The consequences of diabetes are manifold and while prevention is key, the importance of early treatment cannot be over emphasised. People with diabetes are at an increased risk of complications from wound healing. Due to the decreased blood flow, injuries heal slower than in people who do not have the disease. Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. It occurs in 15 per cent of all patients with diabetes and precedes 84 per cent of all lower leg amputations. Many people with diabetes also have neuropathy -- loss of sensation in their hands or feet, which means they do not necessarily notice an injury right away, and the sores and ulcers are usually painless for them.
“A major increase in mortality among diabetic patients, observed over the past 20 years, is considered to be due to the development of macro and micro vascular complications, including failure of the wound healing process,” says Dr Shabeer Ahmed, a general/GI/bariatric surgeon while speaking to City Express.
Wound healing is a mechanism of action that works reliably most of the time. Diabetes mellitus is one such metabolic disorder that impedes the normal steps of the wound healing process. The primary cause is poor blood circulation which causes blood vessels to age and harden faster than normal, leading to reduced sensation.
Managing diabetic ulcer and sores
Management of diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. Maintaining a good blood glucose control leads to adequate blood circulation, thus relieving pressure. Routine debridement should be done to remove devitalised tissue thus maintain a moisture balance to manage exudates.
Treatment options for diabetic ulcers
Foot ulcers in diabetics require multidisciplinary assessment, usually by diabetes specialists and surgeons. Treatment consists of appropriate moist wound dressings, antibiotics, debridement, arterial revascularization and platelet-rich fibrin therapies. Current protocol of treatment involves using gauze dressings soaked with Betadine. Chronic exudates in contact with gauze spread rapidly onto the surrounding healthy periwound skin and macerates the wound. Thus the wound bed gets wider and deeper. While Betadine has a bactericidal effect, it also retards epitheliasaion and growth of healthy granulation tissues. Thus both gauze and Betadine are contraindicatory to wound healing and should be avoided wherever. While the treatment takes its own time, appropriate dressing of wounds helps in faster healing. There are many types of dressings used to treat diabetic foot ulcers such as absorptive fillers, hydrogel dressings, and hydrocolloids. Moist wound therapy is the most followed method of wound dressing. This process involves applying a moist wound dressing to your wound and when in contact with exudates (bacteria and infection), it absorbs them and becomes a soft cohesive gel. It micro-contours to the wound bed leaving no dead space for bacterial colonisations. These moist wound dressings provide a moist wound healing environment apart from an acidic environment that promotes faster recovery. These dressings also help in atraumatic painless removal unlike conventional gauze dressings.
Key dressings like Aquacel and DuoDerm should be used. In case of infected wounds, silver dressings called Aquacel Ag should be used. Below are a few tips to care for your wound:
l Keeping control of blood sugar levels ensures faster healing of the wound.
l The wound should be kept clean with best available moist wound dressings in the market like Aquacel and Duoderm.
l The dressings should be changed at regular intervals of 3-4 days depending upon the severity of the condition.
l Walking barefoot/exposing the wound to dust is not advisable.
l Keep your dressing and the skin around it dry. Try not to get the healthy tissue around your wound too wet from your dressings. This can soften the healthy tissue and cause more foot problems.