Management of Diabetic Foot Ulcer

Diabetic foot ulcer is a major complication of diabetes. It can occur up to 15% of diabetes patients and accounts for more than 80% of below knee amputations, which indicates the severity of the problem. Management of diabetic foot ulcer and diabetic foot need multi-disciplinary approach involving diabetes specialist, chiropodist, and surgeon. Management of diabetic foot ulcer mainly consists of regular wound dressing, use of appropriate bandages regularly, use of suitable antibiotics (against common pathogens that may be harbored in the wound such as staphylococcus, streptococcus, and anaerobic organisms), debridement (removal of dead tissue from wound) and arterial re-vascularization, if possible.ID-100114041

Regular wound dressing:

This is one of the most important step in appropriate management of diabetic foot ulcer. Select an appropriate dressing and keep the wound clean and dry as much as practicable. There are many types of dressings available for management of diabetic foot and most of them are good. There are no studies available to suggest one type of dressing is superior from another type, hence, while selecting type of dressing, cost of dressing should be kept in mind, because management of diabetic foot ulcer is a long process and may require months.

Wound dressing should be accompanied by administration of appropriate antibiotics against common pathogens (staphylococcus, streptococcus, and anaerobic organisms). Culture and antibiotic sensitivity should be done to select correct antibiotic.

Use of hyperbaric oxygen:

Several studies have shown that use of hyperbaric oxygen therapy can reduce risk of amputation. It can also improve and accelerate wound healing process. Use of hyperbaric oxygen therapy among diabetic foot ulcer patients can reduce amputation up to 75% of patients, hence, hyperbaric oxygen therapy should be used where available. Use of hyperbaric oxygen therapy can save lots of money by reducing risk and incidence of disability due to lower limb amputation.

Negative pressure wound therapy:

In negative pressure wound therapy, vacuum is used for removal of cellular waste and excess fluid, which can prolong the inflammatory process and also prolong wound healing (wound healing is already prolonged in diabetes). Unfortunately, the results of use of negative pressure wound therapy are inconsistent in different studies, despite the clear mechanism of action explained. Nevertheless, the facility of negative pressure wound therapy should be used in case of diabetic foot ulcer. More research need to be done to find out what factors causes inconsistency of results in use of negative pressure wound therapy and problem solved.

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