GTN patches?

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I started using GTN patches in diabetic neuropathic patients back in 2015 along with GP's where I worked at the time and got some really good outcomes. I was out of wound care for a couple of years though and when I requested some from a GP in my new job was told definitely no. I then looked into the literature and it's been tested on critical limb ischaemia patients and remains off-licence only for wounds. I am really sceptical about drug company motivations here as it seems a no -brainer that a vasodilator would take blood from deeper tissues in critical limb ischaemia and yet they had triled it here. I think it may be that these vasodilators are too inexpensive for the drug companies and they want to burry them. I find it also almost impossible to believe that a recent hospital Podiatrist provided wound lecture the only autonomic neuropathic effect on wounds discussed was sweating and I even have a former hospital based colleague of mine say that a clear autonomic neuropathy patient wouldn't need any other intervention from vasodilators or similar as they had had a vascular surgery. But will vascular surgery stop a sympathetic nerve from constricting an artery? I haven't seen this if it does and maybe it is that there are drugs that can alter or block the neurotransmitter substances - again I don't know but the lack of education on this whole physiology in pods and pod students is pretty stupid to me even when it comes to AV shunting and I don't think that we wouldn't get it and therefore it's just sweating from the ANS I actually think this lack of knowledge leaves us with one arm tied behind our back. For those interested in some of the autonomic vascular neuropathy responses -the experts believe it is a progressive neuropathy (likely to progress with increased loss of protective sensation) please check out attached.

Cheers
Louise

 

Just noticed I am talking about stupidity of companies that triled! So funny! Definitely meant trialed!