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Diabetes Foot Care: Interventions – Wound Care (Uncomplicated)

Sometimes despite our best efforts to prevent foot ulcers patients still come to this complication and so we are going to spend a little bit of time going over the basic management of wound care but a comprehensive review of wound care is beyond the scope of this training session. In particular we are going to review how to assess a wound, how to classify a foot wound, manage uncomplicated wounds, perform a vascular assessment and determine when to refer. Begin by assessing the wound using the following criteria. Look at the wound dimensions. Is it greater or less than 2 cm? The quality of the wound edge and bed; is it pink and healthy or is it necrotic? Look at the surrounding area. Is it errythematis, is there cellulitis, are there streaks suggesting infection? Note how deep the wound is. Is it penetrating to deep structures, such as fascia, tendon, bone. Are there any foreign bodies? Assess lower extremity blood flow by palpitating pulses or doing an ABI. Then look for signs of systemic infection such as elevated temperature or an elevated white count. We can use a simple classification system that categorizes wounds as uncomplicated or complicated. Uncomplicated wounds are the ones we will be taking care of; are those that are less than 2 cm, have no deep space involvement, less than 2cm of errythemia in the surrounding area, no systemic infection and no vascular insufficiency. By contrast complicated wounds have any of the following: greater than 2 cm, deep space involvement, errythemia greater than 2 cm, and systemic infection or vascular insufficiency. Management of uncomplicated wounds involved the following basic principles. First make sure you have a clean moist environment, with periodic debridements and regular dressing changes. Second, you need to off load the foot so that the healing environment is not damaged by stepping on it. At times you may need to hospitalize the patient to reinforce this. If there is evidence of limited infection, you can start an oral antibiotic that cover staph and strep and then redirect it based on cultures. Monitor the size of the wound and follow up patients on a weekly basis. For wounds that don’t heal after 4 weeks you need to refer them to a specialist and manage them as a complicated wound. As always glucose control is very important. To review a video on debridement of an uncomplicated wound, click on the link. There are some basic principles of dressing changes. Wet to dry is the mainstay using gauze dressing is adequate. Some people use absorbent compounds if there is a particularly soupy wound to absorb some of the moisture and to avoid maceration. Hydrocolloid gels and occlusive dressings have a role in dry wounds. Others use enzymatic debridements when then is a thick eschar to be softened. No presentation on wound healing would be completed with mention of nutrition. You need to have positive nitrogen balance and good basic nutrition. There are studies showing that Vitamin C 500mg/day and zinc supplementation for 10 days are associated with improved healing rates.

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