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A home health bulletin distributed to our physicians February, 2009

Send Us Your Toughest

Diabetic Wounds

As many as 25% of people with diabetes will develop a foot ulcer in their lifetime.(1) Foot ulcers rank as the leading cause of hospitalization for patients with diabetes.(2) Call on AbleCare Home Health to provide thorough wound care at home including novel approaches, competently delivered traditional approaches, and measures designed to prevent future wounds.

NPWT Improves Diabetic Wound Care
(Latest Research)

While the use of negative pressure in wound therapy dates back five decades, its use is still considered novel, and researchers continue to find ways to hone the use of negative pressure wound therapy (NPWT). McCallon et al investigated NPWT specifically for the use of healing postoperative diabetic foot wounds.2 As usual, the patients receiving NPWT achieved definitive closure better than patients receiving standard wound care (at a rate of 2 to 1). In 2005, the Lancet published a study showing NPWT improves healing after partial foot amputations.(3) Compared to standard wound care in 18 American centers, NPWT accelerated formation of granulation tissue and improved the percentage of patients achieving healed wounds in 16 weeks by 44%. Secondary analysis of this data showed that NPWT worked equally well and better than standard wound care for both acute and chronic postsurgical wounds.(4) In a separate study, Page and colleagues showed that using NPWT to treat foot wounds reduced the risk of complications, reduced subsequent foot surgeries, and reduced unreimbursed hospital readmissions by 70% or more.(5) When the patients in their analysis did require rehospitalizations, NPWT correlated with a trend toward reduced length of stay.

In an article published in Wound Care, Fleck and Frizzell commented that failure of NPWT often stems from inadequate staff education and skill.(6) You can assure your patients that the nurses of AbleCare Home Health possess the experience and training necessary to effectively deliver NPWT in the home. Nurses of AbleCare have certified NPWT training from KCI. Because of the risk for maceration if the NPWT dressing comes off for more than two hours, AbleCare always provides an alternative dressing in case the NPWT dressing becomes dislodged or in case there is an interruption in electrical power.

Anodyne Therapy® Successful with
Recalcitrant Diabetic Lesions

Currently, peer reviewed evidence with Anodyne Therapy (monochromatic near-infrared photo energy) and wound care is sparse. The most notable investigation is a collection of case studies led by Lon Horowitz, DPM, published in Advances in Wound Care.(7) Horowitz concludes that Anodyne Therapy does an excellent job of improving wound healing in the feet. One of his cases was a two-year old diabetic ulcer plus a heel ulcer and dehiscent post op wound. The patient was wheelchair bound. As with all wounds in this study, these wounds had failed with other therapies and were life-altering. With Anodyne Therapy, all the patient’s wounds healed in five months and the patient became ambulatory for the first time in two years. AbleCare Home Health makes Anodyne Therapy available to your patients at no extra charge to your patients, Medicare, or insurance. We have seen positive results for accelerating wound healing. While AbleCare nurses will suggest Anodyne when it seems appropriate, Anodyne Therapy will only be used as part of your patient’s wound care if you specifically authorize it.

Wound Prevention Services from
AbleCare Home Health

AbleCare’s diabetic care program will do more than provide advanced, effective care for the existing wound. AbleCare will also investigate the circumstances of the lesion and take measures to prevent recurrences. AbleCare nurses or therapists will inspect every shoe and sock in your patient’s collection and discuss footwear choices with patient and family. Occupational therapists can investigate activities of daily living and help implement safer procedures. Nurses will train patient and family to quickly recognize and address problem spots. AbleCare staff will help connect your patient with other available benefits, products, and services (e.g. diabetic shoes, orthotic fitting, diabetic socks) that can protect your patient long-term.

Please offer AbleCare Home Health
to your patients. 

References

1. Singh N, Armstrong D, Lipsky B. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293: 217-28.
2. McCallon S, Knight C, Valiulus J, et al. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage 2000; 46(8): 28-34.
3. Armstrong D, Lavery L. Diabetic foot study consortium. Negative Pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 2005; 366: 1704-10.
4. Armstrong D, Lavery L Boulton A. Negative pressure wound therapy via vacuum-assisted closure following partial foot amputation: what is the role of wound chronicity? Int Wound J. 2007 Mar; 4(1): 79-86.
5. Page J, Newswander B, Schwenke D, et al. Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects. Adv Skin Wound Care 2004; 17: 354-64.
6. Fleck C, Frizzell L. When negative is positive: a review of negative pressure wound therapy. Wound Care 2004; 3(4): 20-5.
7. Horwitz LR, Burke TJ, Carnegie D. “Augmentation of wound healing using monochromatic infrared energy. Exploration of a new technology for wound management.” Adv. Wound Care. 1999 Jan-Feb;12(1):35-40