SLR - June 2017 - Brian C. Carbonell
Reference: Cavallini M. Ulcer Piercing: A Novel Drainage Technique for Patients Living with Diabetes and Complicated Foot. Journal of Endocrinology Diabetes. 2015 Sept; 2(4): 1–4.Reviewed By: Brian C. Carbonell, DPM
Residency Program: Bethesda Memorial Hospital, Boynton Beach, FL
Podiatric Relevance: Diabetic foot pathology is a common and difficult condition encountered by foot and ankle surgeons. Complicated, deeply contaminated diabetic foot ulcers are often observed in emergency rooms. The clinical problem of diabetic foot infections, with deep abscess, is serious and can jeopardize limb and foot stability. Diabetic infection is a condition that requires surgical intervention with ulcer debridement, resection of necrotic and infected tissues and adequate drainage of abscess collections. This study reveals a new technique to avoid any fluid or exudate stasis in diabetic foot infections. The authors designed a surgical procedure of Ulcer Piercing (UP) and drainage, which allows for constant cleansing of the ulcer and facilitates irrigation of any pierced hidden tract. The technique was utilized in a series of patients living with diabetes and complicated, infected neuropathic ulcers.
Methods: Retrospective study of 35 patients living with diabetes, 19 female and 16 male, mean age 59 (+/-) eight years old, affected by complicated foot infection. All ulcers were at least a Wagner Grade 3, and all patients had ABI over 0.6 and/or TCPO2 of greater than 30mmHg. In all instances, wound exploration was performed with probe, and when indicated, any exposed infected bone/and or tendon removed. The skin on the opposite end of ulcer is pierced, and a silastic tube is passed along through the fistula tract. Once this drainage is passed along the ulcer’s tract, the two ends are tied together with silk stitches to construct a blocked ring. (UP ring). The UP ring is designed to keep the tract open and to facilitate flushing of the fistula tract. Irrigation is performed twice a day with Dakin solution. Systemic antibiotics were also used in the management of patients.
Results: Thirty-three of thirty-five (94 percent) ulcers treated with this technique have healed within seven months. No adverse or negative side effects have been observed with the UP ring. In all patients, the UP ring was definitively removed only when the pierced tract was covered by granulation tissue.
Conclusion: This procedure of ulcer piercing represents an easier and safer treatment of cutaneous ulcers with deep, draining recesses.