Dalbavancin During the COVID-19 Pandemic.

The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an immense impact on the ability of medical staff to perform their daily activities. Thus, we sought to direct patients who had gram-positive Acute Bacterial Skin and Skin Structure Infections (ABSSSI) to our Outpatient Department/Wound Care Center for treatment. We met the challenge of the pandemic by shifting care in the treatment of ABSSSI using a new antibiotic delivery system. We examined the use and cost-effectiveness of Dalbavancin, a unique long-acting lipoglycopeptide antibiotic that is used in the treatment of acute bacterial skin and skin structure infections, during the COVID-19 pandemic. A total of 631 patients were treated in the Outpatient Department/Wound Care Center, with re-evaluation at the Wound Care Center on Day 3 post-infusion. The primary test of cure or major improvement was based on a 4- to 6-week re-assessment by the Wound Care Center Faculty (i.e., Podiatric, Vascular, Plastics, and Infectious Diseases). Treatment effectiveness was determined by examining documentation at follow-up. We also looked at the number of Outpatient Department treatments at the Wound Care Center for the periods 2018-2019 and 2020-2021. The shift of patients from the Emergency Department/Inpatient Department to the Outpatient Department/Wound Care Center was made possible by the use of the novel, streamlined, safe, Food and Drug Administration (FDA)-approved, well-tolerated antibiotic Dalbavancin. Dalbavancin is not prescribed for gram-negative infections, or for random prescribing, contamination, colonization, or prophylaxis. Dalbavancin has a low infusion reaction, low toxicity, long half-life, and low incidence of adverse reactions. Use of this medication was helpful for decreasing the inpatient burden in our facility.

A retrospective study of cryopreserved umbilical cord as an adjunctive therapy to promote the healing of chronic, complex foot ulcers with underlying osteomyelitis.

Complex lower extremity ulcers with exposed bone, tendon, muscle, and/or joint capsule as well as multiple comorbidities including diabetes, ischemia, and underlying osteomyelitis are difficult to heal and associated with high morbidity and mortality and high rates of amputation. A retrospective review was performed to assess healing of 31 patients presenting with 33 complex foot ulcers with a confirmed histopathological diagnosis of osteomyelitis treated by the same surgeon at a single wound care center by the following treatment regimen: sharp debridement, resection of infected bone when necessary, open cortex, antibiotics, and application of cryopreserved umbilical cord (cUC). The average ulcer size was 15.6 ± 17.7 cm2 (0.4-73.95 cm2 ). Overall, 26 out of the 33 wounds achieved complete closure (78.8%). Five patients were lost to follow-up and one patient expired during the course of treatment, not believed to be treatment related. Of the remaining 27 wounds in patients not lost to follow-up, 26 achieved complete healing with an average time to healing of 16 weeks and an average of 1.24 applications of cUC. The results suggest that cUC used as an adjunctive tissue therapy in conjunction with surgical debridement, resection of infected bone, open cortex, and antibiotic treatment may be an effective overall treatment strategy to promote wound healing of complex foot ulcers associated with osteomyelitis. The preliminary results are encouraging and warrant further randomized control studies to determine whether cUC might help address such an unmet medical need.

Resurrection of the Achilles tenotomy.

This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had recalcitrant ulcers requiring further therapy. Our findings in 127 patients with neuropathic diabetic foot ulcers add further credence to the growing evidence that percutaneous complete tenotomy of the Achilles tendon is a viable approach to treat Wagner Grade 1 to 4 foot ulcers.

Healing diabetic foot ulcers using cortical bone fenestration and cell therapy.

Chronic wounds with exposed bone present a challenge for clinicians. Without intact periosteum, cortical bone is relatively avascular and provides a poor base for wound healing and skin grafting. It has been shown that cortical bone fenestration and decortication can expedite wound healing in exposed calvarial bone. We present a case study where cortical bone fenestration and the subsequent application of human skin equivalent were used to heal a chronic wound of the lower extremity. We propose that this technique can facilitate the production of granulation tissue, and can aid the healing of chronic wounds of the lower extremities associated with exposed bone.