- pressure relief (off-loading)
- rest and limited walking
- use of crutches
- plaster or fibreglass casting for offloading and relieving foot pressure.
- protection of ulcers through the use of temporary protection / pressure relief footwear, special insoles or other.
- restoration of blood supply
- surgical approach and cardiovascular risk reduction
- cessation of smoking
- treatment of hypertension and dyslipidimia
- treatment of the infection.
- cleaning and scraping of necrotic tissue and surrounding callus
- targeted oral antibiotic therapy
- surgical drainage to remove necrotic tissue
- arterial revascularisation
- metabolic control and treatment of co-morbidity.
Care and treatment of lower limb wounds and ulcers
Standard treatments for vascular, pressure and diabetic ulcers and wounds, provided by the International Working Group of Diabetic Foot
In addition to local treatment of ulcers, further treatments are applied:
- Advanced medications or active biological products
- growth factors
- bio-engineered tissues
- treatment with systemic hyperbaric oxygen,
- dressings containing silver or other anti-microbial agents
As presented by Prof. A. Piaggesi during the February 2015 congress on the Diabetic Foot in Rome, current standard and additional treatments include a biophysical approach to tissue repair.
- Shock waves
Shock waves, traditionally used for the treatment of inflammation and joint calcification, have been shown to have a stimulation effect on the processes of wound repair. A probe is put in direct contact with the wound for administration of the pressure waves. The therapy requires the use of the system by a physician.
- Low intensity ultrasound.
Ultrasound therapy at low frequency and low intensity is performed through the application of a dispensing device directly onto the wound.
Electrical stimulation applies electric currents which promote certain cellular repair processes. Electrodes are positioned in the vicinity of the wound for the diffusion of surface electric currents. Electrical stimulation has not actually provided significant, repeatable results on efficacy of the reduction of wounds. In addition, positioning of electrodes on the skin requires special patient training.
- Positive pressure therapy.
Positive pressure therapy treatment involves the application of compression in the ulcerated area, increasing blood flow and stimulating cell migration.
- Negative pressure wound therapy (NPWT).
NPWT devices require the application of a sealed dressing which is perfectly adherent to the wound and connected to a vacuum pump, to apply the sub-atmospheric pressure able to aspirate fluids and granulation tissue. The application of sealed NPWT dressings is not feasible at sites with skin folds and is limited to wounds of certain dimensions (depths less than 0.5 cm cannot be treated), prohibiting its use in early stages. In addition, infected wounds cannot be treated. The costs of consumables are also significant.
- Therapeutic Magnetic Resonance (TMR®) for all skin ulcers.
TMR® therapy is non-invasive and can be applied in combination with other standard and additional therapies. The therapy involves the positioning of the patient onto the diffuser mats, which deliver a pulsed magnetic field at a specific frequency and intensity, promoting faster and more complete healing. The therapy does not require the removal of dressings and can be used in all types of relapsing wounds or ulcers, even directly by the patient at home, following appropriate training by medical staff.