a frequent and serious complicat... more Soft tissue and bone infections of the lower limb continue to be a frequent and serious complication in patients with diabetes mellitus. The best choice of antimicrobial for the empiric treatment of moderate to severe diabetic foot infections has not been established clearly. We conducted a prospective, randomized, open-label, multicenter trial comparing piperacillin/tazobactam (P/T) (4 g/0.5 g q8h) and ampicillin/sulbactam (A/S) (2 g/1 g q6h) as a parenteral treatment for 314 adult patients with moderate-to-severe infected diabetic foot ulcers. Patients with polymicrobial infections involving methicillin-resistant Staphylococcus aureus also received vancomycin 1 g q12h. Clinical efficacy rates (cure or improvement) were statistically equivalent overall (81% for P/T vs. 83.1% for A/S), and median duration of treatment was similar in the clinically evaluable populations (nine days for P/T, 10 days for A/S). Drug-related adverse events for both study drugs were comparable in frequency and type. Although both study drugs provide safe and effective empiric treatment for moderate-to-severe infected diabetic foot ulcers, piperacillin/tazobactam has the advantage of covering Pseudomonas aeruginosa (bacteriologic success rate of 85.7%), the most commonly isolated gram-negative pathogen in this study.
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had re...
The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan ... more The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduc...
INTRODUCTION The healing of venous ulcers is difficult, and several sources indicate a multidisci... more INTRODUCTION The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. MATERIALS AND METHODS Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. RESULTS Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patient...
The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan ... more The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds. Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting. Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduc...
This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with ... more This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had re...
Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, c... more Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, cortical bone is relatively avascular and provides a poor base for wound healing and skin grafting. It has been shown that cortical bone fenestration and decortication can expedite wound healing in exposed calvarial bone. We present a case study where cortical bone fenestration and the subsequent application of human skin equivalent were used to heal a chronic wound of the lower extremity. We propose that this technique can facilitate the production of granulation tissue, and can aid the healing of chronic wounds of the lower extremities associated with exposed bone.
Debridement of devitalised tissue is an essential component of the effective treatment of chronic... more Debridement of devitalised tissue is an essential component of the effective treatment of chronic wounds. The Versajet™ Hydrosurgery System is a new technology that simultaneously cuts and aspirates soft tissue. In this study we compared Versajet with ...
Soft tissue and bone infections of the lower limb continue to be a frequent and serious complicat... more Soft tissue and bone infections of the lower limb continue to be a frequent and serious complication in patients with diabetes mellitus. The best choice of antimicrobial for the empiric treatment of moderate to severe diabetic foot infections has not been established clearly. We conducted a prospective, randomized, open-label, multicenter trial comparing piperacillin/tazobactam (P/T) (4 g/0.5 g q8h) and ampicillin/sulbactam (A/S) (2 g/1 g q6h) as a parenteral treatment for 314 adult patients with moderate-to-severe infected diabetic foot ulcers. Patients with polymicrobial infections involving methicillin-resistant Staphylococcus aureus also received vancomycin 1 g q12h. Clinical efficacy rates (cure or improvement) were statistically equivalent overall (81% for P/T vs. 83.1% for A/S), and median duration of treatment was similar in the clinically evaluable populations (nine days for P/T, 10 days for A/S). Drug-related adverse events for both study drugs were comparable in frequency and type. Although both study drugs provide safe and effective empiric treatment for moderate-to-severe infected diabetic foot ulcers, piperacillin/tazobactam has the advantage of covering Pseudomonas aeruginosa (bacteriologic success rate of 85.7%), the most commonly isolated gram-negative pathogen in this study.
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