Diabetic Foot Ulcers

by | Nov 11, 2020 | Uncategorized | 0 comments

A Patient’s Guide to Understanding Your Care

OVERVIEW

If you are reading this, you likely have or know someone who has a diabetic foot ulceration (DFU).  I have been treating DFU’s for the past 30 years and have given many lectures to both professionals and patients to help increase their understanding of these, often complicated wounds.

I present here, some commonly used terms in wound care to define what they mean and give a brief overview of the general care and treatment of a wound.

I know that when patients have a better understanding of their wounds and their treatment plan, they are far more likely to comply with the care plan needed to promote quick healing.  Open wounds carry a risk of infection and possible hospitalization, so it is always beneficial to get them to heal as quickly as possible.

This is not a guide to the healing of any particular wound.  With regard, to healing your particular wound, nothing takes the place of an in-person consultation so that every aspect of the wound and the patient can be considered to create an effective care plan.

I have learned that every ulcer is unique in that each one requires its own care plan of treatment —that is what makes them unique, not their appearance or their location or their size or any other factor.  The care plan, however, is not the end all.  In fact, the care plan may well change at each visit depending on the progress of the wound.

The patient should not be a passive observer in the process.  Ask questions, clarify instructions and be honest in speaking with your doctor about what you’re able to do in helping heal the wound. If you can’t reach it or see it and have no one to help you with that you need to speak up!  There is help available in the form of Home Health Care for those patients who need help in caring for wounds.

ULCER TERMS:

  • Ulceration – A break in the skin of any type.

Note also that when a particular area on the foot has had an ulceration in the past, it is often still referred to as an ulceration that is “Grade 0” or a “previously ulcerated site” long after it has healed because it has the potential to re-ulcerate again.

  • Diabetic Foot Ulceration (DFU) – Typically a pressure ulcer on the bottom of the foot but really any open wound on the foot ankle of a patient with Diabetes.
  • Decubitus – Special name for a pressure ulceration typically found on the back of the heel. Term is also used for bedsore ulcerations on buttocks area of bed confined patients.
  • Venous Stasis Ulceration (VSU) – An ulceration related to Vein Dysfunction (poor blood return to the heart), Typically occur on the medial (inside) portion of the ankle or lower leg.
  • Arterial Ulceration – Ulceration due to Arterial Disease (poor blood supply to the foot), typically seen at the tips of the toes but can occur anywhere.

ULCER DRESSINGS/BANDAGES/TOPICALS

  • Unna Boot – this is a medicated roll bandage that is put on the from the base of the toes up to just below the knee. It is wet when it goes on and usually stays moist until it is removed.  It is covered with cast padding and an ACE wrap or Coban to hold it in place.  Commonly used for VSU’s
  • Hydrocolloid – Such as Cutinova or Duroderm is a gummy type of dressing applied directly on the wound to provide a moist wound environment. Often used on wounds on the bottom of the foot.
  • Medihoney – Surgical honey. Honey has been used since the Egyptions for wound healing. It is applied directly onto the wound.
  • Alginate – “Angle Hair” A specialty dressing that helps to absorb and contain drainage from a wound. May have silver or collagen in it as well.
  • Bacitracin – Topical antibiotic ointment or cream used directly on a wound
  • Triple Antibiotic – Topical antibiotic ointment or cream used directly on a wound
  • Gentian Violet – Liquid topical used directly on or around a wound as a drying agent. Leaves a purple stain where it is applied.
  • Hypafix Tape – Brand name of a particular tape that is far superior to paper tape for adhering dressings. Is breathable and flexible and tends to work well with fragile skin
  • Coban – Stretchy ACE bandage type of dressing that adheres to itself
  • H-Bandage or Knuckle Bandage – “H” shaped bandage with two tabs on each end. Works very well for areas that are hard to get a typical band-aid to adhere to.

CARE BASICS:

Physician Responsibility

  • Evaluation – A thorough examination is the first step in treatment to determine the type of ulceration and establish a care plan to include testing of circulation and nerve function.
  • Testing – Appropriate testing based on clinical exam which may include: X-rays, Blood Tests, Vascular Testing, Sensory Testing
  • Collaboration –  As needed with other care team specialists which may include: Home Health Care, Vascular Surgeons, Endocrinologist, Primary Care, and/or Infectious Disease

Patient Responsibility

  • History – Providing a complete health and ulcer history. If patient is unable to provide it, having someone at visit to help with that recall.
  • Understanding – Listening and asking questions about what caused the wound and what needs to be done to get it to heal.
  • Participation – Making and keeping appointments. Actively trying to control their Diabetes. Completing home care as directed and reporting problems.
  • Follow-up – After the wound has healed, understanding what needs to be done to keep the wound closed and what needs to be done to prevent it or others like it from coming back again.

CARE PLANS:

  • Typical Office Visit – Involves inspecting and treating the wound at each visit and reviewing what has happened since the last office visit. Photographs are often used to help monitor the wounds progression.
  • Debridement – Is the term used for removing the dead or non-viable tissue from a wound to help promote healing. Not every wound needs to be debrided at each visit. There is sometimes bleeding of the wound when they are debrided.
  • Care Plan – This is the patient instructions on what to do until the next visit. It typically covers how to care for the wound (dressings, frequency, etc.), what home/work activities are allowed, and instructions about weight bearing.
  • Advanced Therapies – There are many ways to treat wounds. Cost-benefit needs to be considered with all therapies. Not every therapy is appropriate for every wound. Many wounds heal with a normal progression once professional treatment is started.  Slow healing wounds have a high priority for advanced therapies. The types of advanced therapies available are enough to fill an entire separate blog on that issue.
  • Antibiotics – Every open wound is not infected. If there are signs of an active infection oral antibiotics are prescribed.  In severe cases of advancing infection, IV antibiotics and/or hospitalization are frequently needed.
  • Home Health Care – Is available in certain cases where the patient is unable to perform the wound care or may not be able to come into the office as often as needed for care.
  • Follow-Ups: Frequency of follow-up visits depend on the type of wound and the progress it is making. Active wounds often require weekly visits
  • Referrals – Patients may need referrals to other providers to help in the diagnosis or treatment of their ulcerations. That may include procedures to aid in the treatment of the ulceration such as vascular surgery or testing such as MRI or CT that cannot be done in the office.

Don’t Live Life in Pain! Call us today for an appointment at 505.880.1000. We take care of your feet…so that they’ll take care of you!

Gerard J. Kerbleski, DPM, FACFAS

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