Diabetic Foot Ulcers and Infections: Current Concepts

Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch, Galveston, USA.
Advances in Skin & Wound Care (Impact Factor: 1.11). 12/2001; 15(1):31-42; quiz 44-5. DOI: 10.1097/00129334-200201000-00011
Source: PubMed


PURPOSE: To offer an educational experience that will help improve the participant's understanding of diabetic foot ulcers and infections.
TARGET AUDIENCE: This CME/CE activity is intended for physicians and nurses with an interest in the prevention and treatment of diabetic foot ulcers and infections.
1. Describe the factors that put a diabetic patient's foot at risk for ulceration.
2. Identify the components of optimal treatment of diabetic foot ulcers.
3. Explain the roles of vascular and orthopaedic surgery in the treatment of diabetic foot ulcers and infections.

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    • "While leukocytes are plentiful in the chronic wound environment, their phagocytosis, chemotaxis, and bactericidal activity appears to be diminished, at least in chronic diabetic wounds (Calhoun et al., 2002; Naghibi et al., 1987; Nolan et al., 1978; Zykova et al., 2000). "
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    ABSTRACT: Microbes colonizing and/or infecting chronic wounds undoubtedly play a major and interactive role in impaired healing, especially in amplifying and perpetuating the host innate immune response. The development of molecular techniques to identify and quantify microbial organisms has revolutionized our view of the microbial world. These less-biased, high throughput methods greatly enable investigations regarding host-microbe interactions in the chronic wound environment. This review focuses on the mounting evidence implicating microbes and excessive inflammation in chronic wounds, as well as the challenges associated with understanding how microbes modulate wound healing and the innate immune response.
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    ABSTRACT: Diabetes is an increasingly serious health issue in the rehabilitation population. Foot ulcers develop in approximately 15% of people with diabetes and are a preceding factor in approximately 85% of lower limb amputations. Nurses have significant opportunity to positively influence client outcomes and quality of life by promoting maintenance of healthy feet, identifying emerging problems, and supporting evidence-based self-care and interdisciplinary intervention. Best practice guidelines (BPG), such as those developed by the Registered Nurses Association of Ontario, provide a framework to enhance nursing practice and promote excellence in client care. This article highlights key evidence from the BPG, "Assessment and Management of Foot Ulcers for People with Diabetes," and other relevant diabetes literature. This information better equips rehabilitation nurses to promote ulcer prevention strategies; identifies key factors in ulcer risk; and utilizes current, best evidence for ulcer assessment, management, and evaluation.
    Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 11/2006; 31(6):228-34. DOI:10.1002/j.2048-7940.2006.tb00018.x · 1.15 Impact Factor
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    ABSTRACT: As the US population ages, the number of persistent and recurring wounds will continue to rise. Knowledge of key prevention practices and guidelines will help save patients from possible pain and suffering, as well as keep treatment costs to a minimum. Chronic wounds are caused by a variety of issues. Among the many factors, the aging process by itself takes its toll, predisposing the skin to wounds and other problems such as xerosis and skin tears. The clinical implications of aging are numerous and contribute greatly to the incidence and prevalence of wounds. For example, dry, inelastic skin with larger, more irregular epidermal cells leads to decreased barrier function.1 Flattening of the dermal–epidermal junction (rete ridges) has been observed with the height of the dermal papillae declining by 55% from the third to ninth decade of life.2 As the spaces between the well-vascularized dermis and epidermis increases, several functional changes occur: A 30–50% decrease in epidermal turnover rate during the 30s–80s.1 Loss of sub-Q fat reduces protection from injury from pressure, shear, and friction. Decreased sensory perception increases risk of mechanical forces such as pressure.
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