Diabetic Foot Flashcards
haemostasis
vasoconstriction: stops the bleeding
platelet response: forms blood clot and preliminary extra cellular matrix
stages of wound healing
- inflammatory phase
- reconstruction/proliferation phase
- maturation phase
inflammatory phase
0-3 days
arrival of neutrophils: protect would against bacterial invasion
arrival of macrophages: clear wound of debris
reconstruction/proliferation phase
2-24 days
macrophages begin to stimulate fibroblasts to produce collagen
new capillary development is seen in granulation tissue called angiogenesis
epithelial cells migrate over the granulated wound bed
maturation phase
24 days - 1 year
remodelling - increase the tensile strength
collagen is replaced in a more organised manner
the epithelial layer thickens
decrease in vascularity and scar size
chronic wounds are defined by
four straight weeks of non healing
failure to proceed through an orderly and timely process to produce anatomic and functional integrity
intrinsic factors limiting would healing
- age
- disease eg. peripheral arterial disease, diabetes mellitus
- stress
extrinsic factors limiting wound healing
malnutrition
obesity
smoking
drugs
chemotherapy
some drugs that may limit wound healing
anti-inflammatory
anti-coagulants
corticosteroids
immunosuppressive
local factors affecting healing
wound management practices
hydration of the wound
pressure, shear and friction
foreign bodies
wound infection
necrotic tissue will usually require
debridement
sloughy tissue
granulating tissue
hypergrnaulating tissue
epitheliating tissue
acute symptoms in wound infection
pain
heat
swelling
erythema
exudate
offensive would exudate
chronic wound infection symptoms
delayed healing
increased exudate
discolouration of granulation tissue
friable tissue
new areas of slough
undermining
malodour and wound breakdown
TIME acronym for wounds
tissue
infection
moisture
edge of wound
M: moisture
dessication (dryness) slows epithelial cell migration
excessive fluid causes maceration of wound margins
goals is to remove excess exudate and hydrate the wound
E: edge of wound
cells at the edge may fail to proliferate and migrate
undermining
hypergranulation
what is macrovascular disease
coronary heart disease
stroke
peripheral vascular disease
what is microvascular disease
retinopathy
neuropathy
nephropathy
pathophysiology of peripheral neuropathy
microneurovascular dysfunction with loss and inflammatory response
vasomotor dysfunction with arteriovenous shunting
capillary basement membrane thickening with altered capillary exchange
glycation of matrix proteins
loss of apocrine/eccrine gland function
appearance of foot in peripheral neuropathy
toes curled in claw position
cavus deformity with increased pressure under metatarsal heads
diabetic foot ulcers are typically located at
pressure points
pain in diabetic foot ulcers
usually painless
general appearance of diabetic foot ulcers
pinched out with surrounding callous
warm foot
foot deformity (clawed toes, yes cavus)
pressure offloading
appropriate offloading reduces time to heal, risk of infection and amputation
complete non-weight bearing is ideal and non practical
some types of offloading apparatus
total contact cast (gold standard)
CROW (Charcot restraint orthotic walker)
Aircast
CAM walker/moon boot
wound care shoe/Darco
footwear and insoles
some contraindications for use of the gold standard total contact case
infection
fever
deep sinus tract
extreme exudate
dermatitis or leg wounds
fluctuating/excessive oedema
cast claustrophobia
history of non-compliance
PAD
falls risk
foot sepsis assessment
- resuscitate as appropriate with immediate antibiotics
- asses vascular supply and peripheral neuropathy
- collection present
- plain x-ray, specialised imaging (MRI, WC scan)
- consider need for urgent surgery
once sepsis is absent or controlled
dressings
relieve pressure
revascularisation if necessary
