For every
wound or ulcer, there are a few standards of care
that must be followed closely to ensure proper
and timely healing:
1. Maintain a moist
wound environment. Contrary to popular
belief, it is not helpful to let a wound “dry
out”. Keep an ointment like Vaseline or
Aquaphor in place on a wound at all times.
2. Gently wash
a wound or ulcer with water, saline or a gentle
cleanser. Antibacterial cleansers are fine if
they are not alcohol based. Avoid cleansers that
dry out the wound.
3. Remove necrotic
or infected tissue. This is called debridement.
Debridement should be done by a physician or a
nurse specialist. Enzymatic debridement creams
are sometimes used to help remove minor amounts
of necrotic tissue.
4. Infection control
with antibiotics (Polysporin ointment, dilute
vinegar soaks or systemic antibiotics, for example)
is very important. The proper antibiotic approach
for each wound should be determined by a physician.
5. Nutritional support
of a wound includes eating a balance diet. Remember,
the best wound care in the world cannot heal a
wound if there is underlying malnourishment. For
diabetics, there must be adequate caloric intake
and strict control of blood glucose levels.
Diabetic ulcers
are caused when the foot skin looses sensitivity
(peripheral neuropathy) or when the skin circulation
is impaired (ischemia). Peripheral neuropathy
can lead to wounds that a diabetic person can’t
feel. There is no cure for loss of sensitivity
in the feet, but careful glucose control can prevent
progression. Peripheral neuropathy can cause skin
ulcers and also infection of the underlying bone
(osteomyelitis), which can eventually lead to
lower limb amputation if, in addition, the circulation
in the feet and legs is poor.
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Prevention of diabetic
ulcers is crucial.
o Close control
of blood glucose level.
o Maintain proper body weight.
o Avoid smoking, it damages the circulation
in the feet.
o Foot inspection should be performed
daily.
o Wear comfortable well-fitting shoes.
o Regular washing and thorough drying
of the feet (between toes!) is encouraged.
o Sensory neurological examination should
be performed to monitor sensation.
o Nails should be kept trimmed; cutting
them too short should be avoided. |
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Avoid weight bearing
on a diabetic foot ulcer. Weight bearing relief
can come from the use of contact casts, shoe
inserts, special shoes, and even crutches.
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Referral to a specialist
in foot shoes may be recommended by your physician.
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Bed rest or foot elevation
during the day may be required to keep pressure
off the foot, heels, ankles and toes. |
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Off-loading (relief
of pressure) is the most important aspect
of treating diabetic foot ulcers. Special
fitting shoes and casting of the ulcerated
foot are helpful. |
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Not taking a diabetic
ulcer seriously early may lead to amputation
later. |
Venous Ulcers
are one of the most common forms of leg ulcers.
Small valves that normally prevent blood from
pooling in the legs become damaged. As a result,
the legs swell. This swelling can eventually cause
breaks in the skin that lead to ulceration. Compression
therapy is the most important aspect of venous
ulcer therapy Unna Boots or other compression
bandages can be helpful to heal venous ulcers.
Long-term use of compression stockings is recommended
after a venous ulcer has healed to prevent recurrences.
Pressure ulcers
arise when pressure inhibits blood flow to the
skin (ischemia). The pressure is usually over
a bony prominence like the side of the foot, an
ankle or the sacrum (lower back bones). A bedsore
is an example of a pressure ulcer. With prolonged
pressure (sometimes even a few minutes), the skin
changes to red, blue or black, signifying destruction
of skin cells over the bony area. Pressure ulcerations
are usually very painful. On the feet and legs,
pain is worse when the leg is elevated, and this
type of pain is often relieved by dangling the
foot over a bedside. Off-loading all pressure
and strict prevention of secondary infections
are the most important aspects of pressure ulcer
therapy. Special fitting shoes, casting and frequent
turning of a bedridden person can prevent bedsores
(decubitus ulcers) or other pressure induced ulcers.
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