Wounds in Diabetics

According to figures presented in the International Diabetes Federation website (www.idf.org), the adult population of the Philippines is about 60 million, with 6.3%, or roughly 3.8 million suffering from diabetes. There is a 15% prevalence of diabetic foot ulcers (DFU), which amounts to 570,000 cases of chronic, infected, non-healing DFU’s.

Probably the biggest concern of diabetics is delayed or non-healing of their wounds. As an orthopedic surgeon, I have often been asked by my diabetic patients about to undergo procedures if their surgical wound will have any healing complications. I explain that clean surgical wounds will always have a good chance of healing, because of the sterile environment of the OR, use of antibiotics, and daily wound inspection and dressing. DFU’s, on the other hand, are often problematic, as they are usually (relatively) dirty, improperly cleaned, and oftentimes, neglected. DFU’s occur due to decreased sensation in the feet of diabetics; oftentimes, they do not feel the scrape of a stone against their toes, or the prick of a tack on their foot. Ill-fitting shoes and socks can also cause pressure on the feet and toes, causing blisters. When these blisters rupture, further skin and soft tissue breakdown ensue. Due to the moist environment and abundance of bacteria in the foot, these wounds may evolve into infected, non-healing wounds.

Traditionally, the approach to treating non-healing wounds, especially large, neglected, and infected wounds, has been amputation. Fortunately, new methods and materials for treating and managing these kinds of wounds have been developed and the incidence of major amputation, at least among centers where advanced wound care is being practiced, has decreased. Procedures like ultrasound assisted wound debridement (removal of dead and contaminated tissue) can be done for patients with infected wounds under local or topical anesthesia, negating the need for repeated operating room procedures. Wound dressing materials and cleansing solutions have also advanced, allowing more effective infection control, better wound bed preparation, and faster resolution of wounds. The realization that wound care cannot be managed by a single medical practitioner has increased cooperation between surgical specialists, like orthopedic, plastic, and microvascular surgeons. Large defects brought upon by extensive surgical debridement are no longer feared by wound care specialists as there are techniques that may be employed for maximum soft tissue coverage, as well as wound dressing appliances that promote rapid wound closure.

Prevention strategies should be in place that would allow diabetics to avoid DFU’s entirely; the following are the steps for proper foot care.

• Wash feet daily with mild soap and lukewarm water

• Dry feet thoroughly, especially between the toes

• Apply skin moisturizer, but not between toes, to avoid skin breakdown

• Trim toenails straight across to avoid ingrown toenails

• Do not trim, cut, or file callouses

• Inspect foot with a mirror to check for blisters, cuts, or abrasions

• Do not walk barefoot

• Wear well-fitting shoes with well-fitting socks

• Inspect the inside and the soles of your shoes for stones, pebbles, nails,

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Diabetes is reaching epidemic proportions globally and locally, with a corresponding increase in DFU’s. Wound prevention, early identification of wounds, and advanced wound care can help lessen the potentially devastating impact of DFU’s on diabetics.

At Hilom Wound Care Clinic, our wound care specialist can educate diabetics about proper foot care and provide advanced wound care to manage DFU’s. Please reach out to us through our website www.hilomwoundcare.com, Facebook page, Hilom Wound Care Clinic, our landline- (02) 8652 1111 (loc 648), or mobile number 0995 851 8264. We are located at 2/F Healthcube Medical Clinics, 241 Shaw Blvd, Mandaluyong City.