Diabetopaedia.com - Postitive Living with Diabetes
Foot Ulcer Treatment
Foot Ulcer Treatment
If treatment is based on the following
principles, healing rates of 80 - 90% can be attained. The best
wound care cannot compensate for continued injury, ischemia or
infection. Patients with an ulcer deeper than the subcutis should
be treated aggressively and, depending on local resources and
infrastructure, hospitalisation must be considered.
Principles of ulcer treatment
Relief of Pressure
Non weight bearing is
essential - Limitation of standing and walking- Crutches, etc.
Arterial revascularization
procedures (results do not differ from non-diabetic patients,
but distal bypass-surgery is needed more frequently).
The benefits of pharmacological
treatment to improve perfusion have not yet been established.
Treat smoking, hypertension
and dyslipidemia.
Treatment
of infection
Superficial
ulcer with extensive necrosis
- Debridement
with removal of all necrotic tissue and oral antibiotics aimed
at staphylococci and streptococci
- No topical antibiotics
Deep (limb-threatening)
infection
Surgical drainage
as soon as possible (emergency referral) with removal of necrotic
or poorly vascularized tissue, including infected bone.
- Revascularization if necessary
- Broad-spectrum antibiotics intravenously, aimed at Gram-positive
and negative microorganisms, including anaerobes.
Metabolic control and treatment
of comorbidity
Optional diabetes control,
if necessary with insulin (blood glucose < 10 mmol/l or <
180 mg/dl)
Treat edema and malnutrition.
Local wound care
Frequent wound debridement
(with scalpel, e.g. once a week)
Frequent wound inspection
Absorbent, non-adhesive,
non-occlusive dressings.
Growth factors have
been shown to be effective in plantar Neuropathic ulcers, but
their exact place in treatment has yet to be determined.
The following treatments
are still experimental
- Bio-engineered tissue
- Hyperbaric oxygen treatment.
Footbaths are contraindicated
as they induce maceration of the skin.
Instruction of patient
and relatives
Instruction should be
given on appropriate self-care and how to recognize and report
signs and symptoms of (worsening) infection, such as fever, changes
in local wound conditions or hyperglycemia.
Determining the cause
and preventing recurrence
Determine cause - as
ulceration is a current disease
Prevent ulcers on contralateral
foot and give heel protection during bed rest
Patient must be included
in a comprehensive foot-care program with life-long observation
