Diabetic Foot and Chronic Ulcer Management Program

Chronic non-healing wounds and diabetic foot ulcers are among the most serious and debilitating complications faced by individuals with diabetes and vascular conditions. These persistent ulcers can severely impact quality of life, increase the risk of infections, and often lead to hospitalizations or amputations if not managed appropriately. With growing global incidence, effective and timely treatment of non-healing wounds is more crucial than ever. Advances in wound care—particularly therapies like Heberprot-P—offer new hope to patients suffering from long-standing ulcers that are unresponsive to conventional treatment.

Why Cuba

Receiving treatment in Cuba for diabetic foot ulcers and non-healing wounds offers patients access to one of the most innovative therapies available today—Heberprot-P, a groundbreaking Cuban-developed medication that has transformed the management of chronic ulcers. Unlike conventional treatments, Heberprot-P is administered directly into the wound, accelerating healing from the inside out and significantly reducing the risk of amputation. Cuba is the only country where this therapy is widely and routinely available, administered by highly trained specialists within a healthcare system renowned for its preventive focus, surgical precision, and patient-centered care. For patients seeking advanced yet affordable wound care, Cuba offers a unique opportunity to benefit from a treatment unavailable in most parts of the world.

Diabetic Foot Ulcers and Non-Healing Wounds

Diabetic Foot Ulcers

Diabetic foot ulcer is an open sore or wound that typically occurs on the bottom of the foot in people with diabetes mellitus. These ulcers result from a combination of factors, including poor circulation, peripheral neuropathy, pressure points, and delayed wound healing.

Non-healing wounds

Non-healing wounds, also known as chronic ulcers, refer to skin injuries that fail to proceed through the normal healing stages within an expected timeframe (usually 4 to 6 weeks). This category includes:

• Venous ulcers are chronic wounds typically found on the lower legs, caused by poor blood flow due to damaged or weakened veins.
• Arterial ulcers develop when reduced arterial blood supply leads to tissue ischemia, commonly affecting the feet or toes in patients with peripheral artery disease.
• Pressure ulcers (bedsores) occur when prolonged pressure on the skin reduces blood flow, often affecting immobile patients in areas like the heels, hips, or sacrum.
• Post-surgical wounds are incisions or surgical sites that may fail to heal properly due to infection, poor circulation, or underlying health conditions.

The development of chronic ulcers—especially in diabetic patients—is multifactorial:

• Peripheral neuropathy impairs sensation, making it difficult to notice minor injuries or pressure.
• Peripheral arterial disease (PAD) reduces blood flow to extremities, delaying tissue repair.
• High blood glucose levels impair immune response and collagen synthesis.
• Repetitive trauma or pressure on weight-bearing areas worsens existing wounds.
• Infection can quickly spread in poorly oxygenated tissues, complicating healing.

Without timely intervention, these ulcers may deepen, become infected, or lead to osteomyelitis (bone infection) or limb amputation.

Dangers and Risks to the Patient

Untreated or poorly managed non-healing ulcers can lead to progressive tissue damage and a significant decline in the patient’s overall condition. As the wound persists, it often becomes more difficult to treat, delaying recovery and prolonging the need for medical intervention. In many cases, the patient’s mobility, independence, and quality of life are severely impacted, making early and effective wound management essential.

Untreated or poorly managed non-healing ulcers pose several serious health risks:

• Severe infection, including cellulitis, abscesses, and sepsis
• Tissue necrosis and gangrene
• Hospitalization for wound debridement or intravenous antibiotics
• Amputation, particularly in diabetic foot ulcers with advanced tissue damage
• Reduced mobility and quality of life
• Increased mortality rate, especially in patients with cardiovascular disease or end-stage complications of diabetes

Early detection and targeted treatment significantly reduce these risks and improve long-term outcomes.

Innovative Treatment with Heberprot-P

Heberprot-P is a groundbreaking biopharmaceutical therapy specifically designed for the treatment of diabetic foot ulcers and other non-healing chronic wounds. Developed in Cuba, this innovative solution addresses a critical medical challenge by promoting rapid tissue regeneration in wounds that are resistant to standard care. The key active ingredient in Heberprot-P is recombinant human epidermal growth factor (rhEGF)—a laboratory-produced version of a naturally occurring protein in the human body that plays a vital role in cell growth, tissue repair, and wound healing.

rhEGF works by stimulating the proliferation and migration of epithelial and fibroblast cells within the wound bed, thereby accelerating the formation of granulation tissue, enhancing re-epithelialization, and promoting the overall healing process.

How Heberprot-P Works:

• Stimulates granulation tissue formation and re-epithelialization
• Promotes cell proliferation and migration in the wound bed
• Enhances angiogenesis (new blood vessel formation) to improve oxygen and nutrient supply
• Accelerates healing even in ulcers that have failed other therapies

Heberprot-P has been shown to reduce amputation rates, shorten healing time, and improve overall wound closure success. It is especially effective in deep, ischemic, or infected ulcers, where traditional dressings and antibiotics alone may be insufficient.

Pre-Treatment Diagnosis and Evaluation

Before initiating any wound therapy, a comprehensive diagnostic evaluation is essential. This ensures that treatment is tailored to the patient’s clinical needs and addresses all underlying contributing factors.

Typical pre-treatment assessments include:

• Wound culture and sensitivity testing to detect infection
• Doppler ultrasound or ankle-brachial index (ABI) to evaluate blood flow
• Blood glucose and HbA1c monitoring
• Wound imaging (e.g., X-ray, MRI) if bone involvement is suspected
• Clinical staging of the ulcer
• Assessment of patient’s nutritional status, comorbidities, and immune response

These evaluations are critical in identifying appropriate candidates for advanced therapies like Heberprot-P.

Application of Heberprot-P Treatment

Administered through intralesional injection, Heberprot-P is delivered directly into the edges and base of the ulcer, ensuring maximum therapeutic impact at the site of tissue breakdown. This targeted approach not only improves the speed and quality of healing but also helps reduce the risk of complications such as infection and amputation in patients with advanced or stubborn ulcers.

• Initial Vascular Assessment:
  • Venous Doppler ultrasound of the lower limbs to assess blood flow and detect venous insufficiency or obstruction.
  • Specific pressure measurements conducted by angiologists to evaluate arterial perfusion and tissue oxygenation levels.

• Specialist Consultations:
  • Evaluation by angiology specialists to determine the vascular status and suitability for therapy.
  • Pre-treatment review by anesthesia specialists to assess surgical risks and plan for any necessary procedures.

• Wound Preparation (Surgical):
  • Surgical toilette of the ulcer, involving thorough cleaning and debridement of necrotic or infected tissue to create a viable wound bed.
  • Skin grafting may be performed in cases of extensive tissue loss to promote coverage and healing.

• Heberprot-P Application:
  • Administered via intralesional injection directly into the base and edges of the ulcer.
  • Injections are typically given multiple times per week, under sterile conditions and medical supervision.
  • Treatment is conducted in a controlled clinical environment, ensuring monitoring and adjustment based on the patient’s response.