Diabetic Foot Ulcer
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Transcript of Diabetic Foot Ulcer
Dr. Soumar Dutta
CDMO
Guwahati Refinery Hospital
In diabetes slight injury to glucose laden tissues may cause chronic infection and ulcer formation. In fact DM is the leading cause of non-traumatic lower extremity
amputation.
The reason for increased incidence of this disorder involves the interaction of several pathogenic factors:
NEUROPATHY.
ABNORMALFOOT BIOMECHANICS. PERIPHERAL ARTERIAL DISEASE. POOR WOUND HEALING.
Three types:
NeuropathicIschemicNeuro-ischemic
Depth-ischemia classification of diabetic foot ulcerDepth Depth
classificationclassificationDefinitionDefinition TreatmentTreatment
00 At risk foot, no At risk foot, no ulcerationulceration
PatientPatient education, education, accommodative accommodative footwear, regular footwear, regular clinical clinical examinationexamination
11 Superficial ulceration, Superficial ulceration, not infectednot infected
Offloading with total Offloading with total contact cast (TCC), contact cast (TCC), walking brace or walking brace or special footwearspecial footwear
22 Deep ulceration Deep ulceration exposing tendons or exposing tendons or jointsjoints
Surgical debridement, Surgical debridement, wound care, wound care, offloading, culture-offloading, culture-specific antibioticsspecific antibiotics
33 Extensive ulceration or Extensive ulceration or abscessabscess
Debridement or partial Debridement or partial amputation, amputation, offloading, culture-offloading, culture-specific antibioticsspecific antibiotics
Ischemia Ischemia classificationclassification
DEFINITIONDEFINITION TREATMENTTREATMENT
AA NOT ISCHEMICNOT ISCHEMIC
BB ISCHEMIA WITHOUT ISCHEMIA WITHOUT GANGRENEGANGRENE
Noninvasive vascular Noninvasive vascular testing, vascular testing, vascular consultation if consultation if symptomaticsymptomatic
CC PARTIAL(FOREFOOT) PARTIAL(FOREFOOT) GANGRENEGANGRENE
VASCULAR VASCULAR CONSULTATIONCONSULTATION
DD COMPLETE FOOT COMPLETE FOOT GANGRENEGANGRENE
Major extremity Major extremity amputation, vascular amputation, vascular consultationconsultation
Preventive measures: The major focus of current diabetic foot care is prevention. Preventive strategies combine:
patient education (most important) prophylactic skin and nail care
protective footwear.
. Low-risk individuals must wear non-constrictive shoes. Soft leather or athletic footwear decreases the risk of
tissue breakdown from direct pressure Cushioned stockings are helpful, and white socks make identification
of skin breakdown easier, especially in individuals with impaired vision. Nails should be cut transversely to
decrease the risk of an ingrown toenail. Often, the earliest sign of infection is slowly increasing blood sugars and
insulin requirement.
Strict Glycaemic control.
Proper nutrition.
Antiibiotics: to control secondary infections: Oral cephalosporins, clindamycin,amoxicillin/clavulanate, quinolones.
The primary goal in the surgical treatment of diabetic foot ulcers is to obtain wound closure. Management of the foot ulcer is largely determined by its severity (grade) and vascularity and the presence of infection.REST.
ELEVATION OF AFFECTED FOOT.
RELIEF OF PRESSURES.
DEBRIDEMENT OF ALL NECROTIC,CALLOUS AND FIBROTIC TISSUES.KEEP WOUND MOIST WITH SALINE-SOAKED DRESSING OR HYDROCOLLOID GEL.WOUNDS THAT PRODUCE LARGE AMOUNT OF EXUDATIVE MATERIALS- Treat with absorbent materials (calcium alginate) and dressings while keeping the wound moist. USE OF GROWTH FACTOR GELS: Promote wound healing in wounds with reasonable wound-healing potential.
Osteomyelitis is a prevalent sequel of diabetic foot ulcers. The timing of its diagnosis and treatment is crucial if the diabetic patient is to avoid amputation later.
Fig:Osteomyelites at the head of first metatarsal bone
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