Since Joseph had a family history of diabetes, he knew the importance of checking his feet regularly for diabetic foot ulcers. But despite giving careful attention to his health, he still needed to have one of his toes amputated.
Limb salvage expert Dr. Jeffrey Niezgoda of the Center for Comprehensive Wound Care in Wisconsin was able to save the rest of his foot by using a new treatment called Graftjacket. This treatment helps our body to repair the wound quickly by providing immediate coverage to the wound and a way to rebuild the area of missing tissue. The graft incorporates itself into the wound until it gradually converts into the patient's own tissue.
If we have poor circulation and decreased sensation to pain, we sometimes overlook small cuts, blisters, or ingrown toenails. But when they become infected, they can turn into an open wound that's called a diabetic foot ulcer.
One in four people with diabetes who get a foot ulcer will require a lower limb amputation. Yet half of us have never even heard about foot ulcers. And we can prevent half of of the amputations.
While we have new treatments for diabetic foot ulcers, doing our best to prevent them is a whole lot better. Checking our feet regularly is the key to prevention.
When a correspondent brought Graftjacket to my attention, I had never heard of it. So I studied the literature.
Two recent studies concluded that the Graftjacket Matrix and Graftjacket Matrix Ulcer Repair from Wright Medical Technology in Arlington, Tennessee, are both safe and effective. I have studied the full-text of both reports, although only abstracts of them are free online.
Last month the journal Advances in Skin & Wound Care published a multi-center retrospective study of Graftjacket treatment of 100 foot wounds suffered by 75 people with diabetes. This study concluded that the Graftjack was successful "in both superficial diabetic wounds and in wounds penetrating to the bone or joint."
Two years ago The International Wound Journal reported on a prospective 16-week pilot study. "Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of would healing with respect to wound area and clinically significant differences in would depth and wound volume," this report concluded.
The 2006 study acknowledged that the author, Stephen A. Brigido, DPM, is a "consultant for Wright Medical Technology." Dr. Brigido is a podiatrist at the Foot and Ankle Center at Coordinated Health in East Stroudsburg, Pennsylvania, and one of six co-authors of the 2008 study. The more recent study, however, doesn't say whether any of the co-authors had any potential conflict of interest or not.
Just because someone earns money from a company doesn't mean they make up or even slant the data. But medical ethics are more and more concerned with reporting potential conflicts.
So I turned next to a podiatrist I know personally and highly respect. I also know that he has no financial ties to the company. He is my own podiatrist, Dr. John Jachimiak of Foot & Ankle Care of Boulder County, Colorado.
"I use Graftjacket on ulcers very frequently," he emailed me. "I used it this week to repair a ligament tear. Graftjacket or Apligraf are the two that I use most often, although there are numerous other brands."
Personally, I will keep on checking my feet carefully every evening before I go to bed. But if in spite of all my vigilance, I get a foot ulcer, I won't despair.