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Your patients count on you to help them stay out of the hospital and reduce the pain and discomfort caused by DFUs. We offer negative pressure wound therapy (NPWT), advanced wound dressings, and skin integrity solutions to help your patients on their journey to healing.
DFUs are the leading non-traumatic cause of lower extremity and foot amputations worldwide1
They are partial to full thickness wounds with potential bone involvement that can occur due to diabetes, neuropathy, decreased blood flow, increased pressure on the bottom of the foot, decreased sensation, and other factors. The critical nature of DFUs require timely care to promote wound healing and avoid amputation.
The main objective in DFU management is to prevent amputation by closing the wound as quickly as possible. Osteomyelitis, a common consequence of diabetic foot infections, increases the risk of amputation.2 It has been demonstrated that early initiation* of Negative Pressure Wound Therapy can reduce time to significant closure by up to 50% for acute wounds and 67% for chronic wounds.**3
*Defined as treatment within the first 7 days for acute wound and 30 days for chronic wounds from the first wound treatment date.
** Based on a retrospective analysis conducted on a national insurance provider’s medical claims data, which examined 6,181 acute and 1,480 chronic wound patients that received NPWT from January 1, 2009 to June 30, 2011.
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Up to 24% of DFUs will eventually lead to a lower extremity amputation4
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25% lifetime risk of developing a DFU for patients with diabetes5
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DFUs/amputations cost the NHS £1 in every £1206
Key components of best practice DFU management
Best practice supports the use of topical wound care and dressings to properly manage exudate levels and support moist wound healing.7
Excessive moisture can lead to periwound maceration; whereas inadequate moisture may cause desiccation and cell death.8
Both result in delayed healing and increased costs.
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Treatment of underlying disease process
It is important to manage the patient's diabetes as well as risk factors that can lead to ulceration early in order to treat the wound effectively.7
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Ensure adequate blood supply to the limb
The limb must receive adequate blood supply to promote healing.7
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Local wound care including infection control, tissue debridement and callus removal
Wound care includes managing wound exudate, infection control, tissue debridement and callus removal.7
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Pressure offloading
Pressure redistribution (offloading) and reduction of repetitive shear is critical for prevention of further tissue inflammation or damage, and healing of existing ulcers.7
Advanced wound care and skin integrity solutions for DFU management
Maintaining an optimal wound environment has been shown to play a key role in promotion of wound healing. Best practice guidelines support the use of advanced skin and wound care products as important aspects of standardized wound care practices.1,5
3M's comprehensive portfolio of solutions spans the entire spectrum of advanced wound care and skin integrity needs. From dressings that can manage exudate or provide a barrier to bacterial contamination, to products that help protect your patients’ skin, 3M gives you effective solutions and support your wound care patients need to help encourage healing and help them get back to their lives.
Find solutions below based on the type of wound care application you require.
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Protect the skin
Protecting the skin is vital to help ensure good skin health for patients with diabetes. Adverse skin changes can be noted when dressings are unable to manage the volume of drainage, or are not changed often enough. Research supports routine protection of periwound skin from excess exudate and mechanical trauma, and protection of at-risk, compromised skin as essential parts of wound management and wound bed preparation.9
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For the routine protection of periwound skin in low risk patients.3M™ Cavilon™ No Sting Barrier Film
Including Cavilon No Sting Barrier Film in the DFU wound care process helps protect periwound skin from maceration, and can provide protection from adhesive stripping and or tape trauma. -
For managing moderate to severe skin damage in higher risk patients.3M™ Cavilon™ Advanced Skin Protectant
For severely denuded or at risk periwound skin Cavilon Advanced Skin Protectant has a unique formulation which attaches to wet, weepy skin8 providing long-lasting skin protection.
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Prepare the wound bed
Effective wound management strategies may include the use of topical advanced wound care products to help address the underlying issues of bioburden and inflammation. In a recent study, 100% of the 65 DFUs examined were found to contain biofilm.11 Effective wound management strategies may include the use of topical advanced wound care products to help address the underlying issues of biofilm, bioburden and inflammation.
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Collagen/Oxidized Regenerated Cellulose3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver
In the presence of exudate, Promogran Prisma Matrix transforms into a soft, conformable, biodegradable gel. In an RCT on Diabetic Foot Ulcers (DFU) there were significantly fewer withdrawals from the study because of infection in the Promogran Prisma Matrix group compared with the control group (0% vs.31%, p = 0.012). The sum of matrix metalloproteinase-9 and elastase concentration was higher in non-responders compared with responders at baseline (p = 0.0705) and week 4 (p = 0.012). The results suggest that collagen/ORC/silver normalizes the wound microenvironment and protects against infection, resulting in improved wound healing.12In a 6-week RCT involving DFU patients (n=40), significantly more wounds achieved complete healing (63% [12/19] vs. 16% [3/19]) when treated with 3M™ Promogran Prisma™ Collagen Matrix with ORC and Silver (p<0.03) compared to control treatment specified in the standardized protocol for good wound care.13
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Antimicrobials3M™ Silvercel™ Non-Adherent Hydro-Alginate Antimicrobial Dressing
Silvercel Non-Adherent Dressing can help minimise damaging the wound bed, and minimise fibers or residues left behind after the dressing is removed14. Silvercel Non-Adherent Dressing is effective against a broad spectrum of wound pathogens including MRSA, MRSE and VRE15 and protects newly formed tissue14.
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Optimise the wound environment
Diabetic foot ulcers may be variable depths, partial to full thickness, and may involve tendons and bone. Exudate levels can range from low to high depending on multiple factors including wound size, depth, tissue type, lower extremity edema and the presence or absence of tissue inflammation and infection.16
Selecting products that help optimise the wound environment is important in wound healing. Things to consider include: maintaining an optimal environment through exudate management, providing protection from outside contaminants, and enabling easy application and removal.
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Low to High Wound Exudate3M™ Tegaderm™ Silicone Foam Dressing
Featuring 3M’s innovative silicone adhesive technology in a 5-layer foam dressing, the Tegaderm Silicone Foam Dressing is suitable for use on fragile skin and with compression therapy. Unique multi-layer design absorbs and evaporate moisture away from the skin’s surface, helping to minimize wound maceration and to maintain moisture balance for optimal wound healing. -
Moderate to highly exuding wounds3M™ Kerramax Care™ Super-Absorbent Dressing
Combines a unique wicking layer to distribute exudate throughout the dressing and absorptive polymers that absorb and retain high levels of exudate into a durable yet conformable dressing.
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Negative pressure wound therapy (NPWT)
Based on wound assessment and clinical judgment, NPWT may be appropriate for DFU management, and 3M offers a portfolio of proven NPWT options that are indicated in the management of a variety of wounds, including venous insufficiency.
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Setting the standard for negative pressure wound therapy3M™ ActiV.A.C.™ Therapy System
The ActiV.A.C. Therapy System is a portable NPWT device for the mobile patient with features to help maintain the prescribed pressure at the wound site and detect leaks.3M™ V.A.C.® Therapy System
V.A.C.® Therapy can help to reduce hospitalization time and the risk of complications, which in turn helps facilitate patient transitions from inpatient to outpatient care settings.3M™ Veraflo™ Therapy System
Veraflo Therapy combines the benefits of NPWT with automated instillation and dwell of topical wound solution to provide simulateous cleansing and granulation tissue formation.3M™ Veraflo™ Cleanse Choice Dressing Kit
The Veraflo Cleanse Choice Dressing features three foam layers to provide application options for wounds with varying depths, and allows for single or duo pad application. -
Designed to help manage wounds in challenging locations3M™ Snap™ Therapy System
Snap Therapy System is a disposable NPWT system that combines the simplicity of advanced wound dressings with the proven benefits of negative pressure wound therapy in a discreet design and allows patient mobility.
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Offloading - Help prevent further tissue damage and promote healing
Offloading is defined as pressure redistribution and repetitive shear reduction, and it helps prevent further tissue inflammation and damage, lessens the need for extremity amputations,5 and promotes the healing of existing ulcers.
Only 6% of DFU patients receive Total Contact Casting (TCC), the gold standard of care for offloading and promoting effective healing rates.15 Alternatives to TCC may include bed rest, removable cast walkers, healing sandals, surgical shoes, custom sandals, crutches, walkers and wheelchairs.18
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Case Study Excerpt: Use of the Snap Therapy System to manage a calcaneal diabetic foot ulcer (DFU)
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A 64-year-old male had a calcaneal abscess that had been continually worsening for three months, which necessitated excisional debridement of the necrotic tissue and preparation of a healthy wound bed to facilitate closure via grafting. Empiric antibiotics were initiated, and an MRI was ordered to image the lower extremity. Aggressive sharp excisional debridement was performed on the first day of presentation.
The 3M™ Snap™ Plus Therapy System (-125mmHg; 150ml canister) was applied over the debrided wound after complete removal of necrotic tissue and thorough irrigation. On day 5, a swab culture of the abscess revealed Staphylococcus aureus, and the patient continued the prescribed oral antibiotic regimen. Offloading with a knee scooter was recommended, and wound management continued with the Snap Therapy System. After 13 weeks, the ulcer had resolved.
Figure A: DFU on calcaneus at presentation.
Figure B: Wound at postoperative Day 5 after MRI diagnosis of osteomyelitis and initial treatment with the Snap Therapy System.
Figure C: At 8 weeks, wound bed was prepared to receive dHACM allograft, and treatment with the Snap Therapy System was discontinued.
Figure D: At 13 weeks, the ulcer was completely resolved. -
Retrospective case series Wounds treated with the 3M Snap Therapy System
As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.
Patient data and photos courtesy of William H. Tettelbach, MD, FACP, CWS, Wound Care & Hyperbaric Medicine Clinical Services, Intermountain Healthcare, Salt Lake City, UT.
Randomised controlled trial: Negative pressure wound therapy and advanced moist wound therapy comparison
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The purpose of this study was to evaluate the safety and clinical efficacy of negative pressure wound therapy (NPWT) compared with advanced moist wound therapy (AMWT) to treat foot ulcers in diabetic patients.
A multicenter randomised controlled trial enrolled 342 patients who were assigned to either NPWT (3M™ V.A.C.® Therapy System) or AMWT (predominately hydrogels and alginates) and received standard offloading therapy as needed. The trial evaluated treatment until day 112 or ulcer closure by any means. Patients whose wounds achieved closure were followed at three and nine months.
Primary Endpoint
A higher rate of wound closure was observed in the NPWT group (73 [43.2%] vs. 48 [28.9%], p = 0.007) for the AMWT group.18Key Finding
NPWT appears to be as safe as and more efficacious than AMWT for the treatment of diabetic foot ulcers.18
Helping you develop your skills
Discover online learning that's right for you and deepen your clinical expertise with training opportunities and educational resources available on 3M℠ Health Care Academy.
3M webinars and archived events can help keep you up to date with the latest product guidelines and scientifically supported standards of care.
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DFU resources for your patients
Share the following resources with your patients to provide guidance and help answer questions regarding DFUs.
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DFU Patient Guide
This guide provides a high-level overview of what your patients need to know about the identification, prevention, treatment, and trouble signs and risks associated with DFUs.
Download the DFU Patient Guide (PDF 2.1 MB)
Important information: Patients should consult with their healthcare provider regarding their special conditions and treatments in addition to the information provided in this guide.
Choose the offloading care plan that’s right for your patient
Selecting an appropriate offloading care plan or device is dependent on a patient’s assessment, functional status, wound condition and frequency of reassessment. We can help you determine what products fit best for each
Explore 3M Solutions for different conditions
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Help your patients stay fully engaged in daily activities and enjoy their quality of life with science-based compression therapy and skin integrity solutions.
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When pressure injuries can’t be avoided, establish a standard of care that treats the whole patient. 3M can help with solutions to support therapy goals established between you and your patients.
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Optimal outcomes start with early treatment and consistent management of traumatic wounds. Together, we can strive to reduce preventable complications, drive toward better outcomes and, ultimately, aspire to restore patients’ lives.
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People living with chronic oedema and VLUs want to engage fully in everyday activities - without feeling uncomfortable or self-conscious about what’s on their legs and feet. 3M can help manage challenges related to VLUs.
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We are here to help! Get in touch with our customer support team for advice about our products and how to use them.
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View our advanced wound care and Negative Pressure Wound Therapy and I.V. dressings portfolios and browse our product catalogue.
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Find answers to the most frequently asked questions regarding 3M Health Care.
Note: Specific indications, contraindications, warnings, precautions and safety information exist for these products and therapies. Please consult a physician and product instructions for use prior to application. This material is intended for healthcare professionals.
References
- Hingorani, A., LaMuraglia, G. M., Henke, P., Meissner, M. H., Loretz, L., Zinszer, K. M., ... & Mills Sr, J. L. (2016). The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. Journal of vascular surgery, 63(2), 3S-21S.
- Giurato, L., Meloni, M., Izzo, V., & Uccioli, L. (2017). Osteomyelitis in diabetic foot: a comprehensive overview. World Journal of Diabetes, 8(4), 135.
- Miller-Mikolajczyk, C.; MStat, R.J. Real world use: comparing early versus late initiation of negative pressure wound therapy on wound surface area reduction in patients at wound care clinics. Poster presented at The Wound Ostomy and Continence Nurses Society Annual Conference, June 22-26, 2013. Seattle, Washington.
- Pemayun T et al. Risk Factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case-control study. Diabetic Foot Ankle 2015; 6:29629. doi:10.3402/dfa.v6.29629.
- Armstrong D, Boulton M.D., Bus S. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med, 2017; 376;24.
- Marion Kerr. NHS – London Clinical Network. Foot care in diabetes: The human and financial cost. Insight Health Economics 2017; Available at http://www.londonscn.nhs.uk/wp-content/uploads/2017/04/dia-foot-care-mtg-kerr-27042017.pdf. Last accessed February 2021.
- International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers. Wounds International, 2013. Available from: https://www.woundsinternational.com.
- Schultz GS, Barillo DJ, Mozingo DW, Chin GA; Wound Bed Advisory Board Members. Wound bed preparation and a brief history of TIME. Int Wound J. 2004 Apr;1(1):19-32.
- Bianchi, J. A. N. I. C. E. (2012). Protecting the integrity of the periwound skin. Wound Essentials, 7(1), 58–64.
- Brennan, Mary R.; Milne, Catherine T.; Agrell-Kann, Marie; Ekholm, Bruce P. Clinical Evaluation of a Skin Protectant for the Management of Incontinence Associated Dermatitis: An Open-Label, Nonrandomized, Prospective Study. J of Wound,
- Ceri H, Olson ME, Stremick C, Read RR, Morck D, Buret A. The Calgary Biofilm Device: new technology for rapid determination of antibiotic susceptibilities of bacterial biofilms. J Clin Microbiol. 1999; 37(6):1771-6.
- Gottrup F, Cullen B, Karlsmark T, Bischoff-Mikkelsen M, Nisbet L, Gibson M. Randomized controlled trial on collagen/oxidized regenerated cellulose /silver treatment. Wound Repair & Regeneration 2013; 21: 1-10.
- Lazaro-Martinez JL, Garcia-Morales E, Beneit-Montesinos JV, Martinez-de-Jesus F, Aragon-Sanchez FJ. Randomized comparative trial of a collagen/oxidized regenerated cellulose dressing in the treatment of neuropathic diabetic foot ulcers. Cir Esp. 2007;82(1):27-31.
- AMS data on file JJ-25A, JJ-25B, AMS data on file.
- Report: P1157R 7 day log reduction (2008), AMS data on file.
- Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound care? Wound Repair Regen. 2010 Mar-Apr;18(2):154-8
- Driver RD, Blume PA. Evaluation of wound care and health-care use costs in patients with diabetic foot ulcers treated with negative pressure wound therapy versus advanced moist wound therapy. Journal of the American Podiatric Medical Association. 2014; 104 (2):147-153.
- Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers - a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631-6.
