Robert P. Wunderlich

The Benefit of Electrical Stimulation to Enhance Perfusion in Persons with Diabetes Mellitus

The purpose of this study was to evaluate the effect of galvanic electrical stimulation on vascular perfusion in diabetic patients. Nineteen subjects with diabetes were enrolled. Eleven subjects (57.9%) were diagnosed with impaired peripheral perfusion based upon their initial transcutaneous oximetry values (< 40 mm Hg). The subjects were studied over a 2-day period. On the 1st day, one foot was electrically stimulated for four 60-minute periods by an external electrical stimulation device. Vascular perfusion of both feet was assessed before and after the sessions of electrical stimulation. On the 2nd day, no electrical stimulation was applied and noninvasive vascular measurements were repeated. For the 1st hour, transcutaneous oxygen pressure was measured continuously during stimulation at the lateral aspect of the leg. Subsequently, perfusion between the periods of stimulation was measured on the dorsum of the foot with both transcutaneous oximetry and laser Doppler flowmetry after each stimulation period. In the group with impaired peripheral perfusion, a significant rise in tissue oxygenation as compared to the control measurements was measured during the first 5 minutes of stimulation (p < .040). For those without vascular disease (TcpO2 > 40 mm Hg) however, there was not a significant increase compared to baseline (p = .280). After the periods of stimulation, the stimulated feet did not show any higher perfusion levels than the control feet. Patterns in perfusion during the day, as measured by laser Doppler flowmetry, were similar in the tested feet and in the controls. These data suggest that external subsensory electrical stimulation induces a transient rise in skin perfusion in persons with diabetes and impaired peripheral perfusion.

Reliability of digital videometry and acetate tracing in measuring the surface area of cutaneous wounds

PURPOSE The purpose of this study was to evaluate the reliability of digital videometry and acetate tracing in the measurement of cutaneous wound area. METHODS Four clinicians used both digital videometry and acetate tracing to measure five wounds that were artificially created on a cadaver specimen. In addition, the clinicians used an analog centimeter ruler to determine a rough estimate of the area of each wound. The wounds were measured a total of five times with each measurement instrument using a non-sequential repeat measures design. Associations between the three wound measurement techniques were examined with Pearson correlation coefficients. In addition, intraclass correlation coefficients (ICC) were calculated for each pair of the three measurement techniques. RESULTS Correlation between the measurement systems for all raters combined yielded Pearson r-values of 0.93 for ruler and acetate, 0.95 for ruler and digital and 0.97 for acetate and digital. Furthermore, the average measure ICC between acetate and digital was 0.94, between acetate and ruler was 0.76 and between digital and ruler was 0.57. CONCLUSION These results suggest that wound area measurements obtained using digital videometry and acetate tracing are very similar and both techniques can be used interchangeably in either clinical or research settings.

Skin Temperatures as a One-time Screening Tool Do Not Predict Future Diabetic Foot Complications

This prospective longitudinal study assessed whether baseline mean skin temperature measurements are useful in predicting the most common foot-related complications of diabetes mellitus. We evaluated the mean of baseline skin temperatures taken bilaterally from six plantar sites in 1,588 patients with diabetes. There was no difference in skin temperature based on neuropathy, foot laterality, or foot risk category or between people with and without foot deformity and elevated plantar foot pressure. Whereas people with Charcots arthropathy had slightly but significantly higher mean temperatures (84.8 degrees +/- 3.5 degrees F versus 82.5 degrees +/- 4.7 degrees F), this was not true for those who developed ulcers or infections or who underwent amputations. The presence of vascular disease was not associated with lower skin temperatures. Mexican Americans (83.0 degrees +/- 4.6 degrees F) and blacks (83.6 degrees +/- 4.5 degrees F) had higher mean skin temperatures at baseline than did non-Hispanic whites (81.8 degrees +/- 4.6 degrees F). Baseline measurement of nonfocal mean skin temperatures is not an effective means of screening people for future events. Regular assessment of skin temperatures, using the contralateral site as a physiologic control, may be a better use of this technology.

Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers

Among people with diabetes, 10–25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β‐hydroxy‐β‐methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes.

Risk factors for diabetic foot ulceration: A Logical approach to treatment

Appropriate management of the diabetic foot in a multidisciplinary setting requires knowledge of the risk factors leading to ulceration and limb loss. This article will review the most common risk factors for ulceration and present a validated, treatment-based method to appropriately communicate both the status of the diabetic wound and, more important, the patients location on a spectrum of risk for amputation.