Abstract:

Pain is an unpleasant sensory experience that evokes negative emotions and erodes an individual's quality of life, constituting a significant amount of stress. Chronic-wound patients have described pain as most intense during dressing change and the worst part of living with an ulcer. Wound-related pain is complex, involving a multitude of physiologic and psychologic factors, such as emotional state, culture, personality, meaning, and expectation. Although the exact mechanism(s) remains elusive, a burgeoning body of evidence suggests a close link between stress/anxiety and pain. Wound healing can be compromised by overproduction of cortisol compromising the function of immune system in addition to catecholamines causing vasoconstriction and poor tissue oxygenation. The purpose of this paper is to review the relationships among pain, stress, and wound healing.

Authors:

Kevin Y. Woo, PhD, RN, FAPWCA, Assistant Professor, School of Nursing, Queen’s University, Kingston, Ontario, Canada, Wound Care Consultant, West Park Healthcare Centre, Toronto, Ontario, Canada

PMID: 23023574

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Abstract:

This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had recalcitrant ulcers requiring further therapy. Our findings in 127 patients with neuropathic diabetic foot ulcers add further credence to the growing evidence that percutaneous complete tenotomy of the Achilles tendon is a viable approach to treat Wagner Grade 1 to 4 foot ulcers.

Authors:

Wayne J. Caputo D.P.M., FACFAS, D.P.M. , American Board of Podiatric Surgery, Director of Wound Care Center, Clara Maass Medical Center,Belleville, George Fahoury D.P.M., FACFAS, D.P.M., American Board of Podiatric Surgery, Director of Wound Care Center, Monmouth Medical Center, Long Branch, NJ

PMID: 23225595

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