By the WoundSource Editors
Chronic wounds pose an ongoing challenge for clinicians, and there needs to be a clearer understanding of the pathophysiology of wound chronicity and treatment modalities available.
By the WoundSource Editors
Estimates are that by 2030 there will be 550 million individuals with diabetes in the world. Because almost a quarter of all people with diabetes will develop a foot ulcer at some point, health care workers need to know the best practices for diabetic foot ulcer prevention and treatment.
Determining which diabetic foot ulcer type is important to determine an effective treatment. Here are the different types of these wounds:
The first step in treatment of diabetic foot ulcers is to remove necrotic wound tissue from the wound. It is essential that the method of debridement utilized does not damage nerves, tendons, and blood vessels. Since many people with diabetes don't feel pain from the wound site, health care practitioners can't rely on the patient to let them know when sensitive areas are being examined. The debridement will:
Infection Prevention: Aggressive infection control is necessary to prevent infection. High morbidity and mortality rates are associated with diabetic foot ulcers which means oral and topical antibiotics are recommended if there is any sign of infection. Typically, wound dressings impregnated with antimicrobial agents are used. Simple gauze may actually damage the skin. Alginate and foam dressings provide high absorbency for moderate to heavy exudate. For a diabetic foot ulcer with dying tissue, hydrogels or dressings with collagen and silver are most effective. Most important is matching the absorptive ability of the wound dressing to the amount of wound drainage.
Pressure Offloading: Pressure on the diabetic foot ulcer prevents healing. That is why one key aspect of treatment can be a device to redistribute pressure more evenly throughout the lower leg. This can be done with a non-removable total contact cast or a removable offloading device. Unfortunately, studies have shown that many patients with removable devices only wear them 30% of the day, which can affect the outcomes of the treatment significantly.
Physicians of individuals with diabetic foot ulcers may have difficult decisions to make if wounds do not heal. Many of these patients have a significant cardiac risk and health care practitioners need to make complicated decisions about whether to perform invasive procedures like angiography. Other options can be:
Holistic treatment of the individual with diabetes can help treat the underlying health issues and not only promote faster wound healing but also minimize risk factors that may have contributed to the development of a diabetic foot ulcer. Good diabetic control and lifestyle modification include:
Individuals with diabetes should be instructed to:
In addition, every patient with diabetes should have a comprehensive foot exam yearly. Along with a careful physical exam, health care professionals should reinforce best practices of diabetic foot self-care at each visit to make sure the individual understands the recommendations and importance of caring for their feet.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.