Dr. Brock Liden is a diplomat of the American Board of Podiatric Orthopedics and Primary Podiatric Medicine and a diplomat of the American Board of Multiple Specialties in Podiatry (Prevention and Treatment of Diabetic Wounds and in Diabetic Footwear). He is a Fellow of the American Professional Wound Care Association, a member of the American Medical Athletic Association, the American Podiatric Medical Association, and the Ohio Podiatric Medical Association. He is the Co-Director of the Berger Hospital Wound Care Clinic and is an owner of the Circleville Foot and Ankle LLC and the Reynoldsburg Podiatry Center in Reynoldsburg, OH. He specializes in diabetic ulcer and wound care, sports medicine and limb salvage.	Brock Liden, DPM Co-Medical Director of Berger Hospitals Wound Healing Center with Hyperbaric Oxygen Therapy

	Today's Premier Lecture is on Differentiating Infected from Non-infected Wounds by Warren Joseph, DPM, FIDSA.

Transmetatarsal amputation (TMA) is a valuable procedure for long-term limb salvage when confronted with a non-healing diabetic Charcot foot, ulceration, and infection. Here, we describe a case of a successful salvage of a stalled, dehisced TMA using Vashe® Wound Therapy, a new adjunctive wound care modality. Vashe Wound Therapy is a new FDA-cleared prescription wound care device that contains hypochlorous acid (HOCl), a naturally occurring small molecule that is also generated by white blood cells in the human body to combat invading pathogens.

Case Study

The patient, a 52 year-old insulin-dependent diabetic with chronic neuropathic pain, presented with a wound dehiscence in the transmetatarsal region of the right foot 21 days after the original TMA.  The initial size of the dehisced wound measured 5 cm. x 17.8 cm. x 3.0 cm.  The patient was initiated on a treatment regime of Negative Pressure Wound Therapy (NPWT) for a period of 10 weeks. Dressings were changed three times per week and the wound bed was cleaned with saline. Sharp debridement was carried out as deemed necessary. A picture of the wound about three weeks into the NPWT is shown in Figure 1. Following a 10-week treatment regime with NPWT, the wound appeared infected inflamed and malodorous, and progress to closure had stalled. Vashe Wound Therapy was initiated at this time as an additional therapy. The objective of Vashe Wound Therapy for this patient was to eliminate odor, treat the local infection and advance healing of this surgical TMA dehiscence. 

Figure 1: Picture taken on February 18 after three weeks of NPWT.

Outcome of Therapy

Thirteen weeks after wound dehiscence, Vashe Wound Therapy was initiated as an adjunct wound care treatment to NPWT. Immediately prior to initiation of Vashe Wound Therapy, the dehisced site measured 2.8 cm. x 11.0 cm. x 0.8 cm. (Figure 2). Following one week’s treatment with Vashe Wound Therapy, as an adjunct wound care agent, two wounds had formed that measured 2.5 cm. x 12.0 cm. x 0.5 cm., in the transmetatarsal site, and 0.8 cm. x 2.0 cm. x 0.3 cm. in the distal region of the right foot. Vashe Wound Therapy was applied, via gauze dressings, directly to the wound sites and allowed to remain there for 10 minutes.

Figure 2: Picture during therapy on April 7, immediately prior to initiation of Vashe Wound Therapy.

This treatment regime was repeated three times per week during dressing changes. The wound sites continuously progressed towards closure with no signs of clinical infection. Odor was eliminated throughout the Vashe Wound Therapy treatment. At three weeks of Vashe Wound therapy treatment, the wounds measured 0.3 cm. x 1.0 cm x 0.2 cm., (transmetatarsal site) and 0.2 cm. x 2.0 cm. x 0.1 cm. (distal site) (Figure 3). 

Figure 3: Picture on April 29, three weeks after initiation of Vashe Wound Therapy.

Both wounds healed by eight weeks post-initiation of Vashe Wound therapy treatment. A significant decrease in wound size was observed following the introduction of Vashe Wound Therapy as an adjunct wound care treatment to NPWT. The end result of the eight-week Vashe Wound Therapy adjunct treatment to NPWT was the complete closure of a stalled TMA wound site (Figure 4). Additionally, wound and dressing odor was eliminated through the adjunctive care regime with Vashe Wound Therapy.

Figure 4: Picture of the wound at closure, eight weeks after initiation of Vashe Wound Therapy.

Vashe Wound Therapy is a biocompatible solution to enhance the clinical management of acute and chronic wounds in tandem with the body's natural defenses. It is a safe and effective alternative to common wound irrigants that inhibit wound healing. A breakthrough in science for wound cleansing and debridement An additional boost to the body's own defense Provides key assistance to the body's own natural wound recovery Potential Benefits Reduced length of stay Improved clinical outcomes Patient satisfaction Practice builder The Powerful Nature of Wound Therapy. Effective. Biocompatible. Non-toxic. Sign up for a free 45-day trial of Vashe Wound Therapy.