Wound Bed Preparation for Chronic Diabetic Foot Ulcers

Ahmad Sukari Halim,Teng Lye Khoo,Arman Zaharil Mat Saad

doi:10.1155/2013/608313

Abstract

The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient's general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The “TIME” framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant.

Highlights

The principles involved in wound bed treatment have influenced the management of diabetic wounds, diabetic foot ulcers
In 2006, Sibbald et al expanded the concept to look at the patient as a whole in finding the cause of the wound and optimizing general factors that impair wound healing, diabetes mellitus being one of them [3]
This incidence has indirectly increased the prevalence of diabetic foot ulcers, which occur in 1 to 4% of patients with diabetes mellitus [4, 5], and will further contribute to minor and major amputations of the lower limbs, for which foot ulcer patients have a 25 times higher risk than the rest of the population [6]

Summary

Introduction

The principles involved in wound bed treatment have influenced the management of diabetic wounds, diabetic foot ulcers. The development of diabetic foot ulcerations is multifactorial in origin and generally due to the known consequences of diabetic mellitus, including peripheral vascular disease, peripheral neuropathy, and infection. Peripheral neuropathy is due to vascular disease occluding the vasa nervorum, endothelial dysfunction, and chronic hyperosmolarity causing nerve trunk edema as a result of increased sorbitol and fructose [10] This peripheral neuropathy causes a loss of sensation in the foot with repetitive and unnoticed trauma, structural foot deformities with uneven plantar pressure, and joint rigidities, resulting in eventual tissue breakdown and ulceration in the foot [11]. Foot hygiene, regular inspection, moisturizing, and appropriate footwear are important to prevent diabetic foot infections and aid in healing ulcers Local factors, such as the presence of peripheral vascular disease and neuropathy, may need extra attention. The ulcers are preceded by minor trauma that goes unnoticed or persistent pressure caused by inappropriate footwear or callus formation (Table 1)

The Approaches in Wound Bed Preparation

Aim

Adjunct and Other Treatment Modalities for Diabetic Foot Ulcer

Findings

Conclusion