Diabetic Wounds

A Diabetic Wound

Diabetic Gangrene

Diabetic wounds result because of poor blood supply, damaged nerves and high blood sugar which feed infectious bacteria.

Diabetes is a systemic disease which affects all parts of human body. Unregulated high blood glucose levels will affect over time every blood vessel in the human body. It will cause narrowing of the lumen of the blood vessel and clogging. Over a longer period of time, that will lead to decreased circulation. Decreased circulation and ischemia will promote slowed wound healing and wound infection. Another issue is weakened sensibility of distal body parts, also known as diabetic neuropathy. The most affected parts are distal parts of lower extremity,  especially feet.

Causes of Diabetic Wounds

The causes of wounds in diabetics vary. The most often are puncture wounds, skin cracks, an ingrown toenail or even a simple blister on a bunion if you wear tight shoes. Those wounds in healthy population would heal quickly and would not leave any consequence. But in diabetes patients, due to weaker circulation, those simple wounds can lead to prolonged healing, ulcers, infection or even amputation. This category of people is at higher risk of prolonged wound healing after surgery. You should avoid elective foot surgeries in patients with unregulated diabetes.

Signs and Symptoms of Diabetic Wounds




Many of the patients will not feel any pain, due to neuropathy. They will seek medical attention when they see ulcer on their foot or when they notice drainage from a  wound.

These wounds can look differently from a person to person, That depends on the cause of it. In the case of wound  caused by poor circulation, it may be painful and often followed by necrosis. Those wounds heal slowly. If the wound is caused by loss of sensation it won't be painful. Necrosis is not common and this type of wounds heal faster. Most ulcers are caused by a combination of previous two types. They are named neuro-ischemic wounds.

Diagnosis of Diabetic Wounds

A diagnosis is made after a local inspection. It will help in finding out which type of wound is developed. The site of the wound should be determined as well as the wound bed, It is very important to check if there is necrosis in the wound. Try to find signs of infection. Wound swab can be taken to check which microorganism is causing wound infection. Always check if any underlying bone is exposed. Physical examination will determine if peripheral circulation is causing problems. Foot deformities can also be diagnosed using physical examination. Imaging studies can be made to check the vascular status of extremities ( for example, Color doppler or angiography).

Treatment of Diabetic Wounds

If you had any open wound then it is important to take care of it when it occurs. Clean the wound with clean water and do not use any antiseptic remedy. After the wound is cleaned you can apply antibiotic ointment and cover the wound with sterile bandage or dressing. If the wound is deep or if there are signs of infection (redness, drainage from the wound) you should seek medical attention.

In case of wound infection and necrosis, the wound should be debrided. All necrotic tissue should be removed. Debridement will promote healing and wound drainage. It should be done in medical facility respecting antisepsis and asepsis principles. Antibiotics should be used in oral and topical form.

For diabetic ulcer treatment, it is important to reduce the pressure of the ulcer site. Decreased pressure will promote healing and allow the wound to heal more quickly. For ulcers on foot, casts and braces can be used. You should not increase pressure too quickly after wound closure because it might cause wound dehiscence.

For deeper wounds, negative pressure wound therapy can be the right choice. Vacuum (wound vac) therapy will promote drainage and forming of granulation tissue which will fill up the ulcer defect.

Prevention of Diabetic Wounds

Prevention methods are very important for diabetic patients because it is easier to prevent wounds and ulcers than to treat them. Patient with unregulated glucose levels, which wear tight shoes, which suffer from neuropathy or poor circulation or which have bunions or another foot deformity is at higher risk of ulders.

You should reduce risk factors on which you can affect (quit smoking, avoid alcohol drinking, regulate glucose levels). Do not walk barefoot. You should check your feet for cracks often. You should wash them every day with warm water. It is important to dry them after washing. You can moisture foot skin using cream or lotion. Be sure not to apply moisturizer in between the toes because that will provide a good breeding environment for bacteria and fungus. That will prevent skin cracks which heal slowly. Do not wear tight shoes. Pay attention when treating your nails. Do not cut them too short. On that way, you will prevent ingrown toenail and infection. Choose socks carefully. Your socks should prevent moisture forming and feet sweating.

References

American Podiatric Medical Association, "Diabetic Wound Care“, retrieved from http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=981

Andrew Curry, "Treatments for Diabetic Wounds“, 2016, retrieved from http://www.diabetesforecast.org/2016/may-jun/in-the-flesh.html?referrer=https://www.google.ba/?referrer=http://www.diabetesforecast.org/2016/may-jun/in-the-flesh.html

Constance Matthiessen, "Wound Care: Your Essential First Aid Care Guide“, 2010, retrieved from http://www.webmd.com/a-to-z-guides/wound-care-10/diabetic-wounds

Lisa Fields, "Diabetes and Wounds: Caring for Sores“ , 2015, retrieved from http://www.webmd.com/diabetes/features/diabetes-wounds-caring-sores


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