by Dr. Jayesh Shah ,MD,CWS

Non-healing wounds are very common in diabetics. Twenty percent of hospital admissions of diabetics are because of lower limb problems. The incidence of amputation is six per 1,000. From 1993 – 1999, approximately 67,000 amputations were performed yearly among people with diabetes. The risk of Lower-extremity amputation in people with diabetes is 15 times higher than that of non – diabetic persons and increases with age.

The triad of peripheral neuropathy (loss of sensation), poor circulation and mechanical abnormality are the major contributing factors to the formations of diabetic foot ulcers. Approximately 60 percent of these ulcers are primarily neuropathic (loss of sensation), 20 percent are primarily ischemic ( poor circulation) and 20 percent are both neuropathic and ischemic.

Structural abnormality in the foot contributes a lot to the formation of foot ulcers in diabetic because structural abnormality in the foot leads to increased pressure. When sustained by repetition, this increase in pressure can cause tissue breakdown and ultimately ulceration, which can lead to serious complications.

These three factors – neuropathy (loss of sensation), Peripheral vascular disease (poor circulation) and mechanical abnormalities – must be identified early and corrected if we are to successfully reduce the amputation rate in the diabetic population. If a high risk foot is identified, that patient should see the primary care doctor at least every six months to make sure the foot is well protected with protective (orthotic) shoes and to get examined for any new ulcerations.

Although most diabetic foot ulcers will resolve with a comprehensive wound management program which includes aggressive revascularization when indicated, some patients will develop chronic, non-healing ulcers, Inadequate treatment of chronic ulcers can lead to hospitalization owing to the development of infections and gangrene, and many patients with such severe complications may ultimately undergo amputation of the affected limb.

In last few years there has been considerable better understanding in healing of this chronic non-healing wounds, Multiple products and advanced dressing options are available like Wound Vacuum (negative pressure therapy), Dermagraf (artificial graft), Collagen dressings like OASIS and Growth factors are available to help those wounds heal faster at Wound centers. Sometimes these advanced dressings are also not able to heal wounds and there may be a need for hyperbaric oxygen therapy for some selected non-healing wound.

When the human body’s natural healing ability is compromised, physicians increasingly rely on specialized wound care and, where indicated, hyperbaric oxygen therapy for non-healing wounds.

Hyperbaric oxygen therapy is a therapy during which the patient breathes pure 100 percent oxygen under increase atmospheric pressure. The air we normally breathe contains only 19-21 percent of this essential element.

The concentration of oxygen normally dissolved in the blood stream is thus raised many times above normal (up to 2000 percent). In addition to the blood, all body fluids including the lymph and cerebrospinal fluid are infused with healing benefits of this molecular oxygen.

It can allow oxygen to go the areas which are inaccessible to the red blood cells, enhance white blood cell function and promote the formation of new capillary and peripheral blood vessels. This results in increased infection control and faster healing of a wide range of conditions.

Hyperbaric oxygen therapy is also used in treatment of diabetic wounds, bone infections, crush injuries, failing skin grafts, soft tissue necrotising infections, gas gangrene, radiation tissue damage and other conditions.

Comprehensive wound management, which includes 1. Controlling edema 2. Off loading (to relieve pressure from the wounds) 3. Infection control 4.Debridement (cleaning the dead tissue) are some of the principles followed at the wound centers which helps this Non healing wounds to heal faster.

Let us join hands with American Diabetic Association and Save limbs and in turn save lives.

Dr. Jayesh Shah
Medical Director
Wound and Healing Center at Northeast Baptist Hospital