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Indian Journal of Medical Sciences, Vol. 61, No. 6, June, 2007, pp. 324-325 Editorial Healing and preventing the diabetic foot wound: Where technology, economics and common sense converge Armstrong DG Scholl's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine, Chicago, Illinois Code Number: ms07052 I am grateful to the editorial staff for having given me the opportunity to comment on the intriguing manuscript by Purandare et al. [1] I believe strongly that the insightful issues raised by this manuscript reveal a continued disconnect between technology, economics and common sense in the field of diabetic foot wound healing and prevention. The authors state: ′The development of REGRANEX (recombinant PDGF-BB) evoked interest in immune therapy in diabetic non-healing ulcers. It showed beneficial effect, primarily in non-infected neuropathic ulcers. However therapy was extremely costly (approx. US$9.70 per day) and long-term effects on wound contraction and wound strength as well as recurrences were not satisfactory. Though [this] products [is] still unavailable in our country, [its] usage is bound to be highly cost-ineffective from both, their clinical benefit and economic standpoint." I agree with the authors. However, I believe that the issue lies not only with the cost factor but also with practical common-sense mechanics. Neuropathic diabetic foot wounds develop secondary to repetitive stress over areas of elevated pressure and shear. [2] Reversing this etiologic factor should, in a common-sense world, take precedence over any pharmacological or device-related healing intervention. This concept was largely born in India, with the work of the late Professor Paul Brand [3],[4],[5] and others in Vellore and Kaligiri. However, as physicians, many of us, I fear, still have an aversion toward focusing on the mechanical rather than the pharmacologic. I would argue that the latter cannot be completely effective without a marriage with the former. It is for this reason that many of us call for a combination of irremovable pressure-relieving devices and cost-effective systemic or topical therapies. [6] It is in this manner that we can realize a meaningful reduction in ulcers and amputations throughout the world. References
Copyright 2007 - Indian Journal of Medical Sciences |
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