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This lecture will discuss the basic pathophysiology of the diabetic foot as it relates to chronic wounds as well as the latest guidance from international and national societies. We will focus not only on underlying pathophysiology, but also on current diagnostic, evaluation, and treatment methodologies, all based on current available evidence.

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The lecture will stress the difference between neuropathic diabetic foot ulcers and neuroischemic ulcers. Distinguishing factors will be discussed. Diagnostic tests available will be presented and limitations of the tests discussed. The importance of understanding the limitations of ABIs will be presented. The data demonstrating an increased amputation rate with neuroischemic ulcers will be reviewed. Understanding the difference between neuroischemic and neuropathic DFUs is critical to ensure the appropriate diagnosis and treatment that can promote a decrease in amputation rate.

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This lecture will begin with a focus on the pathomechanics of diabetic peripheral neuropathy. From there, the focus will shift towards care management and patient care options.

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The explosion in treatments for Type 2 diabetes over the last several years has resulted in a myriad of treatment considerations. It is important for all health care providers to be aware of the categories and specific different classes of medications and their effects. With increasing survival rates and the potential for multi-systemic affects, clinicians who treat diabetics not directly related to their endocrine conditions, need to be aware of these medications and their specific actions.

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In this session, we will explore the experience and results of the Podimetrics SmartMat™ program in the quest to end avoidable amputations among veterans living with diabetes.

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Diane's talk will be about Wound Care, Clawback Insurance policies for allografts, Billing, and PGx/Lab work services.

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A review of the history of oxygen therapy for diabetic feet starting with hyperbaric oxygen (HBO) with its long history yet little data to support its use followed by more recent developments with different modes of topical oxygen therapy, focusing on TWO2 with continuous oxygen delivery, cyclical pressure and humidification as needed. Randomized controlled trials and meta-analyses will be discussed.

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This lecture will provide a review of the new PAD Guidelines established by the Joint Committee of American Heart Association and the American College of Cardiology.

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The presence of extant data regarding diabetic foot care and surgery has increased its awareness globally. However, the atypical diabetic presentation needs attention and progressive treatment approach to avoid resulting in the typical pathologies that are associated with diabetic foot care. Can we use the data in our favor to minimize such complications. How can we use the data to support our argument in the progressive treatment of the diabetic population?

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Vascular health is an important aspect to consider in the care of patients with lower extremity issues. This lecture will delve into the importance of vascular evaluations, discuss the limitations and explore newer technology that expands our ability to measure arterial perfusion of the tissue.

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A Scientific and Case-Based Discussion on BioREtain, a Next Generation Placental Allograft Technology for Advanced Chronic Wounds.

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From advanced wound management technologies to a broad range of products and support, discover one-of-a-kind solutions to enhance healing and improve outcomes.

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Despite the myriad of wound care conferences and reports of new advances in limb preservation, the worldwide amputation rates have shown little to no decline. There are many things that remain amiss such as the disparity among those who treat potentially limb-threatening conditions with respect to skill level, knowledge of how wounds heal, considerations of related conditions and more, specific criteria against which to base the decision to amputate versus consideration of salvage. This program will provide new considerations to be considered as important parts of limb preservation as well as provide guidelines against which to juxtapose the client and their condition as to appropriate timing and overall consideration regarding amputation versus salvage.

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Current published consensus guidelines from IWII, WRR, and NPIAP tell us that debridement is vital to the wound healing process. Slough or necrotic tissue in the wound can promote bacterial growth and prevent the formation of healthy granulation tissue. This session will provide guidance around when and how to perform debridement in wound management.

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The lecture will discuss the importance of understanding the difference between true VLUs and edema ulcers. The treatment of both will be presented. The treatment of true VLUs must include management of the wound and treatment of the disease. First line treatment of the venous disease is compression. Surgical options are also available to decrease recurrence and to enhance healing in slowly healing ulcers. The techniques for saphenous vein or perforator vein obliteration will be discussed. The importance of chronic compression to prevent recurrences will be presented.

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This lecture reviews the current standards of care for diabetic foot ulcer and the best practices from guidelines.

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Diabetic foot ulcers continue to challenge the most seasoned wound specialist. Despite past advances, less than 50% of diabetic ulcers are healed 12 weeks after treatment. This session will look at future of DFU treatment regimens.

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The assessment of chronic wounds includes both a primary and secondary assessment. Primary assessment includes ulcer assessment with debridement and a wound care plan. Primary assessment also includes determining and treating the etiology, for example, pressure reduction. Secondary assessment is determining all the factors that can have a negative impact on healing, for example, associated vascular disease or medications. The presentation will also discuss the importance of patient involvement in their care to promote compliance. The theme of the presentation will be “We don’t treat wounds, we treat patients with wounds."

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A review of challenging cases from UT Health San Antonio with emphasis on modern approaches to management.

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This session will discuss evidence-based practices for treating diabetic foot infection including addressing rising antimicrobial resistance.

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Distinguishing osteomyelitis from soft-tissue infection of the foot is important because osteomyelitis is associated with more operations, amputation, and prolonged antibiotic exposure. The approach to osteomyelitis should be guided by several principles, but must be individualized to each unique situation. This lecture will review the clinical presentation, diagnostics, treatment interventions, and treatment strategies of osteomyelitis in the diabetic foot. We will also discuss the role of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) biomarkers. Dr Banks will discuss the recommended optimum cut for values to improve recognition of osteomyelitis

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Agenda: • Why Perform Ankle Brachial Index (ABI)? • Barriers to performing ABI • How Dopplex Ability can benefit your practice • Clinical Evidence • How to perform an ABI with Dopplex Ability

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1. Illustrate the specific techniques and protocols used in applying the novel NPWT dressing in different clinical scenarios 2. Share best practices and tips for healthcare professionals to optimize healing

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Dr Lantis evaluate the evidence supporting intact fish skin graft for the use in diabetic foot ulcers including a in depth look at the Odinn Trial. An in-depth evaluation of the 252 patient prospective randomized control trial evaluating the use of intact fish skin graft for the treatment of University of Texas 2 and 3 diabetic foot ulcers.

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Objectives: 1. Provide a comprehensive overview of the development and evolution of negative pressure wound therapy (NPWT) 2. Explore wound types that would benefit from a novel NPWT dressing 3. Analyze case studies that highlight key application techniques and positive patient outcomes 4. Participate in a question and answer session

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This lecture will highlight Dr Kirsner's journey through wound care highlighting team building, mentorship, and creating education for the next generation of wound care providers

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This lecture summarizes 45 years of research experience particularly related to diabetic neuropathy and the diabetic foot. It will cover the importance of painless neuropathy that we learned from the late Dr Paul Brand, the surgeon who worked with leprosy and later diabetes in India and the United States. Included in this discussion are the important studies published over the last 40 years related to diabetic foot problems, a review of their global prevalence as well as the epidemic currently being experienced of global diabetes.

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Legally Mine will show you how to stop the threat of lawsuits before they ever get started by protecting your assets in time tested and proven legal structures. These same structures allow us to help our tax attorneys save what you would normally pay in income taxes. These are little known tax helps that have significant case history and have stood the test of time.

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This lecture will focus on wound care with evolve over the next several decades. Topics discussed with leveraging technology and biology, repurposing drugs for wound healing, understanding the future of biomarkers and wearables, and appreciating the microbiome.

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This lecture attempts to dispel our misconceptions surrounding psychology of diabetic foot ulceration and reviews the precious little research evidence that links psychological factors to DFU development and healing.

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Learn about current approaches in the management of burn injury to the foot.

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This presentation will review the multi-faceted manifestations of the diabetic neuropathies, focusing mainly on diabetic peripheral sensorimotor neuropathy. It will look at the increasing prevalence of neuropathy across the globe, a brief mention of pathogenesis and then focus on clinical features of the diabetic peripheral sensorimotor neuropathy, the differences between painless and painful neuropathy and finally cover evidence-based therapies for the management of painful diabetic neuropathy.

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Cellular, Acellular and Matrix-like Products (CAMPS), formerly known as skin substitutes, have become a mainstay in the armamentarium of the wound care specialists. The FDA classifies them as wound covers. Are they simply wound protectants or do they contribute to wound closure? This session will will review the potential mechanism of action for CAMPs and the clinical evidence for their use.

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Pressure injuries/ulcers of the lower extremities remain one of the most prevalent and complicated chronic wounds. Pressure injuries/ulcers on the lower extremities have unique considerations for accurate diagnosis and treatment that all health care professionals should be aware of. This course will provide attendees with the key considerations to ensure best possible patient outcomes.

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This lecture reviews the current guidelines on the diagnosis and treatment of the Charcot foot.

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Amputation is a tough topic to discuss with patients. This lecture will outline common levels of amputation and the associated technique.

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The lecture will review the indications for external fixator utilization in various diabetic foot conditions requiring soft tissue and osseous reconstruction.

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In the Spring of 2024, all twelve Medicare Administrative Contractors(MACs) issued similar draft local coverage determinations (LCDs) on the use Cellular, Acellular and Matrix-like Products (CAMPS). What does it mean for the future use of CAMPs? This session will explore the repercussions of this edict.

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Hear from Drs Michael Fishman and Jason Snyder about spinal cord stimulation (SCS) to treat painful diabetic peripheral neuropathy, and how a collaboration between Pain Management Physicians and Podiatrists could benefit your patients and your practice.

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Dr. Levitt will review how MatriDerm, a unique dermal matrix with added elastin, is decreasing time to wound closure and improving patient outcomes in even his most challenging cases.

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The reimbursement landscape evolves and processes change with ongoing regulatory stipulations. This session will review the CarePics/Tissue Health Plus newly created offering, enhancing the fee for service process and value-based future of wound care.

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What does the evidence say about surgery and neuropathic patients? This lecture will explore historical and current articles outlining the recommendations around infection, wound healing, tendon balancing and how best to preserve function.

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The lecture will discuss the treatment of various diabetic foot conditions in patients with end stage renal disease.

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Flexor tenotomies are a fast and easy way to offload a difficult to heal digital wound. This lecture will provide a discussion on the procedure and effectiveness of the procedure. The lecture will provide a brief literature review of the safety and effectiveness of the procedure along with a detailed explanation of the anatomy and pathology behind the deformity.

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This lecture will focus on the approach to the atypical ulcer. Atypical ulcers are often chronic in nature and can be associated with heightened morbidity and mortality.

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In this comprehensive presentation, “Pressure Ulcers: The New Frontier in Wound Research,” we explore the evolving landscape of pressure ulcer management and research. This session will delve into key demographic trends, examining how certain populations, such as the elderly and those in post-acute care settings, are disproportionately affected by pressure ulcers. Utilizing data from clinical outcomes, the presentation sheds light on the impact of post-acute care and its role in informing wound care strategies.

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It is well known that that cost of diabetic foot care is a significant percentage of U.S. Healthcare costs. There are other patient care considerations to include when addressing the total care of our patients; that being the mental health impact when dealing with a chronic wound. The spectrum from fear of amputation to social isolation and depression is demonstrated with many of our patients. Utilizing a case study approach, the presenters will discuss and highlight signs to look for and possible interventions including when referral to a mental health professional is necessary.

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Caring for the patient with a spinal cord injury can present challenging issues. In this session, we will be discussing different types of lower extremity wounds that occur in the spinal cord injury patient as well as treatment options. We will also be looking at preventative measures for these wounds.

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An overview of the use of Topical Oxygen for lower extremity wounds.

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Diabetic limb salvage is very challenging. To have diabetic limb salvage, several classifications have been used. Sometimes, diabetic limb / podiatric specialists get confused with what needs to be addressed first. This lecture will review, compare and explain the classification options and examine approaches to wound healing. The WIFI score classification for diabetic foot wound which has been recognized by International Working Group on the Diabetic Foot will be presented.

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Late night consult for foot/ankle trauma? This presentation will review clinical and surgical principles of open management fracture. It will introduce and highlight the application of Gustilo-Anderson and Mangled Extremity Severity Score in the setting of open fractures management for foot/ankle trauma. Lastly, it will feature a patient case report involving high-energy foot trauma secondary to motorcycle accident.

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Exposure to oxygen upregulates growth factors essential for maintaining a well-vascularized wound core. Oxygen is also required to maintain the necessary partial oxygen pressure (pO2) levels that are responsible for skin healing. Hence, cyclical topical oxygen therapy (TOT) is used to saturate a wound and surrounding tissues with oxygen, inducing localized expression of growth factors. This further induces angiogenesis and upregulation of enzymatic reactions that lead to a reparative environment. This case review demonstrates the efficacy of TOT to treat chronic traumatic lower extremity wounds complicated by venous insufficiency and diabetes mellitus.

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In this presentation of ESWT, Dr Tutnauer will discuss this modality as part of alternative treatment regimen. ESWT can help to minimize severe pain which can be physically debilitating and reduce a patient's quality of life. He will discuss options with regard to ESWT and patient selection.

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Case studies involving minimally invasive surgery with intramedullary fibular nails for ankle fractures in patients with poor skin quality and for managing young active duty military members to prevent significant hardware irritation to the ankle while wearing military boots.

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