What Is Involved in the Treatment of Diabetic Foot Ulcers?

Diabetic foot ulcer treatment is a treatment method for diabetic foot ulcer. There are several methods to reduce stress and protect ulcers.

Diabetic foot ulcer treatment

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Diabetic foot ulcer treatment is a treatment method for diabetic foot ulcer. There are several methods to reduce stress and protect ulcers.

Common causes of diabetic foot ulcers

Even for patients with simple ischemic ulcers, inappropriate shoes are the most common cause of ulcers. Therefore, the shoes of all patients should be examined carefully.

Types of diabetic foot ulcers

Most diabetic foot ulcers can be classified as neurogenic, ischemic, and neuro-ischemic. This can guide further treatment. Evaluation of vascular conditions is necessary when managing foot ulcers. If the dorsal foot arterial pulsation disappears, or if the ulcer does not improve after optimal treatment, more aspects of vascular assessment should be performed. Ankle brachial pressure index (ABPI) less than 0.9 indicates peripheral arterial disease. However, ankle pressure may be pseudo-increased due to arterial calcification. Therefore, other tests should be performed, such as measuring toe pressure or transcutaneous oxygen partial pressure (TcP0z). If amputation is planned, vascular reconstruction is preferred.

Location and depth of diabetic foot ulcers

Neurological ulcers usually occur in the soles of the feet or in areas that overlap with bone deformities. Ischemic and neuro-ischemic ulcers are more common on the tip of the toe or the side of the foot. Due to scabies or necrosis, the depth of the ulcer is difficult to determine. Therefore, neurological ulcers complicated by scabies and necrosis should be removed as soon as possible. However, ischemia and neuroischemic ulcers without signs of infection should not be removed. Elimination in neurological ulcers usually does not require anesthesia.

Signs of diabetic foot infection (see Guidelines for the diagnosis and treatment of infectious diabetic foot): Infections of diabetic foot directly threaten the affected limb and should be treated quickly and aggressively. There are usually no signs and / or symptoms of infection, such as fever, pain, or increased leukemia counts / erythrocyte sedimentation. However, with these manifestations, substantial tissue damage or even abscess formation is likely to have occurred. The risk of osteomyelitis should be understood. If possible, probe should be probed to the bone before debridement is started, as the underlying bone may already be infected. Superficial infections are usually caused by Gram-positive bacteria. If it is a deep infection, Gram staining and deep tissue culture (not surface paper culture) are recommended. These infections are often a mixed infection of multiple bacteria, including anaerobic and gram-positive / negative bacteria.

Treatment of diabetic foot ulcer

The best wound care for diabetic foot ulcers cannot completely avoid injury, ischemia or infection. The ulcers of deep subcutaneous tissue should be actively treated, and hospitalization should be considered according to local health resources and primary medical institutions.

Reducing pressure and protecting ulcers (see special guide for shoes and decompression): mechanical decompression to reduce the formation of keratinized ulcers with an increase in biomechanical pressure; full-contact brace or other brace technology-treatment of foot ulcers; Sexual foot protection; individualized insoles and shoes; reducing weight-limiting standing and walking, using crutches; restoring skin blood flow perfusion; arterial reconstruction techniques: the results are no different from those of non-diabetic patients. However, distal vascular bypass surgery is often more needed; medications that improve blood flow perfusion are inconclusive.

Focus on reducing cardiovascular risk factors (quit smoking, antihypertensive and lipid-lowering therapy, use of aspirin).

Treatment of infection (see Special Guidelines for Diagnosis and Treatment of Infectious Diabetic Foot and Guidelines for Treatment of Diabetic Foot Osteomyelitis):

a Superficial ulcer with skin infection: debride to remove all necrotic tissue, and oral antibiotics against glucococci and streptococci.

b Deep (threatening limb) infections: Perform surgical drainage (emergency) as soon as possible to remove necrotic or poorly-blooded tissue, including infected bone tissue. Vascular reconstruction if necessary; broad-spectrum antibiotics given intravenously to Gram-positive and negative microorganisms, including anaerobic bacteria.

Local wound care (see Guidelines for Wound and Wound Disposal): check wounds frequently; frequent wound debridement (with a scalpel); control exudation and keep moist; consider negative pressure treatment for wounds after surgery; no need for routine treatment The following treatments; the use of bioactive drugs (collagen, growth factors, bioengineered tissues) in neuropathic ulcers; systemic hyperbaric oxygen therapy; dressings containing silver or other antibiotics (Note: foot bathing is contraindicated, which may cause skin maceration).

Education of patients and their families: guide patients in proper self-care, how to identify and report signs of infection or exacerbations of infection, such as fever, changes in local wounds, or hyperglycemia.

Understand the causes and prevent recurrence: Understand the causes of diabetic foot ulcers to reduce the chance of recurrence. To prevent ulcers on the contralateral foot, heel protection should be given during bed rest. Once the ulcer is cured, the patient should be given comprehensive foot care and observed throughout life.

Diabetic foot sensory test

Neuropathy can be detected using 10 g (5.07 Semmes-Weinstein) monofilament, tuning fork (128 Hz) and or cotton wool.

Nylon monofilament (Semmes-Weinstein monofilament): The following points should be paid attention to when inspecting: the feeling should be inspected in a quite calm and relaxed state. First place the monofilament on the patient's hand (elbow or forehead) so that the patient knows how the monofilament feels; the patient cannot see if the examiner applies the monofilament or where it is applied. Each foot should be examined at 3 points; the monofilament is placed vertically on the skin surface; the monofilament is given sufficient pressure to bend it; the entire procedure involves skin contact and removal of the monofilament for about 2s; ulcers, scabs, scars and Use monofilament instead of the surface of necrotic tissue; do not scratch the monofilament on the skin or repeat contact at the test site; press the monofilament firmly and ask the patient if they feel pressure ("yes" or "no"), if Ask again which part is felt ("left foot" or "right foot"); repeat the same part twice, but at least once as a simulation, no monofilament is applied at this time (three times in total for each part); if the patient answers correctly three times Twice, its protective sensation exists. If the answer is wrong twice or three times, the protective sensation is lacking. Consider the patient's risk of developing ulcers. The patient is encouraged by positive feedback during the examination. The medical staff should be alert to the loss of the bending force if the monofilament is used for too long.

Tuning fork: should be checked in a calm and relaxed state. First, the tuning fork is placed on the patient's wrist (or elbow or clavicle) to let the patient know what it feels like; the patient cannot see whether the examiner is using monofilament or where the tuning fork is being applied. The tuning fork should be placed on the bony part of the dorsal phalanges of the first toe; use the tuning fork vertically to continuously apply pressure; repeat twice, but at least once for simulation, and do not vibrate the tuning fork at this time; if the patient answered twice of three times correctly Is positive. If the answer is negative in two of three times (risk of ulcers); if the patient cannot feel vibration at the big toe, repeat the test at the proximal end (ankle, tibia tuberosity); encourage the patient through positive feedback during the test .