(CS-091) Novel Approach To Subulcer Ultrasonic Debridement Of Chronic Diabetic Foot Ulcers

Introduction: Chronic diabetic foot ulcers (DFUs) affect ~25% of people with the diabetes during their lifetime. Despite advances in treatment approaches, ~20% of patients have unhealed DFUs at one year and recurrence is common, with a rate of ~40% within the first year. The use of a percutaneous cutting tool to remove diseased tendon in circumstances of chronic refractory tendinopathy prompted the development of a novel ultrasonic system* for the management of DFUs that targets both the tissue and bone beneath the wound. We report outcomes on eight patients who presented with DFU and were treated using the system.

Methods: The system imparts ultrasonic energy by way of the hollow “micro tip” sharp cutting tool that is activated by a foot peddle, irrigates and cools the needle though an outer sheath and aspirates the debris through the lumen of the needle, removing it from the field of treatment. The micro tip is inserted through two to four 5-7 cm “stab” incisions ≥1 cm from the ulcer edge to facilitate removal of both the scar tissue and osseous prominence. Each portal allows removal of the diseased tissue using a back-and-forth motion. The entire ulcer is treated using successive portals.

Results: Patient demographics were: 4 male/4 female, mean age 58.1 years (30, 79), mean duration of ulcer 20.68 months (2.5, 42). Ulcer size at presentation varied, with mean length 2.61 cm (1.0, 2.5), mean width 1.91 cm (0.7, 3.0), and mean depth 0.37 cm (0.2, 0.5). Mean days to healing post treatment was 55.75 days (20, 182), with no recurrence.

Discussion: Traditional approaches to debridement focus on the wrong side of the wound. Debriding the underside of the ulcer effectively decreases any venous congestion and correct any arterial insufficiency that may be present by removing necrotic tissue, decreases bacterial burden and biofilm, and reduces inflammatory cytokines. Further, removing the cortical bone beneath the ulcer not only decompresses the wound but releases intrinsic growth factors that reside in that cancellous bone. Our findings suggest that this approach should be considered for all patients with recalcitrant neuropathic DFU.