Clinical Application Guide for Successful Healing
What to Look for in Wound Therapy for your patients with 
Non Healing Foot Ulcers
End-Diastolic Compression
Poor blood circulation is a significant factor in nearly all recalcitrant foot lesions, causing a deficit of oxygen and nutrients together with a build up of fluid and waste metabolites. End-diastolic compression using Circulator Boot™ equipment is an essential technique for any clinic that treats at-risk patients. The system includes a cardiac monitor which is connected to the boot and times the pneumatic compression pulses, typically 85 mm Hg pressure, to occur at end-diastole. This increases blood flow in the feet and legs to induce angiogenesis. It disperses antibiotics through the tissues and is often the only technique that is effective against deep infections. The Circulator Boot is arguably the overall most efficient and cost-effective therapy for foot lesions, especially when infection is present and other wound-closure methods have failed. 

Bio Stimulation Laser 
With an output power of at least 250 mW visible and 250 mW infra red light, plus the ability to uniformly scan the entire wound with an applied dose of 3 to 4 Joules/cm2, Low-Level Laser Therapy (LLLT) stimulates granulation tissue and augments collagen synthesis to accelerate healing. 

Galvanic Stimulation 
In this form of electro therapy, a pulsed-DC current, passing though the wound bed by means of conductive dressings, accelerates wound healing. It will usually turn around a stubborn borderline wound to produce healing, and will significantly shorten the healing time in wounds that would eventually heal anyway. All wounds that require daily nursing care should receive either galvanic or laser stimulation to speed healing and wound closure, if only as a cost-saving measure. 

TENS and Interferential Stimulators 
Electro therapy using nerve stimulation (TENS) or interferential current techniques can accelerate wound healing somewhat by relieving the swelling and increasing blood flow to the feet. 

Vacuum-Assisted Closure 
A mild vacuum applied intermittently to the wound by means of an airtight dressing can aid in wound closure. . . .

Local Antibiotic Injection 
An adjunct to end-diastolic compression therapy, the therapist injects a suitable antibiotic directly into and around the infected tissues using an ultra-fine needle prior to a therapy session. The cardio-synchronous compression pulses act to disperse the antibiotics for effectively eliminating even the most difficult cases of cellulitis and osteomyelitis. 

Multi Electrolyte Soak 
Another adjunct to end-diastolic compression therapy, "Sea Soaks" provides the essential micronutrients needed to aid in healing. In a soak solution for the foot during a therapy session, and along with antibiotics and hydrogen peroxide, this provides a soft debridement that largely replaces the sharp debridement sessions which can otherwise be damaging to delicate infected tissues. 

Maggot Debridement Therapy 
Supplied by overnight courier from a biology laboratory, blowfly larvae are applied to the wound to debride, disinfect and promote healing. Until someone invents an instrument that a nurse can use to do an equal job, the little maggots are the best and safest method for cleaning deep infected wounds.


 In clinical testing, what do the researchers say about end-diastolic pneumatic  compression? 
"Excellent outcomes in patients with severe peripheral arterial occlusive disease suggest that the wound care community consider expanded utilization of this modality." — Zink, J. 2003.

About local antibiotic injection? 
"Both osteomyelitis and soft tissue infections can be successfully treated without any surgical interventions." — Dillon, RS. 1986.

About laser therapy for pain control and tissue repair? "
Laser therapy has a positive treatment effect on tissue repair processes and also, on pain control." — Parker, J. Meta-analysis. 2000.

 
The Treatment Plan