Diabetic Foot Salvage by Limited Access Dressing (LAD)

Abstract

Moist wound healing and Negative pressure wound therapy (NPWT) are newer concepts in wound management. NPWT has been shown to be a safe and effective treatment for complex diabetic foot wounds. Limited Access Dressing (LAD) combines the principles of moist wound healing and NPWT along with a provision of two additional ports (1216Frtube) for instilling antimicrobial solution of choice and alters the wound environment without any need to change the dressing. LAD utilizes definite intermittent negative pressure schedule (30 minutes of negative suction and 3½ hours of rest period; minimum 30mmHg of negative pressure). Intermittent negative pressure regimen of LAD reduces the total duration of negative pressure and need for specially designed suction devices. The LAD design has notable advantages, while avoiding some major disadvantages such as an inaccessible offensive smelling wound environment and relatively high treatment cost. Neuropathy, angiopathy, skin changes (cracks), callosities, and foot deformities leads to nonhealing ulcers followed by infection. Non healing ulcers and infection are major reasons for progressive tissue destruction in diabetic patients. Repeated radical debridement leads to loss of certain amount of viable tissue exposing vital structures, bone, ligaments and subsequent desiccation of exposed tissues and infection starts avicious cycle of debridement and further tissue destruction leading to amputation. LAD has been proved to control wound infection, and help in separation of dead tissue from living tissue by autolytic and mechanical debridement while preserving viable tissue as compared to that by surgical debridement. By virtue of better control of infection and systemic inflammatory response syndrome (SIRS), early physiotherapy (minimizing stiffness and deformity), advantages over other modern methods of dressings and ultra conservative debridement (minimal damage to viable tissue by safer intra LAD natural separation of necrotic tissue), LAD acts as a reliable and effective method of limb salvage in diabetic patients.