According to the CDC,  “More than 37 million Americans have diabetes (about 1 in 10), and approximately 90 to 95 percent of them have type 2 diabetes.”

Diabetes can lead to a host of health problems, including neuropathy, a condition that reduces feeling sensations in parts of the body, such as the feet. What’s more, many with diabetes experience a loss of blood flow to their feet due to peripheral artery disease (PAD). In combination, these medical issues encourage the formation of foot ulcers and infections that can lead to amputation.

For many years, Lance Tornatore dealt with foot issues due to type 2 diabetes. With the support of several providers, he managed his symptoms through a number of interventions, including medication management and the initial surgical amputation of his large toe. In the past five years, Lance has worked hard to combat the affects of diabetes.

“I lost a bunch of weight, and things started going well. Then, I developed this ulcer on my foot that wouldn’t go away. The bone became involved and got infected.”

A Bid to Save His Foot

In March 2023, Lance’s medical team made the difficult decision to move forward with another amputation.

Jacob Panici, DPM, a community provider on the medical staff at WakeMed Cary Hospital with Piedmont Foot & Ankle Specialists and Lance’s long-term podiatrist explains, “I began caring for Mr. Tornatore six years ago. He is a diabetic, and he had developed sores on his toes. He had to undergo surgery a few times for the toe wounds. Most recently, he developed sores on what was left of the toes on that foot. We made the decision to remove his toes. That would give him the best outcome based on his history. Shortly after that surgery, he was able to get back into normal shoes and go about his daily activities.”

More Injuries Emerge in Lance’s Foot

Relieved by his speedy recovery, Lance left the hospital the next day, quickly went back to work and resumed his activities. Then, about three weeks post surgery, Lance developed a blister on the side of his foot.

In early July, when it still had not healed, Lance went to the WakeMed Cary Emergency Department and was visited by internal medicine hospitalists as well as his podiatrist, cardiologist and endocrinologist over a nine-day hospital stay where he received an angiogram and angioplasty to provide better blood circulation to his foot. He also underwent debridement in his infected foot with an attempt to sew up the wound, but there was not enough skin available for the procedure.

This time, it was determined that Lance should move forward with receiving care at the new WakeMed Wound Care Center in Cary, and he was taken over via ambulance.

Jacob Panici, DPM, says, “Lance developed a large blister on his foot. When our team addressed it, he had a loss of soft tissue. We were not able to heal it up in the operating room, and because of that large wound, I felt that the WakeMed Wound Care Center was the best place for him — not only so we could institute hyperbaric chamber therapy — but also so we could access other advanced modalities, such as vacuum therapy and general care with the staff at the WakeMed Wound Care Center.”

Lance was relieved to learn that there was an alternative to more amputations. He visited the WakeMed Wound Care Center and received a chest X-ray, lab work and insurance checks to ensure he was approved.

An Introduction to the WakeMed Wound Care Center

Lance took medical leave from his job at the suggestion of Dr. Panici, and he underwent hyperbaric oxygen therapy for two hours, five days per week to address the wound. He also received antibiotics, a wound vacuum and additional protocols to address the ulcer and save his foot.

Lance shares, “The hyperbaric chamber is a pure oxygen environment, and they took me down to a low pressure, similar to what a person would experience when deep-sea diving. This helps wounds heal faster. The care at the center has been exceptional. “

Nurses Chykeash Weeks, Adanna Painson and others have played an especially critical role in administering his care.

Chykeash Weeks notes, “We have provided standardized wound care for chronic patients as well as adjunctive therapy, which for Mr. Lance has involved hyperbaric oxygen therapy to assist in his standard therapy.”

Additionally, Adanna Painson adds, “Mr. Tornatore came in with a chronic Wagner Grade 4: diabetic ulcer of his right lateral foot. What we have been doing weekly is bringing him into the WakeMed Wound Care Center for debridement to remove dead tissue and calluses. Each week, the nurses have been monitoring him and taking pictures, so we can see the progressive healing of the wounds. Right now, the plan for him is to use Santyl ointment to chemically debride the wounds. This has to be changed daily, and he can do this at home. We also have administered a wound vacuum for some time to help facilitate healing.”

Hope for No More Amputations and a Return to an Active Life

Lance has seen great improvement in his foot since utilization of the many therapies available at the WakeMed Wound Care Center.

He observes, “The wound vacuum is one of many interventions that really has helped. It is a device I’d carry like a cross bow. It has tubing that goes down to the wound and literally creates suction to remove fluid. This stimulates tissue growth. Between that and the hyperbaric, I have begun to notice my diabetic neuropathy diminishing. I can now feel pain, which is a very good sign. My foot was purple when I started this process, and now it is a fleshy pink. I walk with a defender boot, which protects my foot from further injury, but also allows me to function. I’m grateful to save my foot.”

At this point, Lance looks forward to total wound closure; resolution of the infection; and a return to regular shoes, his work and his hobbies.

“I lead a fairly active lifestyle including biking and exercising, so I want to get back to that. I am grateful for the care I received at WakeMed Cary Hospital during my angioplasty. I also can’t thank the team at the WakeMed Wound Care Center enough, especially Chykeash and Lindsey. They have taken really good care of me.”

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About the WakeMed Wound Care Center

Designed to help treat hard-to-heal wounds, this service offers patients a customized treatment plan tailored to meet individual needs.

Coordinated care is provided by a multidisciplinary team of experts including general, vascular and plastic surgeons, podiatrists, certified wound care specialists and nurses, physical therapists, orthotists, registered dietitians, hyperbaric technicians, and physicians who are specialty trained in hyperbaric medicine.

WakeMed Wound Care also offers Hyperbaric Oxygen therapy in its monoplace hyperbaric chamber.  A few of the conditions that can be treated with Hyperbaric Oxygen therapy include traumatic wounds, diabetic foot ulcers, other wounds related to circulation impairments, compromised skin grafts and flaps, serious cuts, internal radiation injuries and severe infections.

About WakeMed Diabetes

WakeMed Adult Diabetes Education is pleased to announce four new virtual Diabetes Self-Management Education Classes. These classes provide education to help people with diabetes learn how to take the best care of themselves. This series provides ongoing education and support to help improve compliance and outcomes.

Virtual classes are two hours each and led by Certified Diabetes Care and Education Specialists and Registered Dietitians.