Evolution of Technology


Dermal substitutes or surrogates are a rapidly expanding area of medical technology. Absent of the morbidity and mortality associated with skin grafting, these products confer various benefits when attempting to heal or cover large soft tissue defects or slowly healing wounds. Research has demonstrated the ability of these products to recruit stem cells, decrease wound healing time, serve as scaffolds for eventual skin graft, and prevent future surgeries or procedures, all without donor site morbidity. Sources for these grafts vary from mammalian to fish and reptilian, and vary in size, composition, and anticipated use.

Evolution of Procedure

Wound Coverage

Nonoperative wound care and coverage is the frontline treatment in the invasive management of diabetic foot wounds. While optimization of blood glucose control and other comorbidities is paramount, achieving healing of already present wounds is of paramount importance. Various modalities exist for covering already present wounds. Negative pressure wound therapy, wet-to-dry dressing, antibiotic-laden dressing, contact casting, and xenograft soft tissue coverings all offer various modalities by which providers can potentially achieve coverage of these morbid wounds in an attempt to avoid amputation or other more invasive procedures.

Evolution of Diagnosis

Diabetic Foot Ulcer

Foot ulcerations in the setting of diabetes are difficult to manage conditions which can often lead to foot and/or leg amputation. Due to profound neurological and microvascular damage, individuals with poorly controlled diabetes are prone to developing slow-healing, indolent, chronic wounds which challenge even the most skilled wound care nurses.

In the setting of a poor healing milieu, diabetic foot wounds can linger and expand even in the face of attempted treatment. While amputation is often curative, it is not without risk and harm to the patient. Exhaustion of conservative measures is of paramount importance in the treatment of these wounds. Operative debridement, wet to dry dressings, casting and other forms of immobilization are treatment modalities which can be attempted as an alternative to amputation.