Diabetic Foot Ulcer


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  • India. How Hyperbaric Oxygen Therapy Helps in Healing Diabetic Foot Ulcers & Chronic Wounds?

    Hyperbaric Oxygen Therapy ( HBOT ) is the process of breathing 100% oxygen in a carefully controlled, pressurized environment, resulting in increased oxygen delivery to the body tissues. At pressures greater than normal atmospheric pressure, the body is able to absorb more oxygen into blood cell, blood plasma, cerebral spinal and other body fluids. This increased oxygen activity enhances the body's ability to heal.

    The increased oxygen tension in tissues supports physiologic wound healing, decreasing edema, enhances oxidative killing of bacteria, increasing cellular energy production, antibiotic potentiation, neoangionenesis promotion, enhanced epithelial migration, improved collagen production and granulation-tissue formulation.

    Hyperbaric Oxygen Therapy ( HBOT ) when used as an adjunct treatment of modality can significantly improve morbidity and mortality, reduce length of hospital stay, reduces the need for surgical interventions, lessen the need for surgery or foot amputations, reduces treatments costs, improves quality of life…

    Hyperbaric oxygen Therapy ( HBOT ) is an effective adjunct to standard modalities for the treatment of diabetic foot ulcers used in the western world for over twenty years.

    In India Hyperbaric Oxygen Therapy ( HBOT ) has captured the interests of wound care givers and podiatrists as their counterparts in the western world and will become increasingly an adjunct treatment to provide healing care for Diabetic Foot Ulcers in diabetic patients.

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Diabetic Foot Ulcer

  1. 1. Dr. Soumar Dutta CDMO Guwahati Refinery Hospital
  2. 2. In diabetes slight injury to glucose laden tissues may cause chronic infection and ulcer formation. In fact DM is the leading cause of non-traumatic lower extremity amputation.
  3. 3. <ul><li>The reason for increased incidence of this disorder involves the interaction of several pathogenic factors: </li></ul><ul><li>NEUROPATHY . </li></ul><ul><li>ABNORMALFOOT BIOMECHANICS. </li></ul><ul><li>PERIPHERAL ARTERIAL DISEASE. </li></ul><ul><li>POOR WOUND HEALING . </li></ul>
  4. 6. <ul><li>Three types: </li></ul><ul><li>Neuropathic </li></ul><ul><li>Ischemic </li></ul><ul><li>Neuro-ischemic </li></ul>
  5. 7. Depth-ischemia classification of diabetic foot ulcer Depth classification Definition Treatment 0 At risk foot, no ulceration Patient education, accommodative footwear, regular clinical examination 1 Superficial ulceration, not infected Offloading with total contact cast (TCC), walking brace or special footwear 2 Deep ulceration exposing tendons or joints Surgical debridement, wound care, offloading, culture-specific antibiotics 3 Extensive ulceration or abscess Debridement or partial amputation, offloading, culture-specific antibiotics
  6. 8. Ischemia classification DEFINITION TREATMENT A NOT ISCHEMIC B ISCHEMIA WITHOUT GANGRENE Noninvasive vascular testing, vascular consultation if symptomatic C PARTIAL(FOREFOOT) GANGRENE VASCULAR CONSULTATION D COMPLETE FOOT GANGRENE Major extremity amputation, vascular consultation
  7. 9. <ul><li>Preventive measures : The major focus of current diabetic foot care is prevention. Preventive strategies combine: </li></ul><ul><li>patient education (most important) </li></ul><ul><li>prophylactic skin and nail care </li></ul><ul><li>protective footwear . </li></ul><ul><li>. Low-risk individuals must wear non-constrictive shoes. Soft leather or athletic footwear decreases the risk of tissue breakdown from direct pressure Cushioned stockings are helpful, and white socks make identification of skin breakdown easier, especially in individuals with impaired vision. Nails should be cut transversely to decrease the risk of an ingrown toenail. Often, the earliest sign of infection is slowly increasing blood sugars and insulin r equirement. </li></ul>
  8. 10. <ul><li>Strict Glycaemic control. </li></ul><ul><li>Proper nutrition. </li></ul><ul><li>Antiibiotics: to control secondary infections: Oral cephalosporins, clindamycin,amoxicillin/clavulanate, quinolones. </li></ul>
  9. 11. <ul><li>The primary goal in the surgical treatment of diabetic foot ulcers is to obtain wound closure. Management of the foot ulcer is largely determined by its severity (grade) and vascularity and the presence of infection. </li></ul><ul><li>REST. </li></ul><ul><li>ELEVATION OF AFFECTED FOOT. </li></ul><ul><li>RELIEF OF PRESSURES. </li></ul><ul><li>DEBRIDEMENT OF ALL NECROTIC,CALLOUS AND FIBROTIC TISSUES. </li></ul><ul><li>KEEP WOUND MOIST WITH SALINE-SOAKED DRESSING OR HYDROCOLLOID GEL. </li></ul><ul><li>WOUNDS THAT PRODUCE LARGE AMOUNT OF EXUDATIVE MATERIALS - Treat with absorbent materials (calcium alginate) and dressings while keeping the wound moist. </li></ul><ul><li>USE OF GROWTH FACTOR GELS : Promote wound healing in wounds with reasonable wound-healing potential. </li></ul>
  10. 12. Osteomyelitis is a prevalent sequel of diabetic foot ulcers. The timing of its diagnosis and treatment is crucial if the diabetic patient is to avoid amputation later . Fig : Osteomyelites at the head of first metatarsal bone
  11. 14. Thank you