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Vascular Surgery

Aggressive treatment of diabetic foot can help prevent amputations

02/27/2012

CU-Diabetic FootDiabetic foot, a condition characterized by a range of symptoms from rough and dry skin to infected ulcers that do not heal, is a serious complication of diabetes that affects one in four diabetic patients over the course of a lifetime. Diabetes, a chronic disease marked by high levels of blood glucose, can have severe health consequences. Over time, diabetes damages the body's organs, nerves and vascular system, causing poor circulation, impaired immunity and neuropathy, which is characterized by a loss of sensation to the extremities. These problems combine to make diabetic patients vulnerable to developing foot wounds, ulcers, infections and other deformities - often without the patient's awareness. Without aggressive treatment, these wounds can easily turn into osteomyelitis, a severe bone infection that can necessitate amputation.

Every year in the United States, diabetic patients account for as many as 68,000 amputations - or two-thirds of all amputations not related to trauma. Amputation not only affects a patient's mobility and quality of life; it can also significantly shorten lifespan. The majority of diabetic amputees will not survive more than five years following their amputation.

The UCLA Center for Wound Care and Limb Preservation

The UCLA Center for Wound Healing and Limb Preservation offers advanced care for patients with non-healing wounds who may be in danger of losing a limb. The center's team includes renowned experts in wound care, vascular surgery, podiatry and hyperbaric medicine who assess and treat wounds that do not heal within 30 days, regardless of the source. Because diabetes is the most common cause of non-healing wounds, the center's physicians work closely with specialists at the adjacent Gonda Diabetes Center to provide comprehensive care to diabetic patients. The center's faculty members also conduct research in some of the most innovative treatments under development for non-healing wounds and the vascular problems that cause them.

Center offers sophisticated diagnostic and treatment options

The center offers several sophisticated diagnostic techniques to assess a patient's vascular system, including ultrasound, magnetic resonance angiography (MRA) and computed tomography (CT) angiograms. It includes three operating rooms where vascular surgeons can perform angiograms, angioplasties, and a state-of-the-art technique developed at UCLA designed to heal venous ulcers and veins that are refluxing blood. UCLA is also participating in a multi-site clinical trial that uses stem cell therapy on patients with advanced circulatory problems who have not benefited from other forms of treatment. The therapy involves harvesting bone marrow from the patient's hip, stimulating the patient's own stem cells and thenre-injecting them into damaged leg muscles in an attempt to help them heal.

Wound care options

The center also provides a full range of wound care options, from standard therapies to the most advanced treatments available. Standard therapies to treat non-healing wounds include enzymatic debridement, which dissolves dead tissue; collagen matrix systems, which help cells repopulate on damaged areas; and bovine and synthetic skin grafts to cover ulcers and wounds that will not close on their own. Patients with more complex wounds may receive hyperbaric oxygen therapy, which increases the amount of oxygen dissolved in the blood by exposing the patient to increased barometric pressure within a sealed chamber. About 1,000 diabetic patients with non-healing wounds receive hyperbaric oxygen therapy at UCLA's multi-person chamber every year. Treatment in the chamber typically involves two-hour sessions, five days a week, for a six-week period.

Healing limb-threatening wounds

UCLA's Center for Wound Healing and Limb Preservation provides patients throughout Southern California with the full range of treatment options for non-healing wounds and the diseases that cause them.

"For many patients, a non-healing wound is the first manifestation of underlying vascular disease," says Peter Lawrence, M.D., UCLA's chief of vascular surgery, who oversees the center's operations. "Our center includes vascular surgeons as well as wound care specialists because you can't heal a wound unless it has adequate blood supply."

While the majority of non-healing wounds are caused by diabetes, they can also be due to trauma, surgical incisions, clotting disorders or poor leg circulation. Prompt and aggressive treatment of such wounds, whatever their cause,
is the key to saving limbs, asserts Dr. Lawrence.

"Our goal is to take care of any patient who has a wound that hasn't healed for 30 days," says Steven Farley, M.D., the center's medical director. "What makes us unique is that we offer patients the most options for treating limb-threatening wounds, including innovative surgical techniques, hyperbaric wound care and cutting-edge stem cell therapies."

Participating Physicians

Peter F. Lawrence, M.D.
Chief, Vascular Surgery

Steven Farley, M.D.
Assistant Professor, Vascular Surgery
Medical Director, UCLA Center for Wound Healing and Limb Preservation

Stanley Cowen, M.D.
Staff Physician, Vascular Surgery
UCLA Center for Wound Healing and Limb Preservation

Robert Lee, DPM
Clinical Instructor, Podiatry
UCLA Center for Wound Healing and Limb Preservation

Aksone Nouvong, DPM
Associate Clinical Professor
Vascular Surgery
UCLA Center for Wound Healing and Limb Preservation

B. Chia Soo, M.D.
Professor-in-Residence, Plastic Surgery
UCLA Center for Wound Healing and Limb Preservation


Contact Information

UCLA Center for Wound Healing and Limb Preservation
200 UCLA Medical Plaza
Suite 530B
Los Angeles, CA 90095
(310) 267-0172 information and appointments
www.uclahealth.org/WoundHealing





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