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Surgery > Diabetic Foot > Flashcards

Diabetic Foot Flashcards

1
Q

haemostasis

A

vasoconstriction: stops the bleeding
platelet response: forms blood clot and preliminary extra cellular matrix

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2
Q

stages of wound healing

A
  • inflammatory phase
  • reconstruction/proliferation phase
  • maturation phase
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3
Q

inflammatory phase

A

0-3 days
arrival of neutrophils: protect would against bacterial invasion
arrival of macrophages: clear wound of debris

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4
Q

reconstruction/proliferation phase

A

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

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5
Q

maturation phase

A

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

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6
Q

chronic wounds are defined by

A

four straight weeks of non healing
failure to proceed through an orderly and timely process to produce anatomic and functional integrity

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7
Q

intrinsic factors limiting would healing

A
  • age
  • disease eg. peripheral arterial disease, diabetes mellitus
  • stress
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8
Q

extrinsic factors limiting wound healing

A

malnutrition
obesity
smoking
drugs
chemotherapy

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9
Q

some drugs that may limit wound healing

A

anti-inflammatory
anti-coagulants
corticosteroids
immunosuppressive

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10
Q

local factors affecting healing

A

wound management practices
hydration of the wound
pressure, shear and friction
foreign bodies
wound infection

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11
Q

necrotic tissue will usually require

A

debridement

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12
Q

sloughy tissue

A
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13
Q

granulating tissue

A
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14
Q

hypergrnaulating tissue

A
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15
Q

epitheliating tissue

A
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16
Q

acute symptoms in wound infection

A

pain
heat
swelling
erythema
exudate
offensive would exudate

17
Q

chronic wound infection symptoms

A

delayed healing
increased exudate
discolouration of granulation tissue
friable tissue
new areas of slough
undermining
malodour and wound breakdown

18
Q

TIME acronym for wounds

A

tissue
infection
moisture
edge of wound

19
Q

M: moisture

A

dessication (dryness) slows epithelial cell migration
excessive fluid causes maceration of wound margins
goals is to remove excess exudate and hydrate the wound

20
Q

E: edge of wound

A

cells at the edge may fail to proliferate and migrate
undermining
hypergranulation

21
Q

what is macrovascular disease

A

coronary heart disease
stroke
peripheral vascular disease

22
Q

what is microvascular disease

A

retinopathy
neuropathy
nephropathy

23
Q

pathophysiology of peripheral neuropathy

A

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

24
Q

appearance of foot in peripheral neuropathy

A

toes curled in claw position
cavus deformity with increased pressure under metatarsal heads

25
Q

diabetic foot ulcers are typically located at

A

pressure points

26
Q

pain in diabetic foot ulcers

A

usually painless

27
Q

general appearance of diabetic foot ulcers

A

pinched out with surrounding callous
warm foot
foot deformity (clawed toes, yes cavus)

28
Q

pressure offloading

A

appropriate offloading reduces time to heal, risk of infection and amputation
complete non-weight bearing is ideal and non practical

29
Q

some types of offloading apparatus

A

total contact cast (gold standard)
CROW (Charcot restraint orthotic walker)
Aircast
CAM walker/moon boot
wound care shoe/Darco
footwear and insoles

30
Q

some contraindications for use of the gold standard total contact case

A

infection
fever
deep sinus tract
extreme exudate
dermatitis or leg wounds
fluctuating/excessive oedema
cast claustrophobia
history of non-compliance
PAD
falls risk

31
Q

foot sepsis assessment

A
  • 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
32
Q

once sepsis is absent or controlled

A

dressings
relieve pressure
revascularisation if necessary

Surgery (18 decks)

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