Introduction
A 72-year old woman was admitted to a hospital after being hit by a car. The patient’s history included recurrent diabetic foot ulcers and diabetic neuropathy. The woman also had comorbidities such as hypertension and arterial occlusive disease. For unspecified reasons, the patient hadn’t been receiving treatment and medication for her chronic condition.
The patient had multiple clean minor wounds (i.e., cuts and scratches) from the accident. However, the attention of the medical team was focused on the large ulcer under the patient’s big toe, which might have been caused by uncontrolled type 2 diabetes. Peripheral neuropathy might be identified as the wound’s etiology.
Wound Measurement, Debridement, and Dressing
Accurate measurement of wound dimensions is particularly important and should include the length, width, and depth of the wound.1 The ulcer had a regular shape, so its length and width were measured using paper tape and equaled 6 cm and 4 cm, respectively. The depth of 5 mm was determined by placing a cotton-tip probe into the deepest part of the wound bed and registering the resulting measurement.
The peri-wound area was surrounded by necrotic tissue around the wound’s circumference, which might have led to a further increase in the wound size. There were also signs of inflammation, such as redness, increased temperature, and swelling of the wounded area. Therefore, debridement was necessary to promote proper wound healing.
Surgical debridement was used to remove dead tissues and reduce inflammation. The results of one RCT demonstrated that the healing rate of surgical debridement was 95%, while the rate of conventional wound dressing was 79.2%. Infective complications were also less common in the surgical debridement group.2 Thus, the surgical method was chosen as it proved to be effective by reducing healing time and decreasing the risk of complications in comparison with other wound care methods.
After the surgical debridement, no lavaging agent was used since the methods might be considered equivalent alternatives. The goal of debridement is to remove necrotic dermal tissue, debris, and bacterial elements.3 Thus, the surgical method alone was sufficient to prevent wound infection and ensure timely healing of the ulcer.
Adhesive zinc oxide tape was used for the dressing of the wound. The study researching the treatment methods for chronic diabetic foot ulcers had shown that adhesive zinc oxide tapes contribute to complete disappearance or at least a 50% reduction in the area of necrosis compared to occlusive hydrocolloid dressing.2 The dressing was carefully trimmed and placed on the wound bed without overlapping the healthy tissues of the peri-wound area. Such a method helped to protect the area from maceration.
The patient required special testing since the wound was a complication of diabetes mellitus, which was uncontrolled and untreated before. The screening of blood sugar levels, triglycerides, and cholesterol was done to assess the condition of the patient and prevent future complications of diabetes. A physical examination was performed to evaluate the severity of nerve damage. Additionally, the patient was referred to a physical therapist for further treatment.
Conclusion
Overall, the positive outcome in the case of the elderly patient with diabetic foot ulcer was achieved because of several factors. Firstly, the proper analysis of the patient’s anamnesis, the documentation of the wound measurements, and the examination of the peri-wound area allowed to development of an appropriate care plan. Secondly, the choice of the surgical debridement method was backed by the existing research of the issue, which allowed the medical team to achieve the most favorable outcome. Thirdly, the recommendations of the researchers for the dressing of the wound ensured a shorter time for healing and prevented possible complications. Finally, laboratory testing became the starting point in the treatment of the previously uncontrolled case of diabetes.
References
Coleman K, Neilsen G. Wound care: A practical guide for maintaining skin integrity. Chatswood, Australia: Elsevier; 2020: 5.
Elraiyah T, Domecq JP, Prutsky G, et al. A systematic review and meta-analysis of debridement methods for chronic diabetic foot ulcers. JVS. 2016;63(2): 37-45.
Rosyid FN. Etiology, pathophysiology, diagnosis, and management of diabetics’ foot ulcer. Int J Res Med Sci. 2017;5(10): 4206-4213. Web.