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: RÉSUMÉ Foot ulcers are a significant source of morbidity, mortality and diminished quality of life for patients with diabetes. Hyperbaric oxygen therapy (HBOT) has been proposed as a possible treatment. In this technical review, the results of clinical trials on the use of HBOT for diabetic foot ulcers are reviewed. Many of the studies examining the role of HBOT in the treatment of diabetic ulcers have been retrospective, nonran- domized and noncontrolled. In addition, most studies have included small patient populations with heterogeneous class- es of ulcers. However, results of these studies suggest that HBOT may accelerate wound healing and reduce amputation in a subset of patients with diabetic ulcers. Most patients with Wagner grade 1 and 2 ulcers will heal with carefully administered conventional care (local wound care and effica- cious offloading). Appropriate candidates for HBOT are patients with long-standing nonhealing Wagner grade 3 or higher ulcers with an adequately perfused capillary bed in the wound area (best assessed by the transcutaneous oxygen tension (TcPO 2) response to 100% oxygen challenge).Canadian Journal of Diabetes. 30(4).
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.
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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. · 4.91 Impact Factor