title: Ulcer piercing: cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation.
abstract: OBJECTIVE
  To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing.
  
  
  METHODS
  We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply.
  
  
  RESULTS
  Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection.
  
  
  CONCLUSIONS
  Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply.
  
  
  BACKGROUND
  There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.
authors: MD, Associate Professor of Surgery, Director of Masters of Woundcare. 1 Department of Medical-Surgical Sciences and Translational Medicine, University of Rome, Rome, Italy.
authors: M
authors: M
authors: Cavallini
mesh_terms: D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011677:Punctures; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing