Epigard: a synthetic skin substitute with application to podiatric wound management

The authors present a synthetic skin substitute, Epigard, which was developed in 1973 and has been used worldwide for temporary coverage of open wounds. Epigard is a two-layer, non-medicated wound dressing which approximates the function of human skin. The article discusses the proper indications and usage of Epigard, as well as post operative wound management and definitive wound closure decisions. A case presentation involving a serious diabetic wound infection is discussed. At Doctors Hospital, Epigard has become an important adjunctive therapy in wound management by improving wound healing time and decreasing patient hospital stay.

Bacterial pathogens in infected puncture wounds in adults with diabetes

Infections resulting from puncture wounds to the foot in diabetics appear not to have been previously reported in the medical literature. The purpose of this report is to describe bacterial pathogens identified from bone and soft tissue infections precipitated by a puncture injury in patients with diabetes. In a 7-year retrospective study, the authors evaluated 22 patients with osteomyelitis and 44 patients with soft tissue infections. Medical records and operative culture and sensitivity reports were reviewed. Staphylococcus aureus (68%), Streptococcus species (44%), and Enterococcus species (27%) were the most common pathogens identified. Pseudomonas was more common in cases of osteomyelitis (36%) than in soft tissue infections (18%) (p < 0.001). Pseudomonas was more common in patients that had worn tennis shoes at the time of the puncture injury compared to patients that were barefoot or who wore some other type of footwear (p < 0.001). Seventy-four percent of patients had polymicrobial infections. Anaerobes were identified in only seven patients (11%). This study suggests that polymicrobial infections with few anaerobes are common in infected puncture wounds in diabetics. Pseudomonas is more common in bone infections and is associated with wearing tennis shoes at the time of injury.

Retrospective study of hospitalized patients with chronic leg ulcers in Hawaii

The authors describe 226 patients with chronic leg ulcers at a community hospital over a 14-year period. Most leg ulcers were ischemic or venous in origin and located below the ankle. Fifty-five percent of patients were diabetic and the majority of patients were hypertensive. The cases required prolonged hospitalization for systemic antibiotics and vascular surgery. Only 2.3% of patients required above the knee amputation, and 7% needed below-the-knee amputation.

The Diabetes Control and Complications Trial Study: implications for the diabetic foot

The pathogenesis of foot problems in patients with diabetes mellitus involves multiple factors including macrovascular disease, microvascular disease, abnormalities in blood flow distribution, peripheral neuropathy, autonomic neuropathy, physical stress, and infection. Surprisingly, the role of poor glycemic control in the development of diabetic foot complications has not been well studied. Recently, the Diabetes Control and Complications Trial has provided conclusive evidence that hyperglycemia plays a major role in the development of microvascular complications. Because the etiologic factors that contribute to microvascular complications also play an important role in foot complications, one would expect that tight glycemic control, however achieved, would be effective in both the primary and secondary prevention of diabetic foot problems.

Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis

The purpose of this study was to investigate factors that contribute to the development of osteomyelitis of the foot after a puncture wound in patients with diabetes. Forty-five male and 21 female adults with diabetes that were admitted to the hospital for a foot infection precipitated by a puncture were included in the study. Twenty-two (33%) patients had osteomyelitis (O) based on either a positive bone culture or pathology report. Forty-four patients had soft tissue infections (ST). Age and duration of diabetes were similar in both groups. Patients with osteomyelitis received medical treatment later than patients with soft tissue infections. A significant difference was identified when comparing the time interval from the time of the injury until patients were hospitalized and until they had the puncture wound surgically debrided, and when comparing the interval from when patients first received initial professional medical evaluation until they were hospitalized and until they had the puncture wound surgically debrided. Patients with punctures involving the forefoot (FF) and patients that wore shoes (S) at the time of the injury were more likely to develop osteomyelitis than patients that had rearfoot (RF) injuries O: FF = 20, 90%, RF = 2, 10%, ST: FF = 30, 70%, RF = 13, 30%, p < 0.05) and patients that were barefoot (B) at the time of injury (O: S = 15, 88%, B = 2, 12%, ST: S = 21, 57%, B = 16, 43%, p < 0.05). Osteomyelitis is a common complication in patients with diabetes with a foot infection following a puncture wound.(ABSTRACT TRUNCATED AT 250 WORDS)