Study about the application of LIGASANO® as primary wound dressing in the case of

  diabetic
  foot lesions

The findings are very encouraging in medical, human and economic view.

by Dr. med. Carola Zemlin, internist/diabetology Magdeburg, BRD

 

The diabetic foot syndrome belongs undoubtless to zu the most grave complications of diabetes: a high rate of amputations, high cost for the sickness insurance fund and increased extra pays for the persons concerned,  long stay in hospitals, loss of working hours and/or early disability, be dependend on outside help, immobility, restricted participation on social live, frustration, despair -  this all we associate with the problem "diabetic foot" for the present. As a result of published experience of diabetic-foot-ambulances in the USA, in England and Scandinavia, there is a change in one´s view also in Germany.

It shows that interdisciplical care concepts, structured diagnosis and therapy as well as "life-long foot care" in the case of high-risk patients can improve the situation described at the beginning significantly. On the one hand it is important to throw overboard obsolete doctrines and clichés ("Diabetic feet are not or bad healing, therefore amputating them rather high") as well as ungezielte, expensive(!) Polypragmasien of local wound healing and inadequate orthopedical shoe technique.

On the other hand you have to seek for effective, biologically well tolerated and economy-priced wound dressings at the same time for treating as much patients as possible without Kostendruck. The following contribution deals in a broad sense with the wound treatment by patients with diabetic foot lesions and in a narrow sense with the application of LIGASANO® foam in wounds resp. wound healing impairments of the above mentioned patients.


1. Patients and Methods:

In the period from March 1998 until January 2000 were treatened 15 patients (12 male, 3 female) with an average age of 54 years. Listed were:

  • Kind of lesion (wound healing impairment after amputation/resection, heel ulcera, malum perforans, wounds after sequestrum cut by diabetical neuro-osteo-arthropathy = DNOAP (Syn. Charcot´s syndrome)
  • Dilatation of the wound (WAGNER stage) and wound phase
  • Classification according to ARLT (A=pavK, B=Polyneuropathy, C=A+B=Mischtyp)
  • Duration of the wound
  • Methods of the preliminary treatment
  • Days of hospital stay during preliminary treatment
  • Happened amputations on the same and contralaterale leg
  • Days of hospital stay during the current treatment
  • Methods of the current treatment
  • Number of the ambulante consultations
  • Duration of healing under the current therapy
  • Dressing change (who and how)

Apart from tabular charts there were made detailled case descriptions with photo documentations above every treated patient.


2. Results and Summary

Dates of the Patients / Case History
Number of patients 15
Age of the patients Average age 54 years (41-69)
Sexe of the patients 12 male, 3 female
Diabetes diagnosed since: average 17 years
Type of diabetes: 5x type 1 <> 10x type 2
Amputationen before starting the treatment: 3 pat. with amputations of the lower leg
  9 pat. with amputations of the toes
Further planned amputations: at 6 pat. lower leg
Duration of treatment before: average 300 days (0-1095)
Days thereof stationary: average 74 days (0-270)
Result of the treatment: no wound healing
Estimated cost of treatment: 
Average outpatient: 226 days x 50     DM= 11.300,-
Average stationary:  74 days x 500    DM= 37.000,-
Average total:                         DM= 48.300,-
 
Treatment by Dr. Zemlin with LIGASANO®
Duration of treatment: average 90 days (18-450)
Days thereof stationary: 0 days
realised/necessary amputations: 0
Result of the treatment: wound healing
Estimated cost of treatment: 
Average outpatient:  90 days x 50     DM=  4.500,-
Average stationary:   0 days x 500    DM=  0.000,-
Average total:                        DM=  4.500,-

 
The results (Tab.) speak for themselves. Details about deficiency in work are unnecessary, because all patients are pensioners or invalides.

I have used LIGASANO Polyester foam since already 1994 for wound treatment. The material was first introduced to me by Mr. Rettig, a male nurse and enthusiastic wound therapist from Lüchow-Dannenberg. Little by little I have recognised and appreciated the multi-purpose possibilities of LIGASANO. It has excellent qualities as upholter material over regions with a high pressure burden (heels, edges of feet, plantar by malum perforans, interdigital, toe-tips) and is very helpful for the soft debridement: In doing so LIGASANO is soaked with Ringer´s solution and then the wound will cleansed. Due to the high frictional resistence of LIGASANO necrotic layers and detritus of cells are removed from the wound gently. The debridement with a sterile teeth brush, as recommended in some literature, is superfluous.

We use LIGASANO as a primary wound dressing for about two years and were surprised of its stimulating effects in secretion and granulation! And precicely in deep wound LIGASANO is obviously superior to alginates and hydrocolloides, above all as a result of its additional capillar effect (patient no. 10 and 13).

For the application of LIGASANO in deep wounds we cut the material in various sizes and einschweißen. Subsequently the stripes are going to sterilised by steam and will be distributed for the home care. If the dressing isn´t changed by nursing staff but by the patient or his relatives, we prescribe sterile one-time tweezers.
Finally we use LIGASANO also as a secondary wound dressing as apadding under every wound dressing, as it were the uppermost layer, because a soft drainage pressure and warmth is also necessary for wound cleaning. For this purpose LIGASANO bandages are best qualified for.

Beside the above mentioned multi-purpose application possibilities of LIGASANO the comparatively low costs of this material are a further great advantage! For this reason LIGASANO belongs to our foot ambulance as a unrenouncable part of dressings.

Study patient no. 10
07.10.1999

Study patient no. 10
intermediate control

Study patient no. 10
23.12.1999

 

 

Study patient no. 11
14.12.1998

Study patient no. 11
intermediate control

Study patient no. 11
after 36 days