TOPNURSE~By 2030, it is estimated that more than 550 million people around the world will have diabetes. Approximately 25% of these diabetic patients will develop foot ulcers during their lifetime, which often require advanced diabetic wound treatment to prevent complications. To help achieve the optimal healing environment and protect against problems, there are six key factors to consider when treating diabetic wounds.
1. Wound Assessment
Diabetic wounds fall into three categories: neuropathic, ischemic, and neuroischemic. Knowing the distinct features of each wound category is essential to identifying wound progression, infection, and healing. Failure to properly identify the type of wound that exists can lead to an ineffective diabetic wound treatment plan, causing long-term complications or amputation.
2. Tissue Debridement
Wound debridement, or the removal of necrotic tissue from a wound, will reduce pressure, stimulate wound healing, allow for the inspection of underlying tissue, help with secretion or wound drainage, and optimize a wound dressing’s effectiveness. Clinicians typically recommend sharp debridement by scalpel or scissors, but there are other tissue-removal treatments they may recommend, including larval, autolytic, and ultrasonic.
Only an experienced practitioner who knows which section of the tissue to remove without damaging blood vessels, nerves, or tendons should perform a debridement procedure. Understanding the importance of debridement to your diabetic wound treatment plan is often essential with advanced diabetic wounds.
3. Infection Control
Infections are the top concern in any diabetic wound treatment plan. Due to the high morbidity and mortality rates associated with diabetic wounds, more aggressive forms of infection control are necessary. Both oral and topical antibiotics are recommended for all diabetic wound treatment patients who show signs of infection, even mild ones. Topical antimicrobials can reduce bacteria, protect against further contamination, and prevent the spread of infection deeper into the wound. Typical wound dressings used in treating diabetic wounds are those impregnated with antimicrobial agents to help fight infection. Clinicians often prescribe advanced wound care dressings that include silver, iodine, medical-grade honey, or polyhexamethylene biguanide (PHMB) which work to enhance healing by keeping your wound moist.
4. Moisture Balance
Choosing the optimal dressing for a diabetic wound is essential to successful wound healing. The proper wound dressing will help maintain a balanced moisture environment (not too wet or too dry) and allow the wound to drain and heal properly. The location of the wound will also be taken into consideration by your clinician when they choose a dressing. While each wound needs to be assessed properly, some common dressings that can be used for diabetic wounds include alginates, hydrocolloids, and films.
5. Pressure Offloading
For most diabetic wound treatment plans for patients suffering from foot or leg ulcers, pressure reduction or offloading is a key factor in preventing complications. A non-removable total contact cast (TCC) redistributes pressure evenly throughout the lower leg and can reduce healing times. However, TCC is not always the best choice, especially for infected wounds, so other removable offloading devices may be used including removable cast walkers, Scotchcast boots, or healing sandals.
The most common problem with healing when using removable devices is that some patients do not wear them properly, which can delay wound healing. In these cases, studies have found that patients with removable offloading devices only wear them less than 30% of the day. If you have questions about how to utilize offloading devices, speak with your doctor.
6. Underlying Factors
A diabetes wound patient must be treated holistically in order to identify underlying issues and reduce risk factors that are causing wounds in the first place. Achieving control of diabetes is difficult but essential, especially concerning blood glucose levels, proper nutrition, high blood pressure, and smoking cessation. Other factors, such as proper footwear and adequate blood supply to extremities, need to be assessed. No matter the level of injury, a clinician specializing in this field should prescribe a diabetic wound treatment plan.
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