You want to use what to heal my Ulcer?

Chronic ulceration has been an ever increasing problem with the rise of diabetes.  As time has gone on, new techniques have been developed in an effort to help ulcers heal faster and more definitively.  Some techniques have lost favor in practice, while others have become standard of care.  One technique has changed how we treat ulcers, and it may surprise you where this product comes from.  Let’s define a few terms first.

An autograft is taking tissue from one part of the body and using it somewhere else on the same person.  An example of an autograft would be taking a vein from your leg to use in the heart in bypass surgery, or taking skin from the buttock to cover a burn or ulcer.  An allograft is taking living tissue from one human being and using it in on another human being.  This is the principle currently being used to help heal chronic non-healing ulcers.

Dermagraft and Apligraft are examples of autografts that have been developed to help close diabetic ulcers.  These two products are derived from neonatal foreskin.  Yep, that’s right…  we’ve taken the skin after circumcision and put it together with growth factors to make it grow.  The skin is then cut into smaller squares, packaged, and sent refrigerated so that it can be used in offices across the country.  These grafts contain living cells on a “scaffold” that can integrate with the patient’s skin.  Studies of these products have shown that increase the likelihood of an ulcer healing.

These products are not cheap, but because of their incredible performance in helping diabetic patients, many insurances including Medicare cover anywhere up to six applications of this products.  Your podiatrist can help you understand more about these treatments.

I thought My Ulcer was Healed

So you had an ulcer that you thought had closed up, but every time you visit the podiatrist, he takes a scalpel to your foot and opens the ulcer back up. Why does he do that? Before I answer, let’s talk about three things that an ulcer needs to heal: Offloading, Blood Flow, and Decreased Bacterial Load.

Offloading means taking precautions to insure no weight is being put on the ulcer. This means altering shoe wear or even totally immobilizing the foot with the ulcer. If safety measures are not taken to avoid walking on the ulcer, the friction and sheer forces will not allow a diabetic’s delicate skin to heal over the ulcer.

Blood flow is the key to all healing. It contains the growth factors and oxygen needed for the skin to grow over and close the ulcer. In an effort to close the wound, the body will lay down fibrotic tissue. The wound then becomes “senescent” or asleep, meaning the body forgets that it’s there and stops sending blood and healing factors to it.

Bacteria is naturally found on our bodies, but it can’t penetrate intact skin. Once an ulcer opens up, bacteria can enter and produce substances that stop healing. Bacteria can even enter the blood stream and cause additional problems elsewhere.

Now, you were wondering why the podiatrist cuts you up when you come in. By removing the yellow, fibrotic tissue, we “wake up” the body, reminding it that a wound is there so it continues to send healing factors. We like to cut so that we see bleeding, pink tissue so that we know blood is reaching the wound. Bacteria like to grow on the fibrotic tissue, so by removing it, we decrease the bacteria load on the wound. And lastly, you are less likely to walk on a bleeding wound compared to a wound that looks healed over. By following these guidelines, the healing time of an ulcer is much faster.