Diabetics

THE USE OF DERMAGRAFT A BRIEF REVIEW FOR DIABETIC ULCERATION

This patient is a 65-year-old diabetic the shark coat foot and chronicles. He’s been treated in a conservative matter using the breeding agents went to dry dressings, sterile saline, and antibiotic dressings, all have proved unsuccessful.

After reviewing his medical history and having a long discussion with the patient on the various treatments that may render his ulcer closed and prevent the loss of limb, the decision was made to use Dermagraft.

The general procedure and needed requirements are as follows:

The patient needs adequate circulation to allow for healing, and must be committed to limited ambulation and the possible use of a contact casts.

The protocol for the use of Dermagraft may be obtained from Smith and nephew wound management 1-800 – 876-1261. They will supply you with text, video, and probably a salesperson for your first treatment to make sure that the use of their products is both smooth and successful. It should be noted since the product comes frozen in dry ice that it should be ordered to be delivered the morning of use, if this is not possible the delivery should be within 24 hours of use.

This patient’s blood sugars were watched carefully and an honest effort was made to keep him below 150 with the help of dietitian and his primary provider.

The pictures that follow show the initial lesion as first seen, the derided lesion, the healing lesion, and healed lesion. It should also be noted that this patient followed the Dermagraft protocol with no deviation. The product was applied three times. The patient two years later is still ulcer free and has had regular checkups monthly, concomitant with the use of a mild hydrating cream directly over the area to keep the tissue supple. He is also in a molded shoe with a contact device of double density plastizot. From time to time during his continued treatment we do find small hematoma around the area and some small callus that needs to be removed. We have found addressing these immediately has prevented any breakdown.

This patient was handled in his more conservative matter rather than surgery due to his kidney problems and other medical complications.

THINGS OF INTREST:

1) The average cost is approximately $500 per us; we have found most of the time two or three applications are necessary
2) Medicare does reimburse at a rate that makes the procedure worthwhile. The majority of building will be obtained from the deep debridement not from the reimbursement of the material.

3) Smith and Nephew will pre-certify the patient for product reimbursement.

4) This procedure may be carried out in your office or in the hospital, however is not reimbursable the bedside or in-home.

There are other products which work well with this type of lesion, however we have found this is a nephew has been more than helpful both to the patient and to the doctor when there’s been a problem. This procedure is easy, successful, and gratifying and if given the opportunity you should add it to your armament.