Which plan of ulcer treatment implemented depends on many factors.  Choosing the proper treatment is just as important as addressing the patient’s circulatory, neurological and biomechanical problems.  After accurate staging and measuring the ulcer, the proper treatment is chosen.  Our doctors have experience with many different topical ulcer treatments such as Procuren and Regranex.  If medically necessary, complex deep surgical debridement and skin grafting procedures may be utilized in order to prevent amputation.  Doctors Levine, Brown and Couluris pride themselves on keeping abreast of new medications and technology in the ever-evolving field of wound care.  Recently, an innovative form of therapy available exclusively at our wound care center, the Circulator Boot, has been utilized with great success.

The Circulator Boot is the only boot approved by the FDA for the treatment of arterial diseases in the leg.   This treatment has shown to be very successful in preventing amputation  in  patients  at  risk  due  to  ischemia  or infection. Unlike other types of compression boots,  the Circulator Boot is synchronized with the patient’s heartbeat.  The boot  may be  timed to  compress the leg after each heartbeat, every other or every other third heartbeat.  It does not compress the leg during the moments of heart contraction and arterial inflow into the leg.

Timed with the heartbeat, it may have a compression number per minute equal to the pulse rate.  Other compression boots approved for use in lymph edema or venous statis commonly take 20-30 seconds to inflate, remain inflated perhaps a minute and then deflate over a few seconds; during their inflated periods they block blood flow into the ischemic leg and potentially may cause damage to such legs.

The Circulator Boot is timed to release the leg in anticipation of cardiac systole, thus suddenly dropping pressure in the aorta and allowing the heart to empty its blood more easily during systole.  Returning the venous blood and decreasing the work of the heart contraction, it is a cardiac assist device.

Unlike other external cardiac assist devices, it limits its compression pressure to that commonly found in the end of the heart cycle (diastole).  In this fashion, it does not expel arterial blood from the leg but rather provides pressure to disseminate the arterial inflow around the leg.  Again, unlike other external cardiac assist devices, it is solely designed to use compressed air and thus spares the leg of the weight of a surrounding water bath.

The system lends itself readily to treatment of infected ulcerated legs.  Immersing the leg in bags containing antibiotic solutions may help debride and sterilize the ulcers.

The Circulator Boot has been the subject of numerous studies in the healing of chronic wounds and amputation prevention.  More information may be found on their website:  www.circulatorboot.com