A Case study demonstrating the use TLC – NOSF healing matrix on diabetic foot ulceration
Category – Diabetic foot ulcer
Hope Ramsden, Podiatrist, Harrogate District Foundation Trust
White Cross Court Rehabilitation Hospital
01423 542 300
Diabetic foot ulceration (DFU) is a serious and common complication of type 1 and 2 diabetes. Within England 60,000 patients present with a DFU annually (NDFA 2017), resulting in a £1bn spend to the NHS on DFUs alone in any one year (Guest et al 2016). 85% of lower extremity amputations in patients with diabetes are preceded by an ulcer, of which 70% of these patients will die within 5 years post amputation (Andreas et al 2018). Despite these concerning statistics until recently no satisfactory treatment for neuroischaemic ulcers existed with no evidence supporting any one particular dressing (Edmonds et al, 2018). Recent evidence has highlighted underlying complexities within wound management for neuroischaemic DFU due to a prolonged inflammatory phase with increased matrix metalloproteinase (MMP) and impaired neovascularisation. Recently a local evidence based treatment was introduced which has been proven to reduce healing time for neuroischaemic DFUs. Nano-oligosaccharide factor (TLC – NOSF) acts locally on the two key factors which are associated with impaired wound healing; inhibition of excess MMPs and restoration of angiogenesis by reactivating vascular cells (White et al, 2015 and Edmonds et al 2018).This case study demonstrates the use of the TLC-NOSF treatment in clinical practice using UrgoStart Contact.
A male patient aged 69 years old presented to the podiatry clinic with a new DFU to the right fifth metatarsal phalangeal joint. He had a 3 year history of DFUs to his right foot, however was healed prior to this presentation. It presented as punched out with 100% slough tissue and a blister to the right fifth dorsal distal interphalangeal joint which had failed to heal and had ulcerated. Cellulitis was present to the foot and antibiotic treatment was commenced. HbA1c was 72mmol / mol. The patient had been living with Type 2 diabetes mellitus for 15 years, was a smoker with biphasic pulses and neuropathy to both feet when using a 10g monofilament.
The gentleman was seen in a high risk wound clinic and also attended appointments with the Biomechanical Specialist Podiatrist who made individualised custom made orthotics to offload and redistribute pressure away from the ulcer to prevent further deterioration to the wound. (see photo)
Standards of care required for treating a DFU were followed. A course of antibiotics commenced to treat the cellulitis, one course of larvae therapy was prescribed with the aim of reducing the slough as soon as possible and offloading commenced. Following successful debridement UrgoStart Contact was commenced in order to treat the suspected elevated MMPs and restore neovascularisation to the wound . On commencing the treatment the DFU measured 2.5 x 1.7 cm.
Within 4 days of using the UrgoStart Contact the wound presented as shallow with robust granulating tissue present (see photo). One month after commencing UrgoStart Contact the wound continued to show significant signs of improvement and dressing changes were reduced from twice to once per week, due to a decrease in exudate levels. After a total of 3 months treatment with UrgoStart Contact the DFU healed. (See photo)
As highlighted DFUs present with underlying complexities such as a prolonged inflammatory phase with increased matrix metalloproteinase (MMP) and impaired neovascularisation. The TLC – NOSF healing matrix within the UrgoStart Contact activated the natural key cells involved in the healing process facilitating neovascularization to the wound in addition to reducing the number of MMPs It promoted the formation of granulation tissue and restored the wound on to a healing trajectory.
The UrgoStart Contact dressing was easy to apply for the clinician and was comfortable for the patient. TLC-NOSF reduced the likely hood of the DFU becoming a chronic wound thus reducing healing time and as a result significantly improving the patient’s quality of life.
As a podiatrist I found the TLC – NOSF healing matrix very effective in addressing the challenges in healing this DFU. As the treatment is contained within the dressing it is simple to use. The TLC- NOSF treatment has demonstrated that when used in conjunction with basic standards of care, antimicrobial control, debridement and offloading, healing time can be reduced thus lessoning the potential for further complications and improving outcomes for patients with DFUs[WC1] .