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According to the International Consensus on the Diabetic Foot, a foot ulcer is defined as a full-thickness wound below the ankle in a diabetic patient, irrespective of duration (Apelqvist, 1999). Skin necrosis and gangrene are also included in the current system as ulcers. Gangrene was defined in the International Consensus on the Diabetic Foot as a continuous necrosis of the skin and the underlying structures (muscle, tendon, joint or bone).
In each patient the diabetic foot lesion must be classified according to the extent of the lesion, neuropathy and angiopathy. Various classifications can be used for this purpose (Armstrong, 1998; review by Schaper, 2004).
Treatment of diabetic foot ulcers must be tailored for each patient including:
1) metabolic control
2) revascularization procedures
3) debridement and infection control of the lesion; and
4) use of adjuvant therapies such as Vac Instill, hyperbaric chambers, hyper-oxy boots, Versa-Jet, etc.
Systemic antibiotics and various topical antiseptics have been the cornerstone therapy for controlling the infected tissue. Unfortunately, even when topical application of hydrogen peroxide and iodine povidone exert a good infection control, it is at the expense of a high toxicity to the healthy tissues. Instead, Dermacyn has shown to be both safe and efficient as a wound care product that moistens, lucbricates, debrides various types of lesions.
Patients with diabetic foot ulcers receive applications of Dermacyn after debridement and at every dressing change.
For dressing change:
Spray or rinse Dermacyn over the lesion up to three times a day. The wound must remain moistened with Dermacyn for 5-10 minutes and no further rinsing with saline solution or sterile water is needed.
Dermacyn is applied onto the wound in sufficient quantities to wash the wound bed clean of debris. During the visits on Day 0, Week 1, and Week 2 the ulcer can also be soaked in Dermacyn for approximately 2 to 3 minutes. The wound will be allowed to air dry (approximately 2 minutes). In special cases, fistulas can be thoroughly irrigated with Dermacyn for up to 5 minutes. Dermacyn can also be infiltrated into phlegmons.
In all cases, a gauze saturated with Dermacyn (moist wound dressing, not supersaturated with Dermacyn) must be applied to the wound in quantities sufficient to fill (but not pack) the remaining volume of the ulcer. The wound can then be covered with dry gauze and tape.
The number of times a day that a lesion is cleaned with Dermacyn will depend on the severity of the infection. Yet it is convenient to reduce the number of cleaning procedures down to once a day when: 1) there is not purulent secretion; 2) in the presence of a uniform granulation tissue across the wound and 3) a fibrinous-like white tissue appears on top of the granulation tissue. In these conditions, a cleaning procedure a day would be enough and skin graft procedure can be perfomed.
As part of comprehensive therapy
The use of Dermacyn is fully compatible with the use of other technologies. Physicians in Mexico and Europe are routinely using Dermacyn along with the Vac System with good results. It appears that the concomitant use of Dermacyn with oxygen in hyperbaric chambers, the Jetox system or hyper-oxy boots technologies has an additive effect in terms of wound control. It is worth mentioning that the use of Dermacyn with the Jetox system should be used only in those wounds with a lot of purulent /fibrinous material and not in the presence of a uniform granulating tissue.
Finally, Dermacyn could also be the best solution for debriding wounds with the aid of the VersaJet system.
The first clinical trial conducted in diabetic feet necrobiosis took place in Mexico. In this study, Dermayn did not produce any adverse side effects and there was a significant reduction of fetid odor and cellulitis around the ulcers. Both indicators (fetid odor and cellulitis) are generally known to play a key role with the progression of infection in diabetic foot ulcers. It is possible that Dermacyn water could trigger early wound healing through fibroblast migration and proliferation as it has been previously suggested (Yahagi, 2000).
Dermacyn Wound Care has obtained US FDA clearance for moistening, cleaning, and debriding acute and chronic wounds including Stage I-V pressure ulcers, stasis ulcers, diabetic ulcers, post surgical wounds, burns, abrasions, and minor irritations of the skin.
Dermacyn Wound Care is used as part of comprehensive treatment. It can be applied directly to the wound or used in conjunction with absorbent wound dressings and other wound care products
■NON-IRRITATING: Safe to use around the nose, mouth and eyes.
■READY TO USE: No mixing, dilution or rinsing necessary.
■STABLE: Solution has a shelf life of one year from date of manufacture.
■pH-NEUTRAL: pH 6.2 to 7.8
■EASY TO APPLY: Can be used directly on the wound or in combination with gauze, sponges or other absorbent wound dressings.
■EASY DISPOSAL: No special disposal requirements
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