America's Premier Foot and Ankle Surgeon
Expert Reconstructive, Cosmetic, Aesthetic Foot Surgery

Dr. Vladimir Zeetser, DPM, FACFAS | 818-907-6100

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Expert Wound Care and Limb Salvage by Dr. Vladimir Zeetser

Lower extremity, ankle and foot wounds are becoming increasingly common as our population continues to live longer. Diabetes is becoming an epidemic and is a major cause of lower extremity wounds in the United States. Often, these wounds are chronic and very complex in nature, so they require a trained wound specialist who can effectively manage all aspects necessary to achieve healing, and salvage the limb. In the past and even to this day, there have been unnecessary limb amputations which might have been avoided or minimized under the care of a trained specialist.

Dr. Zeetser has received comprehensive training in lower extremity wound care and diabetic limb salvage. As a specialist in this field, he utilizes advanced surgical techniques, including skin flaps and adjacent tissue transfers, and employs a variety of skin grafting materials available today. He also utilizes a variety of the most advanced topical wound treatments available, including specialized collagen and silver-impregnated dressings, topical medications, medical maggot therapy and other proven modalities. He routinely treats complicated wounds which are difficult to heal and frustrating for most physicians. For this reason, patients have traveled from distant cities for the chance to salvage a limb after being told there was no hope.

In general, most lower extremity wounds can be classified into the following categories, based on the underlying cause:

By far, the most common cause of foot and lower extremity wounds is diabetes, followed by venous insufficiency and P.A.D.

During your initial consultation, the cause of your wound will be determined and a treatment course will be discussed with you in detail.

Diabetic Foot Wounds

There are over than 21 million known people with diabetes in the United States, and this staggering figure continues to grow by almost one-half million annually. It has been estimated that an equal number of persons with diabetes remain undiagnosed. A person develops diabetes when their body is unable to maintain a normal level of sugar in the blood. Insulin, the hormone that regulates the level of sugar, is either not used properly by the body or it is produced in inadequate amounts. When this occurs, diabetes is the result.

Diabetes wreaks havoc with many major organ systems in the human body. Among others, it tends to create some of the worst and life altering complications in the feet. Over one half of diabetic hospital admissions are foot related. This is typically due to the disease process' effect on the nerves and blood vessels. As a result, the main complications include neuropathy (altered sensations which can eventually lead to numbness), peripheral arterial disease, increased risk of infection, decrease in tissue integrity and compromised healing capacity.

Peripheral Neuropathy

Peripheral Neuropathy can manifest itself as abnormal sensations such as burning, tingling, numbness, and pain. Often, patients report feelings of ants crawling on their skin. Treatment can include medications, infra-red light therapy such as Anodyne, and surgical nerve decompression. Dr. Zeetser is one of the few physicians in his area that offers infra-red light therapy.

Wound Care and Limb alvage

Although annoying, these sensations typically represent the early stages of diabetic neuropathy. Often times, the condition can progress to a more dangerous form in which sensation to the foot is diminished or completely lost. With loss of protective sensation, the foot is at a higher risk for complications, including open wounds and infections. Coupled with a bony deformity and ill-fitting shoes, this is a recipe for a disaster. When a diabetic with neuropathy cannot feel rubbing inside the shoe, or cannot feel a cut, scrape, burn or other injury, a wound or infection often ensues.

An additional form of nerve dysfunction that occurs in diabetics is autonomic neuropathy. These nerves control the sweat glands in the feet and their loss causes the feet to become dry and cracked, allowing entry portals for fungal and/or bacterial infections.

Besides sensory related damage that occurs to the nerves, diabetics often have damage to the motor function of the lower extremity nerves. These nerves control the fine movements of the muscles in the foot and lead to muscular imbalances between the many separate muscle groups in the foot. This often results in severe contractures and deformities in the foot, including hammertoes, bunions and plantar metatarsal prominences. These are all potential sources of abnormal pressures and can lead to diabetic pressure wounds.

Damage to the arteries leads to decreased blood flow. This, in turn, causes poor healing and spontaneous wounds, which become easily infected leading to an increased incidence of gangrene (followed by some level of amputation).

Many times, a vascular surgeon is utilized to perform some form of intervention, whether arterial bypass or angioplasty. Dr. Zeetser works closely with very highly regarded vascular surgeons in the area on these types of complicated cases to achieve the best possible outcomes for his patients.

In general, diabetics are systemically compromised and therefore more prone to infections from a variety of micro-organisms. Fungal infections to the nails and skin are extremely common in diabetic feet and result in destruction and eventual disfigurement of the toenails. Thickened nails result in excessive pressure on the nail bed, causing ingrown toenails, sores beneath the nail, and increased risk of toe infection. The damage caused by the fungus in the skin or nails opens the doorway to a secondary infection by dangerous bacteria.

More often than not, the infection is polymicrobial (multiple types of bacteria) including even the media publicized staph infection - MRSA, making these infections more difficult to treat with traditional antibiotics.

Diabetes remains the #1 cause of lower extremity amputations in the United States, accounting for approximately 80% of the 120,000 non-traumatic amputations annually. Frequently, the first reaction by many physicians is to eliminate a complicated wound by performing a below the knee amputation. This eliminates the wound problems, but creates a life-altering change in the patient's mobility, not to mention new challenges with prosthetic limb use. More unfortunate; however, is the accelerated breakdown of the other foot and often a reduction in lifespan.

Limb salvage is the specialized care that involves preservation of as much of the limb as possible, allowing the patient to retain a functional extremity. Diabetic foot wounds that are typically being treated with below knee amputations often can actually be healed with a partial foot or toe amputation.

Dr. Zeetser is willing to take the time necessary to aggressively manage these complex wounds, using the latest surgical techniques and technologies available. He coordinates his patients' care with other medical specialists, as needed, to provide a "team approach" for the optimal outcome.

An Ounce of Prevention…

If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. Feel each foot for swelling. Examine between your toes. See a podiatrist regularly for diabetic foot care.
If you find any injury, no matter how slight, don't try to treat it yourself. Go to a doctor right away.
Wound Care and Limb Salvage

Venous Insufficiency with Venous Stasis Wounds

Poor venous circulation occurs due to incompetent or faulty valves on the deep veins. Rather than properly closing and pumping blood upwards towards the heart, these valves remain partially open, allowing blood to backflow down the legs. The fluid accumulates in the legs, ankles and feet causing swelling and varicose veins. Occasionally, blood clots can develop as well. If not treated properly with elevation and external compression, the condition becomes chronic and the leg swelling gets more severe. As the red blood cells die and rupture, iron is released which stains the skin dark brown. Gradually, the skin becomes thin and shiny and loses its strength. Small blisters may appear in the lower legs or the skin can secrete clear yellow fluid. Eventually the skin ulcerates and large wounds form which are difficult to heal. If not treated in a timely manner, this condition continues to worsen and wounds can become chronic, lasting months to years, until proper treatment is rendered with proper wound care and aggressive management of the venous insufficiency with compression therapies.

This is a common problem that affects both men and women. Pneumatic compression pump therapy can be used for mild cases to physically drain the fluid from the limbs. Dr. Zeetser offers this form of treatment in the office or can assist you in obtaining a device for your home. He also offers a complete line of high quality graduated compression garments, which are necessary for this condition. Often times, patients have received these types of garments/socks in the past which were too tight and difficult to put on or wear. Most people tend to give up on these. Dr. Zeetser and his experienced staff will work with you to determine the exact style and compression strength that you will be able to tolerate so as to ensure that you will properly use the garments.

For merely superficial spider veins which are of a cosmetic concern, treatment is available as well.