The problem wound that we are concerned here is diabetic foot infection and gangrene. Non-diabetic wounds are relatively better to response except varicose ulcer.
The problem in the recalcitrant wound to heal is not in the larger arteries, but rather in the smaller arteries or capillaries that comprise of the microcirculatory system. Average microvasculature is 1/20th of a human hair.
Dysfunction in the microcirculatory system (microangiopathy) is the main pathogenesis for problem wound in the diabetic foot, depriving tissues of nutrients, oxygen clearance of necrotic tissue and waste that leads to gangrene.
In the presence of infection, there will be swelling and inflammation compromised microcirculation further. The environment is not conducive for healing.
The final outcome is wound that is very hard to heal, chronic and worsening day by day. Sometimes require amputation especially in diabetics.
In general, the leg amputation rate in diabetics is forty times higher in diabetics than any other causes combined.
In order to heal the wound, of course, we have to treat the cause. In the case of diabetic foot, the use of right antibiotic following culture and sensitivity.
When there is poor control blood sugar, by all means, we have to treat these underlying problems including subcutaneous insulin, avoiding glucose spike after a meal with chlorogenic acid, metformin, or acarbose.
Even though the underlying causes are under controlled but since the recalcitrant wound usually related to microcirculatory system dysfunction, we have to ensure the oxygen and nutrients be transported to the wound site.
Easily said than done but the very basis for healing can be achieved by effective integrative medicine approaches.
We are proud to say that we have the best facilities for wound management so that healing process can take place. In the State of Johore, many of the procedures only available at our center.
Some case photos. Before and after treatment. Warning: Viewers discretion are advised!
Examples of the approaches are:
1. Hyperbaric Oxygen Therapy (HBOT) – deliver oxygen to the intended site up to 20 times higher than without HBOT. Oxygen dissolves in body fluid without blood, since our tissues are fluid of about 65%.
2. External Counter-pulsation (ECP) – help exchange of stagnant circulation, reduce edema of the lower limbs.
3. Chelation Therapy – improve micro-circulatory dysfunction.
4. Maggot Debridement Therapy (MDT) – microsurgeons help to do sloughing, suck away necrotic tissue and bacteria, improve capillary flow, stimulate healing.
5. Cupping with blood letting – 2000 years ago the words describe cupping as “old blood don’t go, new blood cannot be burnt”. It helps exchange stagnant blood, enable fresh blood to replace at the wound site
It helps exchange stagnant blood, enable fresh blood to replace at the wound site delivering red blood cell hence oxygen. White blood cell delivers to the site help to control infection.
6. Local Acupuncture – surrounding wound stimulate healing. It is one of the cheapest but effective to stimulate wound healing with or without electrical stimulation, with or without moxibustion.
7. Dressing and debridement – excision of necrotic or dead tissue. See how good the dressing and debridement.
8. Infusion or injection of antibiotic – following culture and sensitivity.
9. Nutritional medicine – helps optimum chemical processes in every single cell. (There are estimated 6,000 chemical processes per second in a single cell with nucleus). Cells require optimum nutrition for metabolism, NOT minimum nutrition.
The combination of procedures almost always required and which procedure or combination of approaches is always individualized base on the causes, underlying microcirculatory dysfunction indicated by low oxygen tension at the periphery concerned, the seriousness of the wound, cost-effectiveness, systemic involvement and to some extend affordability.
Look here for before and after photos of diabetic patients.