Diabetic Foot Ulcers


The American Diabetes Association reports that today nearly 30 million Americans have diabetes and that 1 in every 3 Medicare dollars and 1 in 5 total healthcare dollars is spent caring for people with diabetes. Each day 3,835 Americans will be diagnosed with diabetes. Each day, diabetes will cause 200 Americans to undergo an amputation. The economic costs associated with diabetic foot ulcers (DFU) represent the single largest category (33%) of medical expense associated with diabetes. Hospitalization, amputation and long duration of care are the major contributors to the high costs of diabetic foot ulcers.1

Although the LUNA Fluorescence Angiography System cannot prevent cardiovascular diseases or diabetes, it can assist surgeons and physicians treating patients with chronic wounds such as diabetic foot ulcers in determining the most optimal care pathway for patients. LUNA allows physicians to visually assess the quality of blood flow in vessels, micro-vessels and tissue in the lower extremities during certain treatments including pre-and post-interventional procedures such as peripheral bypass and stent implantation.

In 2016, Li and fellow researchers reported in the International Wound Journal that Although macrovascular screening of patients with chronic wounds, particularly in the lower extremities, is accepted as part of clinical practice guidelines, microvascular investigation is less commonly used for a variety of reasons. This can be an issue because most patients with macrovascular disease also develop concomitant microvascular dysfunction. Part of the reason for less comprehensive microvascular screening has been the lack of suitable imaging techniques that can quantify microvascular dysfunction in connection with non-healing chronic wounds. This is changing with the introduction of fluorescence microangiography.2

In the largest prospective study of the use of SPY technology (LUNA) in patients undergoing elective or urgent revascularization for claudication and chronic limb ischemia to date, Zhou and colleagues at Stanford concluded that in 93 patients, SPY technology was a valuable adjunct to the current standard, provided additional information on regional tissue perfusion, and allowed direct visualization of procedural outcomes. The technology may also be a valuable tool to assess various interventional approaches and to determine the necessity and extent of percutaneous interventions.3

In recent clinical case series published in Today’s Wound Clinic, Schlanger, Arnold and Li reported that LUNA offers a new dimension in treating lower extremity ulcerations and chronic non-healing wounds and that the information is reproducible and accurate. LUNA is supplementing clinician’s clinical judgement by providing real-time images of blood flow to the lower extremities that also allow patients to participate in their treatment regimes.3,4,5