All about wound care

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Foot ulcers are among the most frightening complications of diabetes, and with good reason: Each year 15 percent of people with diabetes develop them, and each year 54,000 people with diabetes have an amputation because of foot ulcers that become infected.

Many of those foot ulcers and amputations can be prevented, however – if the wounds that lead to foot ulcers are caught and treated early enough. That’s why it’s so important to control your blood glucose, wear shoes and socks that fit well, check your feet every day, and have your doctor check your feet at every visit.

But what if, despite your best efforts, a wound develops on your foot? What should you do?

The first and most important thing is not to ignore it. Don’t say, “It will probably heal in a few days so I’ll just watch it.” Call your doctor or podiatrist (foot doctor) at once and take steps to treat the wound. A delay of even a few days can mean the difference between healing and a hospital stay or worse.

Basic Wound Care

Until you can get yourself to a doctor, good old-fashioned first-aid is the best way to go when initially treating a wound. Cleanse the wound with saline (a salt solution) or plain water. Soap is generally okay, but it may be caustic to healing cells, so it’s a good idea to consult your doctor or podiatrist first. Avoid solutions such as alcohol or hydrogen peroxide because they can harm healing, viable tissue. Next, apply a topical antibiotic cream like bacitracin and cover the area with a sterile gauze pad. Keep the wound covered and moist.

And now for the most important part: Stay off your foot! Wound care professionals often say “It’s not what you put on a wound that allows it to heal, it’s what you take off of it.” What you take off of it is your weight. Wounds on the bottom of your foot won’t heal properly if you put pressure on them by standing or walking. The pressure kills new cells that are trying to form and reopens the wound.

If you must do some walking or standing, try to limit it as much as possible. The more you stay off the foot, the better you’ll do.

Professional Wound Care

After you dress your wound, see a wound care specialist pronto. A wound care specialist may be your podiatrist or another doctor your endocrinologist, primary care doctor, diabetes educator, or podiatrist recommends.

Several factors will influence the direction your care takes: your circulation, your diabetes control, and whether the wound is infected. Let’s assume that you have good circulation, your diabetes is well controlled, you eat a healthy diet, and the wound is not infected.

First, any unhealthy or dead tissue in the wound will be removed. Most wound specialists prefer a technique called sharp debridement, which involves using a scalpel or scissors to cut out the unhealthy areas. The specialist may also use special medications or dressings to dissolve the unhealthy or dead tissue. Some specialists have successfully used maggots to clear out dead tissue, although this is not standard practice.

If your wound is draining, the wound care specialist will use dressings that absorb fluid well. If the wound is dry, the specialist will add moisture to the dressing. Some preparations also contain growth factors for your skin to boost your body’s ability to heal. There are even skin substitutes grown from human skin. They cover your wound and help your own tissue regenerate.

For larger wounds, your specialist may use a device that applies constant suction to the ulcer. A piece of foam that covers the wound is connected to a vacuum pump. The pump sucks the air out of the wound and the foam. The negative pressure then sucks out any drainage and helps the wound close.

Depending on how severe the wound is, you may have to use special pads or wear a cast to take pressure off the wound. The specialist may prescribe crutches or a wheelchair, as well – particularly if the wound is on the bottom of your foot. If the wound is on the bottom of your foot, don’t even walk on the foot to go to the bathroom.

Say your blood glucose needs improvement or you have poor circulation. Both high blood glucose and poor circulation will raise your risk of infection and make it harder for the wound to heal, so your wound may require more intensive care.

If your wound is severe or infected, or if healing hasn’t progressed as expected, your wound care specialist will probably run some tests, starting with X-rays and blood tests. Other tests may include a bone scan or MRI to check for osteomyelitis (bone infections) or circulation tests like Doppler exams to measure how much blood is getting to the area.

Your wound care specialist may also consult with other specialists, including your diabetes doctor (who will most likely want to see you separately) and a doctor who specializes in infectious disease, and they may determine that surgery is necessary. Although surgery isn’t a pleasant option, it’s often crucial in saving limbs and preventing amputation. A vascular surgeon can help restore circulation to your foot if your circulation is poor. If there is an infection in the bone, the infected portion can be removed. If the ulcer is not healing because of pressure from the underlying bone, your doctor or podiatrist may suggest moving or removing the bone. These procedures can help keep the rest of your foot and leg intact.

Between visits to your wound care specialist, you or a family member will have to take care of the wound at home. (In some cases, a home care nurse may help you get started.) Tending the wound at home may involve gently cleansing the wound and applying the prescribed medications and dressings. Wound care products can be expensive, but they are often covered by medical insurance, including Medicare.

Wound care is a team effort. Make sure that you understand what you or your family members are supposed to do to treat the wound. Don’t be afraid to ask questions or take notes. Conscientious care will ensure that your wound heals and help you avoid foot ulcers and amputation.

ALTERNATIVE TREATMENTS IN WOUND CARE

Standard wound care consists of cutting away dead or unhealthy tissue, cleansing the wound, and treating the wound with various combinations of medication and dressings. However, when wounds don’t respond to conventional treatment, there are alternatives.

Maggots

In 2004, the U.S. Food and Drug Administration approved the use of medicinal maggots for cleaning out wounds. While there have not been any large trials involving the use of these fly larvae, several small studies have shown promising results, and the practice is becoming more accepted among wound care specialists. Of course, there’s a certain “yuck” factor that many patients need to overcome in adopting this treatment technique.

Here’s how it works. First, blowfly eggs are disinfected before they hatch. When the maggots hatch, the wound care specialist places them on the wound and covers them with a sterile dressing. The maggots excrete enzymes that turn dead and unhealthy tissue into a semi-liquid form that they eat. Meanwhile, they “sweat” a substance that kills several kinds of infection-causing bacteria. They won’t eat or harm healthy tissue.

Maggots are left on the wound for about 2 days before the wound care specialist replaces them, and treatment usually takes at least 2 weeks. There have been some reports of pain with maggot therapy, but overall, participants in studies of maggot therapy have had positive results. In several cases, maggot therapy has helped prevent amputation.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy is approved for use in wounds where tissue is unhealthy or dying. As with maggot therapy, there haven’t been any large trials involving the use of hyperbaric oxygen therapy in healing wounds, but small studies have shown positive results.

Treatment consists of sitting or lying down in a pressurized chamber and breathing 100 percent oxygen. This increases the amount of oxygen in your bloodstream, which helps your body generate connective tissue to repair the wound. It also provides your white blood cells with more oxygen with which to fight infection.

Treatment usually lasts about 3 to 4 weeks. If your wound isn’t infected, one 2-hour session a day as an outpatient will probably suffice. But if your wound is infected, you’d probably have to be hospitalized and need two sessions each day.

Hyperbaric oxygen therapy shouldn’t be confused with topical hyperbaric oxygen therapy. Treatment with topical hyperbaric oxygen involves placing a bag over the wounded area and delivering oxygen directly to the wound. There is almost no published research attesting to the usefulness of topical hyperbaric oxygen in healing wounds. In fact, several older studies indicate that there are no benefits to it. So, although some doctors use this technique, it’s controversial and a case of “let the buyer beware.”

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