Welcome to the Website of

Dr. Michael Zapf, DPM, MPH, FACFAS

 Thank you for visiting my website. I have been placing information and articles on this site for many years and have received millions of  hits during that time (and not that many of them were mine). I have designed it for people who like to read about their foot and ankle problems. Since I started the web site, I have added two associates to my practice, Dr. Darren Payne and Dr. Stephen Benson.  Since my site is filled with just my thoughts and opinions they are not, necessarily, shared by my colleagues. To see our less controversial (and less windy) practice web site, I offer you: www.ConejoFeet.com, the practice site for The Agoura Los Robles Podiatry Centers (ALRPC). The ALRPC practice site has a lot of material about our office, many of our policies and the registration forms to be filled out before your visit. I suggest all prospective patients visit www.ConejoFeet.com.

 I made the web site to give my patients the extra depth information that I don’t always have time to cover in the office visit. Visitors who are not my patients are welcome to browse the information found here. My younger colleagues are both under 50 and they, like many their age, do not favor in depth reading. They prefer their information presented to them in a few short, crisp bullet points. I, being of the, ahem, older generation, like to read about my ailments in greater depth. Here, I present the greater depth. If you ask a question about heel pain or bunions that I have not answered in my two monographs, I will quickly add it so that it is as complete as I can make it. If you agree with this philosophy, welcome to my page. If you correspond with me please let me know if you like the in depth reporting.

 Remember, this site is in no way intended to tell you how your own ailment or problem should be treated, only the approach I use when confronted with certain situations. Your problem may well be different from what you think it is and should always be evaluated by the appropriate professional, whether podiatrist, orthopedist or other authority. Please understand that I, nor anyone else, can offer you a proper diagnosis or treatment plan without seeing and feeling the problem at hand (foot?).  Happy reading.

 Sincerely, Michael Zapf, DPM, MPH, FACFAS, FACFAOM

 P.S. All the information in this web site is © by me and it is mine alone. No picture or any of the articles cannot be used by anyone without permission from me, personally.

01/08/2012

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ACORN ARTICLE    October 26, 2000 

New Factors In Wound Healing

              “So Doc, let me see if I got this straight. You’re gonna treat my foot with pig guts and sea weed?” was how Larry greeted my new treatment regimen for his slow to heal foot ulceration. I admitted that this amusing characterization was a not entirely false representation to what I had just told him.

            Larry is one of many people with hard to close wounds. Wounds that refuse to heal are frequently found on the feet but they can be just about anywhere on the body. Diabetes, poor circulation or both are common findings. Larry had both. Most wounds heal if the circulation is good and the wound is kept open and clean.

            Treating these wounds has become an industry onto itself. There are companies that sell many millions of dollars a year worth of products to get wounds to heal. Those of us on the front lines of ulcer and wound care are bombarded by new products every month. I explained to Larry some of the most exciting new products.

            Larry’s wound produces a lot of moisture. Too much moisture is bad so something is needed to absorb the extra fluid. Who would have guessed that a product made from seaweed would be the answer. Classified as an alginate, sea weed dressings can absorb many times their weight in fluids. Even better, the mixture of the alginate and wound fluid creates a gel that further encourages healing. For many people adding a seaweed dressing creates the perfect environment to heal a wound. It helped Larry but it was not enough; he needed growth factors.

            Growth factors are to wounds what Miracle Grow is to roses. It adds just the right ingredients to encourage the body to heal the wound. Currently there are three sources of growth factors available.

The first growth factor commercially available was Procuren, a product developed at a few private wound care centers from patients’ own blood cells. If you are at a Procuren wound care center a paste will be made from your own platelets, a cell found in your blood. Procuren contains about 5 separate growth factors and is daily placed on the wound.

About two years ago the second growth factor product, Regranex, hit the market. Regranex comes in a little tube (a $300 tube!) and is applied to the wound once a day. With Regranex or Procuren, wounds seem to heal 10% faster and 10% of otherwise non-healing wounds will now heal. For many people these products have been a lifesaver.

Three months ago a third product, Oasis, made its way to the market. Oasis is derived from what the package insert politely calls porcine gastrointestinal submucosa. To you and me that means the lining of pig’s intestines. You already read what Larry calls it. The product is processed to remove all that is pig but leaves a whole “pen” of wound growth factors, actually many more than the earlier products. It comes as a parchment-like sheet that is placed on the wound and stays for up to a week at a time. In my practice I have seen the Oasis product heal several wounds that were not helped with any other methods. This product goes beyond lifesaver; I call it a sole-saver.

If the Oasis doesn’t work I might suggest a try with Apligraf which is a living tissue derived from neonatal foreskins. In a personal e-mail from the manufacturer they assured me that it was from the foreskin of full term infants who volunteered (actually the parents volunteered) to donate the base material.  Apligraf is an actual layer of skin about the size of a silver dollar. It has all the properties of skin. If you cut it with a knife it will heal. Placed on the wound it becomes a skin covering. Special properties allow it to turn into whatever kind of skin it is supposed to represent. Placed on the toe it becomes toe skin. Placed on the bottom of the foot it becomes thick bottom of the foot skin. I had a chance to apply Apligraf at a wound care seminar in Phoenix and I welcome the addition to my wound care tools.

Larry doesn’t know about the Apligraf. If he is a little squeamish about “pig guts” I cannot imagine what he will say when I tell him about baby foreskins. He doesn’t read the Acorn so do me a favor and don’t give him this, er, little tip.

Dr. Michael Zapf is a Board Certified podiatrist with offices in Agoura Hills and Thousand Oaks. If you have questions about wound care please call his office at (818) 707-3668.

Send mail to (zfootdoc at doctor dot com) with questions or comments about this web site.
Copyright © 2000 Michael A. Zapf, D.P.M., F.A.C.F.A.S., F.A.C.F.AOA.M.
Last modified: January 08, 2012