Evidence-based protocol for diabetic foot ulcers.

Department of Surgery, Wound Healing Program, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 07/2006; 117(7 Suppl):193S-209S; discussion 210S-211S. DOI: 10.1097/01.prs.0000225459.93750.29
Source: PubMed

ABSTRACT Diabetic foot ulcers are the single biggest risk factor for nontraumatic foot amputations in persons with diabetes. Foot ulcers occur in 12 to 25 percent of persons with diabetes and precede 84 percent of all nontraumatic amputations in this growing population. Because of the high incidence of foot ulcers, amputations remain a source of morbidity and mortality in persons with diabetes. Strict adherence to evidence-based protocols as described herein will prevent the majority of these amputations.
The collective experience of treating patients with neuropathic diabetic foot ulcers in four major diabetic foot programs in the United States and Europe was analyzed.
The following protocol was developed for patients with diabetic foot ulcers: (1) establishment of good communication among the patient, the wound healing team, and the primary medical doctor; (2) comprehensive, protocol-driven care of the entire patient, including hemoglobin A1c, microalbuminuria, and cholesterol as well as early treatment of retinopathy, nephropathy, and cardiac disease; (3) weekly objective measurement of the wound with digital photography, planimetry, and documentation of the wound-healing process using the Wound Electronic Medical Record, if available; (4) objective evaluation of blood flow in the lower extremities (e.g., noninvasive flow studies); (5) débridement of hyperkeratotic, infected, and nonviable tissue; (6) use of systemic antibiotics for deep infection, drainage, and cellulitis; (7) off-loading; (8) maintenance of a moist wound bed; (9) use of growth factor and/or cellular therapy if the wound is not healing after 3 weeks with this protocol; and (10) consideration of the use of vacuum-assisted therapy in complex wounds.
In diabetic foot ulcers, availability of the above modalities, in combination with early recognition and comprehensive treatment, ensures rapid healing, minimizes morbidity and mortality rates, and eliminates toe and limb amputations in the absence of ischemia and osteomyelitis.

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    ABSTRACT: Objective: Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience. Methods: This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or amputations were done. Vacuum dressing was changed twice weekly in outpatient department. Wounds were closed secondarily if possible or covered with split thickness skin graft in another admission. Results: All the wounds were successfully granulated at the end of vacuum therapy. Mean hospital stay was 7.5 days. Vacuum dressing was applied for a mean of 20 days. There was reduction in the size of the wound. Thirteen patients underwent secondary closure of the wound under local anesthesia, 18 patients required coverage with split thickness skin graft and 7 patients healed with secondary intention. Conclusion: Vacuum assisted closure appeared to be an effective method to manage complex diabetic wounds requiring sterile wound environment.
    Pakistan Journal of Medical Sciences Online 01/2015; 31(1):95-99. DOI:10.12669/pjms.311.6093 · 0.10 Impact Factor
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    ABSTRACT: Copyright: © 2014 Alavi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Up to 25% of patients with diabetes will develop a foot ulcer during their lifetime with a 50-70% recurrence rate over the ensuing 5 year. Additionally more than 50% of patients with a diabetic foot ulcer (DFU) develop a diabetic foot infection (DFI). DFI remains a challenge to manage because of coexisting immunopathy. Antibiotic therapy is the main stay of treatment for patients with deep and surrounding tissue infection. A multidisciplinary approach is required with the focus on the comprehensive patient assessment, vascular assessment with revascularization, proper offloading devices and use of appropriate antimicrobials. Wound care professionals have a unique position to lessen the inappropriate use of antimicrobials.
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