Patient description
60-year-old female with uncontrolled type 2 diabetes (HbA1c 12.0%), peripheral neuropathy, and peripheral artery disease (PAD). Using silver sulfadiazine cream and gauze bandage for left foot ulcer that developed from or after an insect bite. Fully ambulatory in post-op shoes. Intermittent sharp pain in left foot.
Wound presentation
Patient presented with full-thickness ulcer, measuring 3.2cm x 3.2cm x 1.7cm, on left lateral foot over the fifth metatarsal base.
Vascular exam revealed left femoral bruit. Left dorsalis pedis (DP) and popliteal pulses nonpalpable and monophasic with Doppler. Angiogram demonstrated widely patent left common, internal, and external iliac arteries; very mild PAD in left common and superficial femoral artery; 40% focal stenosis of left popliteal artery; occlusion of left anterior tibial artery; left DP filled via collaterals; extensive calcific plaque in peroneal artery with diffuse narrowing; extensive calcific plaque in post-tibial artery.
Treatment
Patient underwent left popliteal to DP artery bypass using in situ greater saphenous vein conduit. Left lateral foot wound was surgically debrided. On Day 1, negative pressure wound therapy was started. A full-thickness skin graft was applied to ulcer. On Day 54, skin graft failure was noted. Ultrasound demonstrated occlusion of bypass graft. Ulcer was sharp debrided and enzymatically debrided with collagenase ointment, ADAPTIC™, and gauze. On Day 67, treatment started with hyperbarics (adequate blood supply to the wound was confirmed); enzymatic debridement was continued. The wound was sharp debrided and hyperbarics continued, and treatment was started with REGRANEX Gel; enzymatic debridement was discontinued. On Day 117, hyperbaric treatment was completed and treatment with REGRANEX Gel continued for another eight and a half weeks. Ulcer was completely healed* on Day 176.
Results* After failure of a skin graft, treatment with good ulcer care and REGRANEX Gel was initiated. Ulcer healed approximately 12 weeks after the initiation of this treatment regimen.
*Individual results will vary.
Case studies contributed by Susie Seaman, NP, MSN, CWOCN.
Patient description
50-year-old male with type 2 diabetes, peripheral neuropathy, peripheral artery disease, left fifth toe amputation for osteomyelitis, stenting of right and left external iliac arteries. Has had recurrent left foot ulcers for three to four years. Fully ambulatory in post-op shoe with cutout under ulcer.
Wound presentation
Patient presented with a full-thickness diabetic ulcer, measuring 1.2cm x 1.0cm x 0.4cm, on the plantar surface of the left foot under the first metatarsophalangeal (MTP) joint. Ulcer had 100% granulation, no bone probe, and was surrounded by callus. X-ray was negative for osteomyelitis under ulcer.
Exam revealed left femoral pulse 2+, no bruit. Left popliteal pulse was nonpalpable. Left dorsalis pedis (DP) and posterior tibial (PT) pulses 2+. Left DP was triphasic with Doppler; left PT was biphasic.
Treatment
At initial exam Day 1, ulcer was sharp debrided and treatment was started with REGRANEX Gel. Patient was off-loaded with a post-op shoe and crutches. On Day 7 and Day 17, ulcer was sharp debrided and treatment with REGRANEX Gel continued. On Day 17, treatment with REGRANEX Gel was discontinued, and ulcer was covered with ADAPTIC™ dressing and gauze. Ulcer was completely healed* on Day 27; order was placed for diabetic shoes for patient.
Results* Size of ulcer decreased after just one week of treatment. After five and a half weeks of treatment with less than one tube of REGRANEX Gel and good ulcer care, patient’s diabetic foot ulcer was completely healed.
*Individual results will vary.
Case studies contributed by Susie Seaman, NP, MSN, CWOCN.
Patient description
The patient was presented to ER with DFU. Angiogram to determine vascularity. A week later, sharp debridement was performed. Patient was then discharged to home care with REGRANEX Gel, three days post-debridement with forefoot offloading wedge shoe. Home health nurse monitored patient until seen four weeks later.
*Individual results will vary.
Clinical study results for REGRANEX Gel
In clinical trials, REGRANEX Gel was found to help wounds heal faster and more completely than placebo.4
Review efficacy dataFormulated for healing
Therapy with REGRANEX Gel initiates healing by attracting repair cells to revitalize wounds.7
Review the MOA