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1362564096 anatomy and spread of foot infections

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anatomy and spread of foot infections

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1362564096 anatomy and spread of foot infections

  1. 1. ANATOMY & PATHOPHYSIOLOGY OF DISBETIC FOOT INFECTION DR ARUN BAL PRESIDENT DIABETICV FOOT SOCIETY OF INDIA
  2. 2. PLANTAR ARCHES
  3. 3. ARCHES OF FOOT LONGITUDINAL TRANSVERSE
  4. 4. LONGITUDINAL ARCHES MEDIAL: HIGHER MORE MOBILE RESILIENT LATERAL:LOW LIMITED MOBILITY BUILT TO BEAR WT.
  5. 5. TRANSVERSE ARCHES
  6. 6. CONCEPT OF PLANTAR SPACES
  7. 7. PLANTAR SPACES
  8. 8. SURGICAL TREATMENT OF DIABETIC FOOT MID FOOT ABCESS WITH TOE GANGRENE Dr.bal
  9. 9. SURGICAL TREATMENT OF DIABETIC FOOT DRAINAGE OF MID FOOT ABCESS- POST OPERATIVE Dr.bal
  10. 10. CROWDING OF TOES CAUSING ARTERIAL THROMBOSIS
  11. 11. ANATOMY OF THE HEEL
  12. 12. MAJORITY OF DIABETIC FOOT ULCERS ARE IN THE REGION OF 1ST MTP JOINT
  13. 13. HAWAI(WEB & TOE STRAP) SLIPPERS ACCENTUATE TOE DEFORMITIES
  14. 14. HAWAI SLIPPERS /STANDING
  15. 15. HAWAI SLIPPERS /WALKING TOE PRESSUR E
  16. 16. PATHO- BIOMECHANICS OF DIABETIC FOOT ULCCEER BIOMECHANIC S OF FORE FOOT AMPUTATION Dr.bal
  17. 17. PATH -BIOMECHANICS OF DIABETIC FOOT ULCER BIOMECHANIC S OF FOREFOOT AMPUTATION Dr.bal
  18. 18. CAUSE OF 2ND MT ULCER
  19. 19. ANATOMICAL BASIS OF SPREADING FOOT INFECTION
  20. 20. HEMOSTASIS 1 hour W O U N D I N G Platelets Fibrin INFLAMMATION days 1 through 7 Proteoglycans Neutrophils Macrophages] Lymphocytes PROLIFERATION days 2 through 20 Normal wound healing Fibroblasts[produce growth factors] Collagen Epithelial Cells Endothelial Cells REMODELING 1 week to 6 months Collagen Fibril Cross linking Scar Maturation Time from injury
  21. 21. WOUND BED PREPARATION DYNAMIC & RAPIDLY EVOLVING CONCEPT REDUCES THE WOUND HEALING TIME REDUCES HE COST OF THE TREATMENT DEFINATION:GLOBAL MANAGEMENTTO ACCELERATE ENDOGENOUS HEALING AND TO FACILITATE OTHER THERAPEUTIC MEASURES IT IS THIRD STAGE OF WOUND CARE REVOLUTION
  22. 22. EVOLUTION OF TIME FRAMEWORK T = TISSUE MANAGEMENT I = INFECTION/INFLAMMATION CONTROL M = MOISTURE CONTROL E = EDGE/EPIDERMAL CONTROL
  23. 23. TISSUE MANAGEMENT DEBRIDEMENT REMOVAL OF NECROTIC, DEVITALIZED, CONTAMINATED TISSUE SHARP AND/OR SURGICAL DEBRIDEMENT NECROTIC TISSUE MASKES THE INFECTION CREATES PHYSICAL BARRIER TO HEALING INHIBITS CONSTITUENTS OF EXTRACELLULAR MATRIX PREVNETS GRANULATION TISSUE
  24. 24. SELECTION OF TYPE OF DEBRIDEMENT SIZE,POSITION,TYPE OF THE WOUND MOISTURE LEVEL PAIN MANAGEMENT TIME AVAILABLE FACILITIES AVAILABLE LEVEL OF HEALTHCARE TRAINING
  25. 25. SURGICAL OR SHARP DEBRIDEMENT FASTEST WAY TO REMOVE DEBRIS AND NECROTIC TISSUE MINIMAL DAMAGE TO THE SURROUNDING TISSUE RELEASES CYTOKINES THAT HELPS WOUND REPAIR NEEDS TRAINING NEEDS INFRASTRUCTURE
  26. 26. SHARP DEBRIDEMENT A B C
  27. 27. SURGICAL DEBRIDEMENT A B
  28. 28. ENZYMATIC DEBRIDEMENT MOST SELECTIVE EXOGENOUS PROTEPLYTIC ENZYMES ARE USED TO RMOVE NECROTIC TISSUE WORK WITH ENDOGENOUS ENZYMES TO DEGRADE THE NECROTIC TISSUE MAY CAUSE MINOR TRASIENT PAIN AND DISCOMFORT
  29. 29. Papain-Ures Collagenase Debridement +++ +++ Speed ++ + Selectivity - +++ Pain ++ - Mt.Debridement - ++ Reduce Bact.Burden ++ +++ Reduce Exudate ++ ++ More Gran.Tissue ++ Epithelization - ++ ENZYME DEBRIDEMENT
  30. 30. AUTOLYTIC DEBRIDEMENT NATURAL DEBRIDEMENT PHAGOCYTIC CELLS AND PROTEOLYTIC EZYMES LIQUIFY AND SEPARATE NECROTIC TISSUE MOIST ENVIRONMENT NECESSARY FOR AUTOLYTIC DEBRIDEMENT CAN RESULT IN TO SIGNIFICANT WOUND EXUDATE DOES NOT DAMAGE HEALTHY TISSUE REQUIRES MINIMAL TECHNOLOGY AND TRAINING MINIMAL PAIN
  31. 31. BIOLOGICAL DEBRIDEMENT USE OF LARVAE /MAGGOTS GREEN BOTTLE FLY LARVAE USEFUL IN PATIENTS WITH THICK SLOGH LIMITED AVAILABILITY NOT ACCEPTED BY MANY PATIENTS ERADICATES INFECTION AND SMELL
  32. 32. MECHANICASL DEBRIDEMENT NON SELECTIVE METHOD WOUND IRRIGATION,WHIRPOOL THERAPY,WET TO DRY DRESSING SIGNIFICANT DISCOMFORT AND PAIN WOUND IRRIGATION IS UNSUITABLE FOR GRANULATING WOUNDS
  33. 33. MAINTENANCE DEBRIDEMENT AN EXTENDED PHASE OF DEBRIDEMENT REQUIRED DUE TO CO MORBIDITIES SIGLE EPISODE OF DEBRIDEMENT MAY NOT BE SUFFECIENT OFFERS DISTINCT ADVANTAGE IN WOUND MANAGEMENT ENZYMATIC AND AUTOLYTIC DEBRIDEMENT IS VERY USEFUL
  34. 34. Vacuum-Assisted Wound Closure Topical negative pressure therapy which can be used to achieve closure of diabetic foot wounds The pump applies subatmospheric pressure through a tube and foam sponge applied to the ulcer over a dressing and sealed in place with a plastic film The dressing is replaced every two to
  35. 35. Vacuum-Assisted Wound Closure Negative pressure improves the dermal blood supply, and stimulates granulation which can form over bone and tendon. It reduces bacterial colonisation and diminishes oedema and interstitial fluid Course of treatment is usually 7-10 days The effect may wear off after 3 days but if the pump is removed and then
  36. 36. VAC pump
  37. 37. VAC pump dressing
  38. 38. VAC pump sponge
  39. 39. Healing wound after VAC pump
  40. 40. Healed wound after VAC pump
  41. 41. Larva therapy (maggots) The larvae of the green bottle fly Lucilia sericata are used to debride ulcers, especially in the neuroischaemic foot This results in relatively rapid atraumatic physical removal of necrotic material Larvae also produce secretions that have antimicrobial activity against Gram-positive cocci including MRSA
  42. 42. THANK YOU

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