SURGERY 
for Diabetes Care Clinicians 
Professor Pinjala Ramakrishna MS FRCS FICS
Chief of Vascular Endovascular Surgery at 
Nizam's Institute of Medical Sciences, Hyderabad, 
Editor, Vascular Endovascular Interventions and Surgery Update,
Tutor for the Royal College of Surgeons, Edinburgh UK
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Diabetic wound management

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 What is new in the
 diabetic wound management -
 with vascular problems ?

Has there been any better wound dressing in the recent past?
Yes, graft skins (Tissue engineering techniques) Dermagraft, Apligraf and other cultured skins. But they are available at premium cost like any other products. But debridement is essential to get faster healing of the ulcers. In one at end of 12 weeks of treatment 56% showed healing while only 38% showed healing in the controlled.

Is it possible to change pressure points or reduce the pressure in the diabetic foot with silicone injections?
A recent randomized controlled study has shown that is possible to alter the pressure point in the diabetes patients with silicone injections. Van Schie CHM et al in diabetes care 2000; 23: 634-8.

Is PDGF (Becaplermin) good for the diabetic wounds associated with neuropathy?
4 randomized controlled trials have shown that it is useful in early healing of the ulcers. It is not yet introduced in India. This is awaiting approvals in India.

Larval therapy is there any scientific basis for this treatment?
There seems to be benefit in the neuropathic, ischemic wounds with slough with larvae. However one has to sterile larvae for this purpose. There are no controlled trials for this evidence.

Can we consider the combination of the statins and benzafibrate for diabetic dyslipidaemia?
There seems to be good benefit with this combination. Cardiovascular event rate has come down to 2% from 9.5% in 6 months time with this combination. Gavish D et al A J Intern Med 2000; 247:563-9.

Would you consider that in your diabetic foot patients with vasculopathy?

Clopidogrel Is it better than Aspirin and Pentoxifylline in preventing the complications?

Answer: seems to be better in the over all risk reduction and cardiovascular event rate reduction.

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go to index page in www.diabetes.org.in