None — Diabetes Foot Complications
The American Diabetes Association estimates 23.6 million people in the U.S. have diabetes. Roughly 1.6 million new cases are diagnosed annually in Americans 20 and older.
Over time, people with diabetes are at risk for developing a number of complications. Diabetes is associated with circulation problems and poor wound healing. In addition, roughly 60 to 70 percent of diabetics develop neuropathy, a form of nerve damage. The condition can affect the ability to feel pain in affected areas (like the feet). In some cases, nerve damage is so severe, the patient can't even feel pain from a tack or nail embedded in the bottom of the foot. Even a small wound may go unnoticed until it develops into a serious ulcer.
No matter what the original cause of the injury, compromised circulation and poor wound healing mean the injury often doesn't heal as quickly as it would in healthy, non-diabetics. If bacteria get into the wound, the infection can become very difficult to treat. Sometimes the tissue in the immediate area dies (gangrene). To prevent the infection from spreading, doctors may recommend amputation of the affected area.
According to the National Institute of Diabetes and Digestive and Kidney Disease, more than 60 percent of non-traumatic amputations are performed for complications of diabetes.
Improving Wound Healing
A big obstacle to complete healing is getting healthy skin to completely cover and close the wound. When other treatments fail to close the wound, doctors may recommend a skin graft. A section of healthy skin is taken from another area of the body and placed over the wound, hopefully, spurring healing.
The problem with a skin graft is that is ultimately requires the body to heal at two sites (the donor and wound sites). To limit the amount of donor skin, some physicians use an instrument to punch a pattern of tiny holes into the skin patch. The skin in then pulled into a fish-net like pattern and placed over the wound. David Armstrong, D.P.M,. M.D., Ph.D., Surgeon with the Arizona Health Science Center in Tucson, says the process stretches out the total area of donor skin by up to three times its original size. The donor skin is sutured or stapled into place. Hopefully, new skin cells will fill in mesh and close the wound.
Mincing Micrografts
Traditionally, skin grafting is done in the operating room using a special bladed instrument, called a dermatone. Even when only a small skin graft is taken, the technique still causes a considerable amount of pain at the donor site.
Physicians at the Southern Arizona Limb Salvage Alliance at the University of Arizona are using a new technique, called micrografting. Using an instrument, called the XPANSION® System (Wright Medical Group, Inc.), doctors remove a tiny patch of skin. The donor skin is cut (minced) into very fine pieces, then spread, like a topping, onto the wound site.
Armstrong explains the tiny pieces of skin are like little islands in the wound site. The skin "islands" grow together, forming larger islands. Eventually, all the islands connect to form a solid piece of tissue covering the wound.
By mincing the donor skin, doctors are able to cover an area that's up to 100 times the size of the original graft. Thus, only a tiny amount of healthy skin is needed to cover many wounds, reducing trauma and pain at the donor site.
Research suggests the new technique is more effective than standard skin grafting in promoting healing of chronic wounds. In addition, the skin grafting takes only about 20 minutes and can be done in an outpatient setting, using local anesthetics.
Armstrong says traditional skin grafts will still be the standard treatment for most patients. However, micrografting may be ideal for patients with diabetes (who often have other complications from the disease) and those who have lost a significant amount of skin (like burn patients or soldiers with severe trauma).
For general information on diabetes:
American Diabetes Association Centers for Disease Control and Prevention National Institute of Diabetes and Digestive and Kidney Diseases