Important Foot Wound Care Factors

Diabetic pressure wounds are prevalent on the feet of many neuropathic patients

. Usually, if the arterial circulation is adequate, and the nutrition status is evaluated for protein intake, the final step is to offload the area. This is, certainly the most difficult part of wound care in our population. Everyone wants to remain active, and walking is a major component of this mentality. The initial screening protocol consists of taking an x-ray, listening to the arterial pulse with a hand held Doppler, and recording a HA1c value to determine long-term blood glucose control, then moving on to the physical examination of biomechanics. In some cases, the main issue is not an underlying bone infection, or ill fitting shoes. A definitive diagnosis of "gastroc equinus" can be diagnosed.

This may require about 2 weeks of time for continued debridement so that the wound begins to improve, but the central deepest portion becomes next to impossible to offload.

Around this time, the patients are scheduled for endoscopic gastroc recession, which is done with a 0.7 cm incision that heals in most cases after 7 days. This is a profound procedure which offloads the forefoot considerably, and in certain cases becomes the final step towards healing wounds. THere may also be a dermal skin graft application which also heavily increases the healing capacity of this particular wound.

There are many examples of how wound care can be performed by looking at the global picture in each patient. Sometimes the foot structure itself is the issue and requires reconstruction. Sometimes a bone infection is underlying, and excision of that portion of the bone is required, and even sometimes a leg needs more circulation requiring vascular interventions. This allows rapid wound healing, and lowers the statistical possibility of deep seeded infections which can lead to amputations.

Each wound has a cause, and without a thorough examination, followed by extensive diagnostics and microbiologic cultures, many wounds will remain non-healed. Weekly comprehensive debridement, X-rays on site, MRI and ABI testing. For the more complex wounds a reconstruction repertoire consists of internal and external fixation. However, limb salvage should be taken very seriously, and we all know that once a limb is lost, the statistics are not in a patient's favor for a 5 year lifespan afterwards in diabetic patients.

by: drkevinlam

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