In this case scenario, Mr. P.K is a 50 years old man, known as a diabetic patient for ten years. He is currently on insulin of 12 IU units in the morning and 6IU in the evening, and the abdomen is his preferred injection site. Mr. P.K reports that he is compliant with his medications. He has been attending his diabetic clinic at the facility every 2 months. Mr. P.K had been admitted four days ago for one month and managed for the diabetic foot on both limbs. The inpatient management involved surgical toileting and debridement with antibiotic use and closed dressing. Upon discharge, he was advised of the importance of alternate days of the wound dressing.
On examination, his random blood sugar was 6mmol/liter, blood pressure 120/70mm/hg, and temperature of 36.5 degrees Celsius. General examination revealed tar-stained fingernails, and upon inquiry, the patient admitted to using cigarettes occasionally. There was a wound on the plantar surface of the toes on local examination, and both feet were dressed; slight oozing was noted on the left foot. The dressing on the right heel was clean, and no oozing was noted. However, the wounds were noted to be contracting well on both feet. There was also no change in the color or temperature of the limbs.
The posterior tibia and dorsalis pedis pulses were felt, and the patient did not report peripheral neuropathy. I went ahead and first cleaned the wound and the surrounding area with saline and removed the necrotic tissues. Proceeded to use betadine antiseptic to clean the wounds further. Used an antibiotic ointment to keep the wounds clean and covered with a non-adherent dressing. I further advised the patient on the importance of keeping the wound covered and reducing the pressure on the feet. The patient was also encouraged to do regular blood sugar level monitoring and the harm caused by smoking cigarettes. Mr. P.K was advised to get a wheelchair in the meantime to offload the pressure on his heels. He was hesitant at first, but I went ahead and explained the reasons why this was important. The patient was requested to return three days later for the next dressing appointment.
Diabetic foot is one of the major complications of diabetes mellitus. It is associated with peripheral neuropathy, arterial diseases, and foot deformities. Studies have shown that most non-traumatic amputation is a result of diabetes. The risk of a diabetic foot wound increases with age and the duration of diabetes (Bronze, 2020). Regular and proper wound cleaning and dressing help wounds heal more quickly and often prevent infections from the external environment, complicating the healing process. Wound dressing ought to provide protection, lessen symptoms and encourage healing. The non-adherent dressing is often regarded as the standard treatment for most diabetic foot wounds. This is because they are designed to provide a moist wound environment.
Most people have a common belief that wounds tend to heal quickly when they are aired out. However, studies have shown that the contrary is true that they will heal much faster with a layer of moisture on top of the wound. This is except for excessively draining wounds from the inside, which would need absorbent dressing instead. The dressing should also be changed frequently to allow for wound inspection and healing progress (Mathias et al., 2017). Thorough wound cleaning and debridement are crucial to removing necrotic tissues, delaying the healing process. While debriding a diabetic foot wound, ensure that you have adequate lighting. Some of the benefits of debridement are such as stimulating wound healing, helping in draining the wound, allowing the healthy underlying tissue to be examined, and reducing pressure on the ulcer.
Cleaning the wound with antimicrobial agents is a necessary measure of infection prevention. Infection of a diabetic wound is associated with high morbidity and mortality rates, and therefore aggressive infection control is needed. You can also cover the wound with dressings containing antiseptic agents, depending on the nature of the wound. Regular blood sugar monitoring is vital in all patients with diabetic foot wounds. This is because high blood sugar levels alter the white blood cells during the process of healing. High blood sugar levels can also lead to peripheral artery disease, limiting the flow of blood to the wound and thus affecting the healing process.
For any wound to heal effectively, it is important to reduce pressure on it. Healing of diabetic foot wounds may require you to be off your feet for some time to allow recovery to take place. As part of reducing pressure on the foot, patients are advised to avoid walking directly on foot for several days (LeVitre, 2021). Walking aids and wheelchairs can be used for some time until the wound is healed. Smoking decelerates the wound healing process since it prevents the wounds from getting enough oxygen which is essential for healing (“Smoking Negatively Impacts Wound Healing”, 2021) Also, it causes an increase in blood sugar levels, which causes a delay in healing.
Management of diabetic foot wounds is complex and requires multidisciplinary care. Even when the above practices are carried out, some of the foot ulcers do not heal completely are the healing process is arrested due to recurrent inflammation and failure to offload pressure from the foot. On the other hand, some of the wounds progress well to full recovery. The next best intervention that would be advisable with a consult from the physician is changing the patients’ footwear. Rocker bottom footwear is helpful to redistribute plantar pressure because the soles of the rocker bottom shoes have an added thickness and other features intended to change the gait mechanics (Gargiulo, 2017). This intervention can be recommended for Mr. P.K if the wounds take longer than expected and he no longer wants to be immobile.
References
Bronze, M.S. (2020). Diabetic foot infections: Practice essentials, background, pathophysiology. Emedicine.medscape.com. Web.
Gargiulo, G. (2017). Rocker-bottom footwear: Effects on balance, gait. Lower Extremity Review Magazine | Rehabilitation • Trauma • Diabetes • Biomechanics • Sports Medicine. Web.
LeVitre, J. (2021). Tips for diabetic foot wound infection and treatment. Certified Foot & Ankle Specialists. Web.
Mathias, D., Goveas, D., & Murthy, M. (2017). Diabetic foot ulcer and treatment: A review of progress and future prospects. International Journal of Trend in Scientific Research and Development, 2(1), 858-863. Web.
Smoking negatively impacts wound healing – Advanced healing. Advanced Tissue. (2021). Web.