Diabetic Foot Ulcer A Complete Solution Therapy Approach with Adapted Products
A Complete Solution for Diabetic Foot Ulcers This booklet focuses on the recommended treatment of diabetic foot ulcers. Diabetes is regarded as the health crisis of the 21st century. Did you know that: n 285 million people worldwide are affected by diabetes 1 n Each year a further 7 million develop diabetes 1 n More than 9 million Canadians live with diabetes or prediabetes 1 n 15% of persons with diabetes will develop a foot ulcer 2-3 n Every 30 seconds a lower limb is lost due to diabetes somewhere in the world 4 n The total costs for treating a diabetic foot ulcer can range from $10,000 to $60,000 5-6 The diabetic foot ulcer is one of the most severe effects of diabetes. BSN Medical offers a full package of primary dressings, fixation products and casting products for pressure offloading to help you help your patients. Today, diabetes is extremely widespread. The disease is increasingly a result of lifestyle choices, in particular lack of exercise, excessive blood pressure and excess weight. Early recognition and taking a proactive stance help to keep the late effects in check. 1 Canadian Diabetes Association 2 National Institute of Diabetes and Digestive and Kidney Diseases: Diabetic Neuropathy: The Nerve Damage of Diabetes. Washington, DC, US Department of Health and Human Services, 1995. 3 Mayfield JA, Reiber GE, Sanders LJ, et al.: Preventive foot care in people with diabetes. Diabetes Care 1998; 21:2161-2177. 4 Kshitij Shankhdhar, MBBS, Dip Diab, A World of Difference in Diabetic Foot Care, Podiatry Today, Volume 21 Issue 11, November 2008. 5 Glover JL, Weingarten MA, Buchbinder DS, Poucher RL, Deitrick GA 3rd, Fylling CP: A 4-year outcome based retrospective study of wound healing and limb salvage in patients with chronic wounds. Adv Wound Care 10:33 38, 1997. 6 Apelqvist J, Ragnarson-Tenmvall G, Persson U, Larsson J: Diabetic foot ulcers in a multidisciplinary setting: an economic analysis of primary healing and healing with amputation. J Intern Med 235:463 471, 1994. 2
Assessment and Treatment of the Diabetic Foot Ulcer Assessment and Treatment The Canadian Association of Wound Care has developed Best Practice Recommendations for the Prevention, Diagnosis and Treatment of Diabetic Foot Ulcers 1 and recommends the following treatment algorithm 2, in which pressure redistribution is a key component in treating the cause. Person with Diabetic Foot Ulcer Identify and Treat the Cause Vascular flow Awareness of neuropathic changes Pressure redistribution Glycemic control Lipid control Local Wound Care Patient-Centered Concerns Adherence to plan of care Quality-of-life issues related to lifestyle changes Debridement Callus and necrotic tissue Infection Control Rule out/ treat osteomyelitis Moisture Balance Control exudate The importance of offloading Pressure is a factor in 90 percent of diabetic plantar ulcers, and the pressure must be modified or removed. Pressure-induced ischemia occurs in tissues over bony areas of weight-bearing during ambulations and standing. Neuropathy prevents the perception of protective pain, resulting in a increased potential for tissue breakdown. Diabetic plantar ulcerations require aggressive and effective downloading in order to achieve wound healing. 3 1 Heather L. Orsted, RN, BN, ET, MSc; Gordon Searles, OD, MD, FRCPC, FACP; Heather Trowell, BSC, OT (c); Leah Shapera, RN, MSN; Pat Miller, RN, ET; and John Rahman, Certified Orthotist. 2 Sibbald RG, Orsted HL, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: Focus on infection and inflammation. Ostomy/Wound Management. 2003;49(11):24-51. 3 Nursing Best Practice Guideline: Assessment and Management of Foot Ulcers for People with Diabetes. Toronto: RNAO. 2004 3
Treating the Cause with Pressure Redistribution Most diabetic foot specialists consider total contact casting as the pressure offloading Gold Standard in the treatment of non-infected DFU, neuropathic foot wounds and Charcot foot. 1 What is a total contact cast? A composite, anatomically conforming, below knee cast that is applied with minimal padding, enclosing the toes. How does total contact casting work? It effectively reduces plantar pressure and redistributes pressure to the cast: Up to 30% of load is distributed to the cast wall 2 Average forefoot offloading is 65% 3 Pressure is reduced up to 84% at metatarsal heads 4 Why is TCC Gold Standard? n It allows for healing while ambulating n It forces compliance* n It provides an intimate total contact with forefoot, arch, heel, Achilles tendon, and lower leg n It eliminates the propulsive phase of gait n It shortens the stride length n It protects the affected limb from trauma n It minimizes vertical (ground reactive pressures) and shear stresses *Total contact casting forces compliance Armstrong et al. 5 demonstrated that patients using removable cast walker for off-loading wore their device on average during only 28% of their total daily activity, and even the subset most adherent to their off-loading regimen still only wore the device for a total of 60% of their total daily activity. This highlights a key advantage of the total contact cast: it is a non-removable device, which the patient must wear 100% of the time, therefore increasing treatment efficacy. 1 American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care 1999;22:1354-60. 2 Shaw, J.E., et al. The mechanism of plantar unloading in total contact casts: implications for design and clinical use. Foot Ankle Int, 1997. 18(12): p. 809-17. 3 Hartsell HD, Fellner C, Frantz R, et al. The repeatability of total contact cast applications: implications for clinical trials. J Prothèses et orthèses 13 (1) :4-7, 2001. 4 Birke, JA, Sims DS, Buford WL. Walking casts: effect on plantar foot pressures. J Rehabil Res Dev 22:18-22, 1985. 5 Armstrong DG, Lavery LA, Kimbriel HR, et al. Activity patterns of patients with diabetic foot ulceration: patients with active ulceration may not adhere to a standard pressure off-loading regimen. Diabetes Care 2003;26:2595-7. 4
Total Contact Casting is the Gold Standard Total Contact Casting is the most effective offloading device in healing neuropathic foot wounds, as overwhelmingly validated by clinical results. A study by Armstrong et al. 1, involved 63 patients with non-infected neuropathic plantar foot ulcers and compared the TCC with a removable cast walker and a half shoe. All patients were followed for 12 weeks and had weekly visits for wound care and debridement. 100% 90% 80% 70% 89.5% 50.4 61.0 70 60 50 60% 50% 40% 33.5 65.0% 58.3 40 30 Percent Healed Mean Days to Healing 30% 20% 10% 0% Total Contact Cast Removable Cast Walker Half Shoe 20 10 0 Mueller et al. 2 also compared the TCC with another treatment modality. Patients were randomized to receive TCC treatment or to avoid weight bearing and use sterile saline wet-to-dry dressings. The group treated with TCC showed 90.4% healed in an average of 33.5 days, as the non-tcc group showed 31.5% healed in an average of 65.0 days. Myerson et al. 3 used TCCs on 71 plantar ulcers. 90% of the ulcers healed at a mean duration of 5.5 weeks. Those are just a few examples of the clinical evidence available supporting the use of total contact casting as pressure offloading device. In short: n 18 studies (4 randomized) show total contact casting results in consistent healing of active diabetic foot wounds from 36-52 days for 85-95% of patients. n A meta-analysis of 526 ulcers in 493 patients presented by Peter Cavanagh at the 2000 American Diabetes Association 60th Scientific Sessions, showed TCC use resulted in 88% healing in mean time of 43 days. 1 Armstrong DG, Nguyen HC, Lavery LA, et al. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001;24:1019-1022. 2 Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial. Diabetes Care 1989L12(6):384-8. 3 Myerson M, Papa J, Eaton K, et al. The total-contact cast for management of neuropathic plantar ulceration of the foot. J Bone and Joint Surg; 74-A(2):261-269, 1992. 5
Introducing the Cutimed Total Contact Cast Kit BSN Medical is simplifying the pressure offloading Gold Standard solution! The Cutimed Total Contact Cast Kit has been developed in partnership with healthcare professionals dealing with diabetic foot ulcers every day. The result is a recipe that offers the most effective and comfortable TCC through an easy standardized technique. It combines specifically chosen and proven casting materials to provide an intimate comfortable close fit and proper pressure redistribution for an optimized healing environment. The kit provides several advantages such as: n Standardized technique n Optimal effectiveness n Time savings n Convenient all-in-one kit n Increased compliance BSN Medical also provides hands-on educational sessions, training material and on-site support. One example of success with Cutimed Total Contact Cast Kit Day 1 Day 4 Day 7 Day 14 Day 33 Day 47 6
Local Wound Care Discover Cutimed advanced wound care products from BSN Medical, an innovative wound management range which reliably covers all wound healing phases. Once the diabetic foot ulcer is being addressed with pressure offloading, adequate local wound care is required for optimal healing conditions. Especially designed to aid in the treatment of chronic wounds such as diabetic foot ulcers, our new Cutimed range offers a complete selection of effective and patient-friendly products. Local Wound Care Debridement Infection Control Moisture Balance Cutimed Gel Cutimed Sorbact dressing / pad Cutimed Cavity Cutimed Sorbact gel Fixation: Leukomed T, Hypafix transparent The Cutimed Sorbact range has proved effective in infected diabetic ulcers and in preventing an infection. By a unique mode of action the microbial load is effectively reduced without using a chemically active agent, such as silver. Cutimed Sorbact is not linked to undesirable side effects or bacterial resistance and supports the natural wound healing process. 7
Ordering Information Cutimed Total Contact Cast kit Code Dimensions Box Contents Everything you need for one total 7349900-1 kit contact cast Cutimed Sorbact dressing Impregnated acetate fabric primary wound dressing for deep or superficial wounds Cutimed Sorbact pad Impregnated acetate fabric with an additional absorbent core for exudate management Cutimed Sorbact gel Sorbact dressing impregnated with hydrogel for the promotion of autolytic debridement 7216401 4 cm x 6 cm 5 dressings 7216400 4 cm x 6 cm 40 dressings 7216501 7 cm x 9 cm 5 dressings 7216500 7 cm x 9 cm 40 dressings 7216101 7 cm x 9 cm 5 dressings 7216100 7 cm x 9 cm 40 dressings 7216201 10 cm x 10 cm 5 dressings 7216200 10 cm x 10 cm 40 dressings 7216300 10 cm x 20 cm 20 dressings 7261100 7.5 cm x 7.5 cm 10 dressings 7261101 7.5 cm x 15 cm 10 dressings Cutimed Gel Hydrogel used on dry wounds to promote autolytic debridement and create a moist wound environment Cutimed Cavity Foam dressing used to protect the wound and absorb exudates and moisture 7261000 8 g 10 tubes 7261001 15 g 10 tubes 7261002 25 g 10 tubes 7262100 5 cm x 6 cm 10 dressings 7262101 10 cm x 10 cm 10 dressings 7262103 15 cm x 15 cm 05 dressings The Cutimed range of products offers high flexibility in the therapy of chronic wounds. Choose your dressing with the easy-to-use pictograms according to exudate level, wound depth and wound phase: Wound Phase Necrotic Infected Sloughy Granulation Epithelization Wound Depth Shallow Deep Shallow + deep Exudate Dry to low Low to medium Medium to high High to excessive PE110615TCC R2 BSN Medical Inc. 4455 Autoroute Laval West, Suite 255 Laval (QC) Canada H7P 4W6 Tel. 1-877-978-5526 Fax 1-877-978-9703