Ulcer

It has been suggested that up to 85% of amputations can be avoided when an effective care plan is adopted. Unfortunately, insufficient training, suboptimal assessment and treatment methods, failure to refer patients appropriately and poor access to specialist footcare teams hinder the prospects of achieving optimal outcomes.

Successful diagnosis and treatment of patients with DFUs involves a holistic approach that includes:

Optimal diabetes control

Effective local wound care

Infection control

Pressure relieving strategies

Restoring pulsatile blood flow

Diabetic Foot Ulcers

DFUs are complex, chronic wounds, which have a major long-term impact on the morbidity, mortality and quality of patients’ lives. Individuals who develop a DFU are at greater risk of premature death, myocardial infarction and fatal stroke than those without a history of DFU. Unlike other chronic wounds, the development and progression of a DFU is often complicated by wide-ranging diabetic changes, such as neuropathy and vascular disease. These, along with the altered neutrophil function, diminished tissue perfusion and defective protein synthesis that frequently accompany diabetes, present practitioners with specific and unique management challenges.

Management of Diabetic Foot Ulcers

Treating the underlying disease processes

Ensuring adequate blood supply

A patient with acute limb ischaemia is a clinical emergency and may be at great risk if not managed in a timely and effective way. Aside from critical limb ischaemia, decreased perfusion or impaired circulation may be an indicator for revascularisation in order to achieve and maintain healing and to avoid or delay a future amputation.

Local wound care, including infection control

The European Wound Management Association (EWMA) states that the emphasis in wound care for DFUs should be on radical and repeated debridement, frequent inspection and bacterial control and careful moisture balance to prevent maceration.

Pressure offloading

In patients with peripheral neuropathy, it is important to offload at-risk areas of the foot in order to redistribute pressures evenly. Inadequate offloading leads to tissue damage and ulceration.

*It is important to debride a wound and refer patients to a specialist for choosing the correct method of debridement. Inadequate wound management can cause rapid deterioration with potentially devastating consequences.