Diabetic foot ulcers and infections: current concepts.
ABSTRACT 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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ABSTRACT: A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care. It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors. The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system. In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons. We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.
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ABSTRACT: Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.Journal of the American Academy of Dermatology 01/2014; 70(1):1.e1-1.e18. DOI:10.1016/j.jaad.2013.06.055 · 5.00 Impact Factor
Article: Wound Prevention[Show abstract] [Hide abstract]
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.