Health Care Spending in Patients With Stage 3 and Stage 4 Pressure Injuries and Patients With Diabetic Foot Ulcers Treated Early With Clostridial Collagenase Ointment: A Retrospective Data Review.

INTRODUCTION: Clostridial collagenase ointment (CCO) is the only enzymatic agent indicated for debriding chronic dermal ulcers that is approved by the United States Food and Drug Administration. OBJECTIVE: The objective of this study is to estimate health care spending among patients with Stage 3 and Stage 4 pressure injuries (PIs) and patients with diabetic foot ulcers (DFUs) who experienced early (ie, within 30 days of index diagnosis) versus late (31 to 90 days of index diagnosis) initiation of CCO. METHODS: Patients with PIs and DFUs between January 2007 and March 2017 were identified. One-to-one matched cohorts were used to compare all-cause health care spending and disease-related health care spending between the early initiation and late initiation groups. RESULTS: Compared to the early CCO initiation group, all-cause health care spending for the late CCO initiation group was higher in both patients with PIs and in patients with DFUs within the 12-month follow-up period. Compared to the early CCO initiation group, disease-related health care spending for the late CCO initiation group was higher in both patients with PIs and in patients with DFUs within the 12-month follow-up period. All computations were statistically significant. CONCLUSIONS: Early initiation of CCO provides both all-cause and disease-related health care savings to payers and persons managing patients with PIs or DFUs. Payers, providers, and facilities should consider mechanisms to encourage the early use of CCO to lower costs.

Combining the Benefits of Collagen and Negative Pressure Wound Therapy to Heal a Chronic Diabetic Foot Ulcer: A Case Report.

INTRODUCTION: Diabetes affects 30 million children and adults in the United States, equivalent to 1 out of every 11 people in the country, and results in costs of $327 billion annually. Interventions that can improve healing rates and/or reduce the size of diabetic ulcers may lower the incidence of infection, rate of amputations, and cost of care. This report is on the use of a collagen wound contact layer in conjunction with negative pressure wound therapy (NPWT) to achieve healing in a chronic diabetic foot ulcer (DFU). CASE REPORT: A known patient with type 1 diabetes presented with a chronic DFU of 6 months' duration. Previous treatment modalities included offloading regimens and topical therapies (ie, clostridial collagenase, human platelet-derived growth factors, and 6 applications of a human amniotic membrane allograft). A collagen wound contact layer was applied to the debrided wound bed with subsequent debridements performed every other week, weekly NPWT dressing changes, and weekly contact layer changes. A 91% reduction in wound area was seen at day 35, with complete healing at day 63, and no recurrence at 18 months. CONCLUSIONS: The combination of a collagen wound contact layer and weekly NPWT had a significantly positive effect on healing in this chronic DFU. The regimen was well-tolerated and simple to administer in this case.

The Effects of Collagenase Clostridium histolyticum on Plantar Fibromatosis: A Case Study.

Plantar fibromatosis, also known as Ledderhose's disease, is a rare disorder of benign fibroblast proliferation involving the plantar aponeurosis (i.e., plantar fascia). Traditionally, surgical intervention has been the most common treatment for plantar fibromatosis. However, numerous studies have reported high recurrence rates of plantar fibromatosis after surgical intervention, as well as wound healing difficulties and nerve injury. Plantar fibromatosis often coexists with other superficial fibrous diseases such as Dupuytren's contracture and Peyronie's disease; immunohistochemical and ultrastructural analyses suggest a relationship between Ledderhose's disease and Dupuytren's contracture. The US Food and Drug Administration approved collagenase Clostridium histolyticum for the treatment of Dupuytren's contracture in 2010 and Peyronie's disease in 2013. This case study presents the successful treatment of Ledderhose's disease almost 4 years (45.5 months) after off-label use of collagenase C. histolyticum injection in a 22-year-old white female who had recurrent plantar fibromatosis after surgical intervention.

Do Not Limit Where Ulcer Debridements Can Be Performed!

Medicare is a national program administered on a local level by Medicare Administrative Contractors (MACs). This brief report focuses on the potentially negative outcomes that may ensue as a result of MACs limiting the place of service for ulcer debridement. With the information included herein, the hope is that this problem can be addressed by all parties involved in wound care, including medical directors at these MACs, to remove this limitation impacting patient care.

Significance of sesamoid ossification in peroneus longus tendon ruptures.

Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.