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.
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.
Up to 24% of DFUs will eventually lead to a lower extremity amputation4
25% lifetime risk of developing a DFU for patients with diabetes5
DFUs/amputations cost the NHS £1 in every £1206
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.
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
The limb must receive adequate blood supply to promote healing.7
Wound care includes managing wound exudate, infection control, tissue debridement and callus removal.7
Pressure redistribution (offloading) and reduction of repetitive shear is critical for prevention of further tissue inflammation or damage, and healing of existing ulcers.7
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.
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
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.
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.
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.
3M™ 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.12
In 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
3M™ 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.
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.
3M™ 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.
3M™ 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.
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.
3M™ 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.
3M™ 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.
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
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.
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.
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.
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.18
NPWT appears to be as safe as and more efficacious than AMWT for the treatment of diabetic foot ulcers.18
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Share the following resources with your patients to provide guidance and help answer questions regarding DFUs.
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.
Important information: Patients should consult with their healthcare provider regarding their special conditions and treatments in addition to the information provided in this guide.
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
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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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.