Tag: David G. Armstrong

Considering Function When Evaluating Threatened Limbs

At the Southwestern Academic Limb Salvage Alliance (SALSA), we have long nicknamed our program “Toe and Flow,” highlighting the central nature of podiatric and vascular surgery to the interdisciplinary team. However, this may be inadequate to describe what we actually do. “Toe, Flow and Go” might better describe what we are doing in clinic, on the hospital wards, and on our research team … As we get more and more adept at technique and technology for limb preservation and limb salvage, what we’re faced with often is a much more fundamental question, which is just because we can do something to preserve a limb, should we? I know people have discussed and talked about this over the years but we are really doing our best to live at it SALSA and USC … read more

The Diabetic Foot in Remission: Strategies to Make Prevention Pay

September 25, 2018 1:00 pm to 2:00 pm EDT
Presented by: Dr. David G. Armstrong, DPM, MD, PhD

Because neuroischemic complications are associated with a high rate of recurrence, this presentation proposes a slight shift in how health care providers counsel and communicate risk to their patients. If the epidemiology of this problem is comparable with that of cancer, and recurrences are common, then perhaps language commensurate with such risks should follow.


After initial healing of an index wound, patients are referred to not as being cured but rather as being “in remission.” This concept is easy for the patient and the rest of the team to understand, and it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications.

This program will review tried-and-true as well as up-to-the-minute advances in biologics, consumer electronics, mechanics, medicine, and surgery that are “pushing the envelope” in extending ulcer-free, hospital-free, and activity-rich days in efforts to make prevention pay.


Registrants will learn how to:

  • Identify risk factors for ulceration
  • Identify risk factors for amputation
  • Understand the impact of diabetes on the health care system
  • Understand the impact of diabetic foot complications on the health care system

Study: Diabetic Foot Complications Among The Top 10 Causes Of Disability

David G. Armstrong DPM MD PhD


Diabetes-related lower extremity complications are a major cause of global disability, according to a recent study in Diabetic Medicine.


The study notes that of the 435 million people worldwide estimated to have diabetes, about 19 to 34 percent will experience a foot ulcer during their lifetimes.1 My coauthors and I note that diabetic foot complications are a leading cause of infection, hospitalization and amputation throughout the world although evidence-based care can prevent these outcomes … read more

Wound Care Advantage Launches Advanced Discovery Research Alliance

SIERRA MADRE, Calif.–(BUSINESS WIRE)–Apr 24, 2018–Wound Care Advantage (WCA), in collaboration with internationally renowned podiatric surgeon Dr. David G. Armstrong, the Southwestern Academic Limb Salvage Alliance (SALSA) and Gen1 Research, has launched Advanced Discovery, a new investigative research alliance dedicated to revolutionizing patient care through evidence-based science. Advanced Discovery will offer access to an international network of advanced wound and hyperbaric treatment centers, laying the groundwork for meaningful investigative research. In partnership with approved manufacturers and research facilitators, the Alliance will evaluate a variety of diagnostic and treatment modalities with a unified goal of positively impacting wound healing outcomes while reducing the cost of treatment. Gen1 will provide extensive administrative support and infrastructure for the studies.


Chronic wounds affect approximately 5.7 million patients in the U.S., costing the healthcare system more than $20 billion annually. 1 This burden is growing, due to a rapid increase in diabetes and vascular disease, an aging population, and rising healthcare costs. In fact, the cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer 2 and diabetic foot ulcer patients are twice as costly to U.S. Medicare as those with diabetes alone … read more

Toward Eliminating Diabetic Foot Amputation In The Next Generation

David G. Armstrong, professor of surgery at the Keck School of Medicine of USC

Humanity crossed a line in 2009: For the first time in history, more people in the last decade died from non-communicable disease than from all the plagues in the world combined. We’ve entered what science pundit Steve Jones has, in a rather macabre but perceptive manner, dubbed the Age of Decay.


First was the Age of Disaster — 95 percent of human history — when people died from starvation, accidents, violence and cold temperatures. Around 12,000 years ago, we learned to “circle the wagons,” if you will, as a species. As we became agrarian, we moved closer together to store food. A natural byproduct of this was the Age of Disease, when plagues decimated populations. We’re now in the Age of Decay, when the big killers are non-communicable diseases — cancer, cardiovascular disease and diabetes. Pulmonary disease is fourth.


The longer that I have labored in my line of work, the more I realize it is the height of hubris as a clinician to think that I can “fix” anyone. Rather, I think the best thing I can do is help folks move through the world a little bit better. Our goal in this age as clinicians, scientists, policymakers, is to think not about fixing everything but rather to delay decay.


We all rightly take cancer and heart attacks seriously. Diabetes, however, has not risen to that level. If one were an evil deity and wanted to sock it to humanity, one wouldn’t pick something like cancer or a heart attack. Those are often far too dramatic. One would rather choose diabetes: It is silent, sinister and it happens in the background. No one sees it coming. How, then, does diabetes cause amputations?

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Can Lactic Acid Bacteria Speed Wound Healing?

David G. Armstrong DPM MD PhD

Researchers are showing faster wound healing following the administration of lactic acid bacteria into wounds.


The study, published online in the Proceedings of the National Academy of Sciences of the United States of America, used a mice model to show wound healing.1 Researchers transformed Lactobacilli with a plasmid encoding C-X-C motif chemokine 12 (CXCL12), noting this enhanced wound closure via proliferation of dermal cells and macrophages, also leading to higher transforming growth factor-beta (TGF-β) expression in macrophages. The study notes that bacteria-produced lactic acid reduced the local pH, which inhibited the peptidase CD26 and facilitated a higher availability of bioactive CXCL12.


The authors also note that Lactobacilli delivering CXCL12 improved wound closure in mice with hyperglycemia or peripheral ischemia, conditions associated with chronic wounds.1 The study adds that the treatment showed macrophage proliferation on human skin in an in vitro model of wound epithelialization … read more