1) Diabetic foot ulcers occur in approximately 15% of people with diabetes and are caused by factors like peripheral neuropathy and peripheral artery disease.
2) Risk factors include age, duration of diabetes, smoking, poor blood sugar control, and history of foot ulcers or amputations. Native Americans, African Americans, and Hispanics have higher risk.
3) Treatment involves controlling blood sugar, debridement, antibiotics if infected, offloading pressure on the foot, moist wound care, and addressing any underlying vascular problems or foot deformities. The goal is to accelerate healing and prevent infection recurrence.
This document summarizes key information about diabetic foot from a presentation. It discusses:
- The pathophysiology of diabetic foot which involves neuropathy, vasculopathy, and infection leading to tissue breakdown.
- Classification systems for diabetic foot ulcers including the Wagner and University of Texas systems which grade severity.
- Treatment involves a multidisciplinary approach, good glycemic control, wound care, antibiotics, and may require debridement, amputation or reconstructive surgery depending on the severity of infection and ischemia.
- Goals are to prevent ulcers through education and offloading pressure on the feet, treat existing ulcers and infections, and control factors like neuropathy and poor circulation to promote healing.
This document discusses the pathophysiology and management of diabetic foot. It covers the epidemiology, risk factors, classification, pathogenesis involving neuropathy, infection, ischemia, and biomechanics. It also describes the clinical evaluation including history focusing on previous foot problems and risk factors, and physical examination assessing neuropathy, infection, and ischemia. Thorough examination of the foot and wound is important to guide appropriate management.
Diabetic foot ulcers pose a serious risk for patients with diabetes. The document discusses that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer, with annual incidence rates of 3-10%. Key risk factors include neuropathy, peripheral vascular disease, foot deformities, and inappropriate footwear. Management requires a multidisciplinary approach including wound care, infection control, offloading pressure areas, and patient education on proper foot self-care. The goals are to heal ulcers, prevent amputation, and maintain foot health and function.
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
Diabetic foot complications are a major source of morbidity and health care costs. They result from a complex interplay of ischemia, ulceration, infection, and Charcot's joint due to diabetes-related changes. Hyperglycemia leads to nonenzymatic glycosylation of proteins and tissues, formation of advanced glycosylation end products, and accelerated atherosclerosis. This causes peripheral vascular disease, neuropathy, and foot deformities which impair sensation and blood flow, making the feet susceptible to infection, ulceration, and gangrene. Charcot's joint is a destructive foot arthropathy caused by loss of sensation from diabetic neuropathy.
Chronic venous insufficiency is a disease of the lower limb veins caused by venous reflux or obstruction over many years. It commonly causes symptoms like leg swelling, skin changes, and can lead to leg ulcers. Treatment involves compression therapy, medications, and procedures to address superficial and deep vein reflux or blockages. Endovenous thermal ablation techniques like radiofrequency ablation have replaced traditional surgery as they allow for treatment in outpatients with fewer complications and faster recovery. Sclerotherapy can also be used but has a lower occlusion rate of treated veins.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
A 64-year-old man presented with sudden onset of pain and loss of sensation in his right leg. Examination found absent pulses, decreased sensation, and an inability to move his toes, indicating acute limb ischemia. The document discusses the etiology, pathophysiology, clinical evaluation, investigations including Doppler ultrasound and angiography, and treatment approaches for acute limb ischemia including thrombolytics, surgery, and amputation. The goal of therapy is to restore blood flow, preserve the limb if possible, and prevent recurrence through anticoagulation.
This document summarizes key information about diabetic foot from a presentation. It discusses:
- The pathophysiology of diabetic foot which involves neuropathy, vasculopathy, and infection leading to tissue breakdown.
- Classification systems for diabetic foot ulcers including the Wagner and University of Texas systems which grade severity.
- Treatment involves a multidisciplinary approach, good glycemic control, wound care, antibiotics, and may require debridement, amputation or reconstructive surgery depending on the severity of infection and ischemia.
- Goals are to prevent ulcers through education and offloading pressure on the feet, treat existing ulcers and infections, and control factors like neuropathy and poor circulation to promote healing.
This document discusses the pathophysiology and management of diabetic foot. It covers the epidemiology, risk factors, classification, pathogenesis involving neuropathy, infection, ischemia, and biomechanics. It also describes the clinical evaluation including history focusing on previous foot problems and risk factors, and physical examination assessing neuropathy, infection, and ischemia. Thorough examination of the foot and wound is important to guide appropriate management.
Diabetic foot ulcers pose a serious risk for patients with diabetes. The document discusses that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer, with annual incidence rates of 3-10%. Key risk factors include neuropathy, peripheral vascular disease, foot deformities, and inappropriate footwear. Management requires a multidisciplinary approach including wound care, infection control, offloading pressure areas, and patient education on proper foot self-care. The goals are to heal ulcers, prevent amputation, and maintain foot health and function.
This document discusses diabetic foot ulcers. It defines a diabetic foot ulcer and lists risk factors such as neuropathy and peripheral vascular disease. It describes the etiology involving neuropathy, angiopathy, and infection. Clinical presentation includes examination of the ulcer, skin, pulses, and neurological assessment. Classification systems like Wagner's are mentioned. Workup involves biochemical testing, imaging, and assessment of vascular and neurological function. Management discusses wound care, offloading pressure, infection treatment, and surgical interventions.
Diabetic foot complications are a major source of morbidity and health care costs. They result from a complex interplay of ischemia, ulceration, infection, and Charcot's joint due to diabetes-related changes. Hyperglycemia leads to nonenzymatic glycosylation of proteins and tissues, formation of advanced glycosylation end products, and accelerated atherosclerosis. This causes peripheral vascular disease, neuropathy, and foot deformities which impair sensation and blood flow, making the feet susceptible to infection, ulceration, and gangrene. Charcot's joint is a destructive foot arthropathy caused by loss of sensation from diabetic neuropathy.
Chronic venous insufficiency is a disease of the lower limb veins caused by venous reflux or obstruction over many years. It commonly causes symptoms like leg swelling, skin changes, and can lead to leg ulcers. Treatment involves compression therapy, medications, and procedures to address superficial and deep vein reflux or blockages. Endovenous thermal ablation techniques like radiofrequency ablation have replaced traditional surgery as they allow for treatment in outpatients with fewer complications and faster recovery. Sclerotherapy can also be used but has a lower occlusion rate of treated veins.
Diabetic foot complications are a major cause of lower limb amputations. Factors like neuropathy, vasculopathy and immune dysfunction contribute to foot ulceration and infection in diabetes. Ulcers are classified based on etiology and severity. Management involves metabolic control, wound care, offloading, antibiotics, vascular assessment and revascularization if needed. Long term prevention relies on regular foot screening, education on foot care, appropriate footwear and multidisciplinary team approach.
A 64-year-old man presented with sudden onset of pain and loss of sensation in his right leg. Examination found absent pulses, decreased sensation, and an inability to move his toes, indicating acute limb ischemia. The document discusses the etiology, pathophysiology, clinical evaluation, investigations including Doppler ultrasound and angiography, and treatment approaches for acute limb ischemia including thrombolytics, surgery, and amputation. The goal of therapy is to restore blood flow, preserve the limb if possible, and prevent recurrence through anticoagulation.
The document discusses varicose veins, including their anatomy, causes, symptoms, diagnosis, and treatment options. It describes the superficial and deep venous systems in the lower limbs and how perforator veins connect them. Incompetent valves in the perforating veins can allow reverse blood flow and cause varicose veins. Conservative treatments include compression stockings and sclerotherapy to occlude veins. Surgical options are vein stripping or ligation of incompetent veins and perforators. Newer minimally invasive treatments like endovenous laser ablation use laser energy to occlude veins.
This document discusses clinical features, signs, classifications, complications, and theories of venous disease and varicose veins. Key points include:
- Common symptoms are aching, heaviness, and leg pain that is worsened by standing and improved by elevation.
- Signs include dilated, tortuous subcutaneous veins and complications such as ulceration, eczema, and bleeding.
- Varicose veins are classified clinically, etiologically, anatomically, and pathophysiologically.
- Complications include hemorrhage, dermatitis, ulcers, and deep vein thrombosis.
- Two theories for venous ulcer formation are the fibrin cuff and white cell trapping theories, which involve
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
The document discusses the approach and classification of leg ulcers. It begins by defining a leg ulcer and classifying them as non-specific, specific, or malignant. The main causes of leg ulcers are then discussed, including venous insufficiency (80-85% of cases), arterial disease, neuropathy, infection, trauma, and malignancy. Diagnostic evaluation of a leg ulcer involves obtaining a thorough history and physically examining the ulcer, surrounding skin, and vascular and neurological systems. Key distinguishing features of venous versus arterial ulcers are also provided.
This document summarizes chronic venous insufficiency (CVI), which occurs when veins cannot pump enough deoxygenated blood back to the heart. CVI mainly affects the legs and can cause varicose veins, spider veins, and reticular veins. The venous system includes deep, superficial, and perforating veins. The great and short saphenous veins are major superficial leg veins. CVI is caused by primary muscle pump failure, venous obstruction, or valvular incompetence. It can lead to complications like ulcers, pigmentation changes, and lipodermatosclerosis. Treatment includes conservative measures, sclerotherapy, and surgical procedures like vein stripping to remove damaged veins.
This document discusses diabetic foot ulcers. It begins by defining a diabetic foot ulcer and explaining that uncontrolled diabetes can lead to skin breakdown in the foot. It then discusses risks like neuropathy, vascular disease, and infection that can develop from diabetic ulcers and increase the risk of amputation if left untreated. The document outlines the anatomy of the foot and the pathophysiology of how diabetes can damage nerves, blood vessels, and lead to infections in the foot. Classification systems for diabetic ulcers are presented. The treatment section emphasizes a multidisciplinary approach and the importance of wound care, offloading, and antibiotics if needed to promote wound healing and prevent amputation.
The document describes the venous drainage system of the lower extremity, including the long saphenous vein (LSV), short saphenous vein (SSV), deep veins, and perforating veins. It provides details on the anatomy and course of the LSV and SSV. Surgical procedures for varicose veins are discussed such as ligation and stripping, ligation of incompetent perforators, and newer minimally invasive techniques like foam sclerotherapy, endovenous laser ablation, and radiofrequency ablation. Post-operative care and potential complications are also summarized.
This document discusses wound healing and the treatment of chronic ulcers. It covers the following key points:
1. Wound healing occurs in four stages: haemostasis, inflammation, proliferation, and remodeling. Chronic ulcers fail to heal due to prolonged inflammation.
2. Common causes of non-healing ulcers include local infection or trauma, venous or arterial insufficiency, and systemic factors like diabetes or malnutrition.
3. Treatment involves correcting underlying causes, wound cleaning and dressings, and revascularization for arterial ulcers using techniques like bypass surgery, angioplasty, or stenting to improve blood flow.
The document discusses diabetic foot complications including ulceration and infection. It provides details on:
1) Evaluating and diagnosing foot issues in diabetics through history, examination, and investigations including imaging and microbiology tests.
2) Classifying foot ulcers into grades based on severity to guide treatment, which may include debridement, antibiotics, and surgery such as amputation for severe cases.
3) Managing common issues like Charcot neuroarthropathy through a multidisciplinary approach including offloading and bracing to prevent deformity.
Peripheral Arterial Occlusive Disease (PAOD) is atherosclerosis of the arteries in the extremities, causing reduced blood flow and ischemia. It affects up to 10% of people over 65 in Western countries. Left untreated, mortality rates increase to 30% at 5 years, 50% at 10 years, and 70% at 15 years. Risk factors include diabetes, hypertension, smoking, and family history. Smoking is the greatest risk factor and cessation is paramount for treatment. Claudication, or muscle pain with exercise, is a common symptom as is rest pain, ulcers, and gangrene. Physical exams look for reduced pulses and blood flow to assess severity. Treatment focuses on risk factor modification, exercise,
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
The document discusses varicose veins, which are distended and dilated veins caused by blood pooling in the legs. It describes the venous system and explains that varicose veins occur due to defects in valves that normally prevent backflow of blood. Symptoms include heaviness, pain, swelling, and skin discoloration or ulcers. Treatment options addressed are compression therapy, sclerotherapy, and surgical procedures like vein stripping to remove damaged veins.
The document discusses the role of nurses in managing venous and arterial ulcers. It defines venous and arterial ulcers, describes their risk factors, pathophysiology, clinical manifestations, diagnostic procedures, and medical and nursing management. Regarding nursing management, the key responsibilities are to promote wound healing, prevent infection, reduce pain, prevent ulcer recurrence, and maximize circulation to the affected area through actions such as proper wound dressing, compression therapy, nutritional support, pain management, and health education.
Diabetic foot infections and ulcers are common complications of diabetes that occur due to peripheral neuropathy, peripheral artery disease, and immune dysfunction caused by hyperglycemia. Risk factors include prior ulcers or amputations, foot deformities, and peripheral artery disease. Evaluation involves assessing infection severity, underlying bone involvement, and vascular status. Management requires wound debridement and dressings, antimicrobial therapy, glycemic control, and possible surgery. Close follow up is needed to monitor treatment response and detect any need for treatment modifications.
This document discusses risk factors, causes, signs, and management of diabetic foot ulcers. It notes that peripheral neuropathy and vascular disease increase risk by impairing sensation and blood flow. Ulcers form where calluses or bony deformities concentrate pressure. Evaluation includes wound culture and imaging to check for osteomyelitis. Treatment involves wound debridement, offloading pressure, and antibiotics for infection. Surgery may be needed for uncontrolled infection, amputation, or deformity correction. Regular foot screening and appropriate footwear can help prevent ulcers.
This document provides an overview of chronic venous disease. It discusses how valves in the veins of the legs can fail, causing blood to pool and increase pressure. This can lead to mild issues like leg heaviness or more severe problems like ulcers. The document outlines the anatomy of the venous system and describes the normal physiology of blood flow back to the heart. It explains that chronic venous disease is caused by valve issues or problems that increase venous pressure. Symptoms can include leg swelling, skin changes, and ulcers if left untreated. Management focuses on reducing symptoms through leg elevation, exercises, compression therapy and treatment of complications.
This document provides an overview of infective endocarditis (IE), including its introduction, classification, pathogenesis, clinical manifestations, diagnosis, and treatment. Some key points:
- IE is defined as an infection of the inner lining of the heart (endocardium) that can involve heart valves, the inner lining of the heart chambers, or defects in the heart wall.
- It is classified based on temporal evolution (acute vs. subacute) and location (native valve, prosthetic valve, device-related, right-sided). Common causes include streptococci, staphylococci, and enterococci.
- Diagnosis is based on the Modified Duke Criteria, which considers
Peripheral vascular disease (PVD) refers to narrowed, blocked, or spasming blood vessels outside the heart and brain. It is commonly caused by atherosclerosis which leads to the buildup of fatty plaques in the arteries (atherosclerotic plaques). Symptoms range from mild intermittent leg pain with walking (intermittent claudication) to severe leg or foot pain at rest or skin ulcers/gangrene of the lower leg or foot. Treatment involves lifestyle changes, medications to reduce pain, plaque, or blood clotting, and potentially minimally invasive or open surgical procedures to restore blood flow if more conservative options are ineffective.
Diabetic Foot slide show vascular surgerydrmetwally7
The document discusses diabetes as a global epidemic and leading cause of death. It notes that the number of people with diabetes is expected to rise significantly by 2030. Diabetes is a major risk factor for foot ulcers and lower limb amputation. The document then examines in detail the risk factors and pathophysiology of diabetic foot ulcers and amputation, including neuropathy, foot deformities, peripheral artery disease, and the multidisciplinary approach needed for prevention and treatment.
Diabetic foot ulcers are a major complication of diabetes, affecting around 15% of people with the disease. They are caused by neuropathy, peripheral vascular disease, and foot deformities resulting from diabetes. Treatment involves wound debridement, managing any infection, revascularization if needed, and strict offloading of pressure on the affected foot to aid healing. Left untreated, diabetic foot ulcers can lead to amputation in around 50-70% of cases.
The document discusses varicose veins, including their anatomy, causes, symptoms, diagnosis, and treatment options. It describes the superficial and deep venous systems in the lower limbs and how perforator veins connect them. Incompetent valves in the perforating veins can allow reverse blood flow and cause varicose veins. Conservative treatments include compression stockings and sclerotherapy to occlude veins. Surgical options are vein stripping or ligation of incompetent veins and perforators. Newer minimally invasive treatments like endovenous laser ablation use laser energy to occlude veins.
This document discusses clinical features, signs, classifications, complications, and theories of venous disease and varicose veins. Key points include:
- Common symptoms are aching, heaviness, and leg pain that is worsened by standing and improved by elevation.
- Signs include dilated, tortuous subcutaneous veins and complications such as ulceration, eczema, and bleeding.
- Varicose veins are classified clinically, etiologically, anatomically, and pathophysiologically.
- Complications include hemorrhage, dermatitis, ulcers, and deep vein thrombosis.
- Two theories for venous ulcer formation are the fibrin cuff and white cell trapping theories, which involve
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
The document discusses the approach and classification of leg ulcers. It begins by defining a leg ulcer and classifying them as non-specific, specific, or malignant. The main causes of leg ulcers are then discussed, including venous insufficiency (80-85% of cases), arterial disease, neuropathy, infection, trauma, and malignancy. Diagnostic evaluation of a leg ulcer involves obtaining a thorough history and physically examining the ulcer, surrounding skin, and vascular and neurological systems. Key distinguishing features of venous versus arterial ulcers are also provided.
This document summarizes chronic venous insufficiency (CVI), which occurs when veins cannot pump enough deoxygenated blood back to the heart. CVI mainly affects the legs and can cause varicose veins, spider veins, and reticular veins. The venous system includes deep, superficial, and perforating veins. The great and short saphenous veins are major superficial leg veins. CVI is caused by primary muscle pump failure, venous obstruction, or valvular incompetence. It can lead to complications like ulcers, pigmentation changes, and lipodermatosclerosis. Treatment includes conservative measures, sclerotherapy, and surgical procedures like vein stripping to remove damaged veins.
This document discusses diabetic foot ulcers. It begins by defining a diabetic foot ulcer and explaining that uncontrolled diabetes can lead to skin breakdown in the foot. It then discusses risks like neuropathy, vascular disease, and infection that can develop from diabetic ulcers and increase the risk of amputation if left untreated. The document outlines the anatomy of the foot and the pathophysiology of how diabetes can damage nerves, blood vessels, and lead to infections in the foot. Classification systems for diabetic ulcers are presented. The treatment section emphasizes a multidisciplinary approach and the importance of wound care, offloading, and antibiotics if needed to promote wound healing and prevent amputation.
The document describes the venous drainage system of the lower extremity, including the long saphenous vein (LSV), short saphenous vein (SSV), deep veins, and perforating veins. It provides details on the anatomy and course of the LSV and SSV. Surgical procedures for varicose veins are discussed such as ligation and stripping, ligation of incompetent perforators, and newer minimally invasive techniques like foam sclerotherapy, endovenous laser ablation, and radiofrequency ablation. Post-operative care and potential complications are also summarized.
This document discusses wound healing and the treatment of chronic ulcers. It covers the following key points:
1. Wound healing occurs in four stages: haemostasis, inflammation, proliferation, and remodeling. Chronic ulcers fail to heal due to prolonged inflammation.
2. Common causes of non-healing ulcers include local infection or trauma, venous or arterial insufficiency, and systemic factors like diabetes or malnutrition.
3. Treatment involves correcting underlying causes, wound cleaning and dressings, and revascularization for arterial ulcers using techniques like bypass surgery, angioplasty, or stenting to improve blood flow.
The document discusses diabetic foot complications including ulceration and infection. It provides details on:
1) Evaluating and diagnosing foot issues in diabetics through history, examination, and investigations including imaging and microbiology tests.
2) Classifying foot ulcers into grades based on severity to guide treatment, which may include debridement, antibiotics, and surgery such as amputation for severe cases.
3) Managing common issues like Charcot neuroarthropathy through a multidisciplinary approach including offloading and bracing to prevent deformity.
Peripheral Arterial Occlusive Disease (PAOD) is atherosclerosis of the arteries in the extremities, causing reduced blood flow and ischemia. It affects up to 10% of people over 65 in Western countries. Left untreated, mortality rates increase to 30% at 5 years, 50% at 10 years, and 70% at 15 years. Risk factors include diabetes, hypertension, smoking, and family history. Smoking is the greatest risk factor and cessation is paramount for treatment. Claudication, or muscle pain with exercise, is a common symptom as is rest pain, ulcers, and gangrene. Physical exams look for reduced pulses and blood flow to assess severity. Treatment focuses on risk factor modification, exercise,
The document provides information on acute abdomen including its definition, epidemiology, physiology, differential diagnosis by location, history and physical examination findings, important investigations, management principles, and criteria for surgical consultation. Acute abdomen is defined as sudden severe abdominal pain lasting less than 24 hours that often requires urgent diagnosis and some causes need surgical treatment. The differential diagnosis considers location of pain and includes conditions like appendicitis, diverticulitis, bowel obstruction, pancreatitis and others. Key aspects of evaluation involve history, physical exam, labs, imaging and identifying high-risk patients who may require emergent surgery.
The document discusses varicose veins, which are distended and dilated veins caused by blood pooling in the legs. It describes the venous system and explains that varicose veins occur due to defects in valves that normally prevent backflow of blood. Symptoms include heaviness, pain, swelling, and skin discoloration or ulcers. Treatment options addressed are compression therapy, sclerotherapy, and surgical procedures like vein stripping to remove damaged veins.
The document discusses the role of nurses in managing venous and arterial ulcers. It defines venous and arterial ulcers, describes their risk factors, pathophysiology, clinical manifestations, diagnostic procedures, and medical and nursing management. Regarding nursing management, the key responsibilities are to promote wound healing, prevent infection, reduce pain, prevent ulcer recurrence, and maximize circulation to the affected area through actions such as proper wound dressing, compression therapy, nutritional support, pain management, and health education.
Diabetic foot infections and ulcers are common complications of diabetes that occur due to peripheral neuropathy, peripheral artery disease, and immune dysfunction caused by hyperglycemia. Risk factors include prior ulcers or amputations, foot deformities, and peripheral artery disease. Evaluation involves assessing infection severity, underlying bone involvement, and vascular status. Management requires wound debridement and dressings, antimicrobial therapy, glycemic control, and possible surgery. Close follow up is needed to monitor treatment response and detect any need for treatment modifications.
This document discusses risk factors, causes, signs, and management of diabetic foot ulcers. It notes that peripheral neuropathy and vascular disease increase risk by impairing sensation and blood flow. Ulcers form where calluses or bony deformities concentrate pressure. Evaluation includes wound culture and imaging to check for osteomyelitis. Treatment involves wound debridement, offloading pressure, and antibiotics for infection. Surgery may be needed for uncontrolled infection, amputation, or deformity correction. Regular foot screening and appropriate footwear can help prevent ulcers.
This document provides an overview of chronic venous disease. It discusses how valves in the veins of the legs can fail, causing blood to pool and increase pressure. This can lead to mild issues like leg heaviness or more severe problems like ulcers. The document outlines the anatomy of the venous system and describes the normal physiology of blood flow back to the heart. It explains that chronic venous disease is caused by valve issues or problems that increase venous pressure. Symptoms can include leg swelling, skin changes, and ulcers if left untreated. Management focuses on reducing symptoms through leg elevation, exercises, compression therapy and treatment of complications.
This document provides an overview of infective endocarditis (IE), including its introduction, classification, pathogenesis, clinical manifestations, diagnosis, and treatment. Some key points:
- IE is defined as an infection of the inner lining of the heart (endocardium) that can involve heart valves, the inner lining of the heart chambers, or defects in the heart wall.
- It is classified based on temporal evolution (acute vs. subacute) and location (native valve, prosthetic valve, device-related, right-sided). Common causes include streptococci, staphylococci, and enterococci.
- Diagnosis is based on the Modified Duke Criteria, which considers
Peripheral vascular disease (PVD) refers to narrowed, blocked, or spasming blood vessels outside the heart and brain. It is commonly caused by atherosclerosis which leads to the buildup of fatty plaques in the arteries (atherosclerotic plaques). Symptoms range from mild intermittent leg pain with walking (intermittent claudication) to severe leg or foot pain at rest or skin ulcers/gangrene of the lower leg or foot. Treatment involves lifestyle changes, medications to reduce pain, plaque, or blood clotting, and potentially minimally invasive or open surgical procedures to restore blood flow if more conservative options are ineffective.
Diabetic Foot slide show vascular surgerydrmetwally7
The document discusses diabetes as a global epidemic and leading cause of death. It notes that the number of people with diabetes is expected to rise significantly by 2030. Diabetes is a major risk factor for foot ulcers and lower limb amputation. The document then examines in detail the risk factors and pathophysiology of diabetic foot ulcers and amputation, including neuropathy, foot deformities, peripheral artery disease, and the multidisciplinary approach needed for prevention and treatment.
Diabetic foot ulcers are a major complication of diabetes, affecting around 15% of people with the disease. They are caused by neuropathy, peripheral vascular disease, and foot deformities resulting from diabetes. Treatment involves wound debridement, managing any infection, revascularization if needed, and strict offloading of pressure on the affected foot to aid healing. Left untreated, diabetic foot ulcers can lead to amputation in around 50-70% of cases.
This document discusses diabetic foot issues from an orthopedic surgery perspective. It begins by noting the increasing prevalence of diabetes and its complications, particularly for the feet. The rest of the document covers: classifications of diabetic foot lesions; diagnosing and managing the condition; and questions around organizing patient care, the roles of orthopedic vs vascular surgery, treating plantar ulcers and osteitis, and whether an "acute foot" requires surgical or medical intervention. Specific topics discussed in more depth include the pathophysiology of neuropathy, arteriopathy and their effects; prevalence and risk factors for ulcers and amputation; and characteristics and consequences of neuropathic, ischemic and infected lesions.
This document discusses the management of diabetic foot disease. It begins by outlining the challenges, which include foot ulceration being common and often preceding lower limb amputation. Prevention is emphasized as the first step. It then covers the epidemiology, etiology, assessment, and treatment of diabetic foot lesions and ulcers. Treatment involves identifying risk factors, examining the foot, assessing vascular status, offloading, managing infection, and considering adjunct therapies like growth factors or hyperbaric oxygen. Surgical debridement and antibiotics are used depending on the severity and presence of osteomyelitis or infection. The goal is to heal ulcers and prevent amputation through a multidisciplinary approach.
This case report describes a 55-year-old woman with diabetes who presented with a foot ulcer. She developed swelling and blackening of her left second toe after being bitten by a cat. The ulcer progressed in size over time. She had a history of diabetes for 5 years and was on antidiabetic treatment. Examination found a large irregular ulcer on the top of her foot. Investigations showed elevated blood sugars. She underwent ray's amputation of the second toe and was treated with antibiotics, insulin, and other medications. The differential diagnoses considered were wet gangrene, varicose ulcer, and venous ulcer.
This document discusses diabetic foot ulcers. It begins by providing background on the increasing prevalence of diabetes and risk of foot ulcers. It then describes the main causes of foot ulcers as peripheral neuropathy and peripheral vascular disease resulting from complications of long-term hyperglycemia. The document outlines methods for classifying and assessing foot ulcers, including examining for deformities, vascular abnormalities, and loss of sensation. Treatment approaches discussed include offloading pressure, debridement, wound dressings, and antibiotics to address infection based on culture results. The goal of treatment is to heal ulcers and prevent further complications such as amputation.
Diabetes-related Clinical Complications: Novel Approaches for Diagnosis and M...asclepiuspdfs
Metabolic diseases such as hypertension, obesity, diabetes, and vascular diseases have reached epidemic proportions worldwide. In the past four decades, childhood and adolescent obesity has increased four-fold worldwide. During the same period, obesity in adults has doubled and diabetes has increased by four-fold. In China, India, and the USA, the number of prediabetes is more than diabetics. This population is at considerable risk for developing diabetes, its clinical complications, and acute vascular events. The management of modifiable risks for cardiometabolic risks has improved considerably. Several major studies have demonstrated, that robust management of modifiable risks for cardiovascular diseases (CVDs), significantly reduces premature mortality from CVDs. Considering the progress made in the risk assessment, risk management, we feel strongly, that not much progress is made in the areas of primary prevention and early risk assessment, for clinical complications associated with metabolic diseases, in particular, diabetes. The majority of the clinical complications associated with diabetes are due to dysfunction of the vascular system or nervous system. Complications include vasculopathy leading to subclinical atherosclerosis, heart attacks, and stroke.
Dr. Vinay Jain presented on diabetic foot. Some key points:
1. Diabetes can cause nerve damage (neuropathy), poor circulation (peripheral arterial disease), and foot deformities which make the feet susceptible to ulcers and infection.
2. About 15% of diabetics develop foot lesions in their lifetime, with an amputation rate 15 times higher than non-diabetics.
3. Risk factors for foot complications include long diabetes duration, neuropathy, past ulcer/amputation, and poor blood sugar control.
4. Treatment depends on the severity of the ulcer and includes wound cleaning, offloading pressure (casts, special shoes), surgery if needed, and amputation in
Diabetic neuropathy is a major cause of neuropathy worldwide and may lead to amputations and incapacity. This study aimed at a detailed and updated review on diabetic neuropathy, focusing on its epidemiology, classification, clinical features, risk factor, diagnostic investigation and treatment. Dr. Siva Rami Reddy E "A Basic Review on Diabetic Neuropathy" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21391.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21391/a--basic-review-on-diabetic-neuropathy/dr-siva-rami-reddy-e
Diabetic peripheral neuropathy is a common complication of diabetes that causes numbness and sometimes pain in the hands and feet. Long-term high blood glucose levels associated with uncontrolled diabetes can damage nerves over time. Symptoms include burning, tingling, and reduced sensation. Foot complications from neuropathy are a major cause of morbidity and can lead to foot ulcers and amputation if not properly managed. Regular screening for neuropathy and other foot problems along with patient education on proper foot care can help reduce risks of ulcers and amputations.
This document discusses the approach to diabetic foot problems. It defines diabetic foot as a disease involving neuropathy, angiopathy, and infection leading to tissue breakdown and possible amputation. Diabetic foot affects 15% of Jordan's diabetic population and can result in ulcers, osteomyelitis, and amputation. Proper assessment involves examination of the skin, nerves, blood vessels, and any wounds or infections. Treatment requires a multidisciplinary team approach involving different medical specialties.
The document discusses the diabetic foot and ankle. It notes that diabetes requires treatment from a multidisciplinary team, with vascular disease often requiring input from vascular surgeons. The orthopedic surgeon sees increasing cases of ulceration, deformity, osteomyelitis, and Charcot osteoarthropathy as direct complications of diabetes. The key topics covered are the pathophysiology of hyperglycemia on tissues, assessment of diabetic foot pathology, management of foot/ankle ulceration and Charcot disease, and treatment of ankle fractures in diabetics. Early diagnosis and a multidisciplinary approach are important to prevent complications.
ueda2013 prevention of amputation-d.mamdohueda2015
Up to 70% of all leg amputations occur in people with diabetes. Relatively simple interventions can reduce amputations by 50-80%. To prevent amputation, mild foot pathology must be diagnosed and treated before it progresses to advanced stages. A simple prevention plan outlined by the International Working Group on the Diabetic Foot involves regular foot exams, patient education, appropriate footwear, and treating non-ulcerative issues. With regular low-cost care focused on prevention, amputation rates in diabetes can be significantly reduced.
GOUTY ARTHRITIS ASSOCIATED WITH KIDNEY FAILURE bizkyflavour
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• Pitfalls and pivots needed to use AI effectively in public health
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• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Diabetic foot Ulcer
प्रमेह पिड़िका
Department of Shalya tantra
Presented by -
Payal Sindel
Year -2022-23
BAMS Final year
Pt. Khushilal sharma govt.(auto.) ayurveda college and institute , Bhopal(M.P.)
Dr Payal Sindel
2. Introduction
Diabetic foot ulcers occur in approximately 15% of persons with
diabetes. Of those who develop a foot ulcer, 6% will be hospitalized
due to infection or other ulcer-related complication.
The risk of foot ulceration and limb amputation increases with age and
the duration of diabetes.
Diabetes is the leading cause of non-traumatic lower extremity
amputations in the U.S. Between 14-24% percent of patients with
diabetes who develop a foot ulcer will require an amputation, and foot
ulceration precedes 85% of diabetes-related amputations.
In the U.S., 82,000 amputations are performed each year on persons
with diabetes, half of those age 65 or older.
The good news is that a foot ulcer is preventable if the underlying
conditions causing it, diabetic peripheral neuropathy and/or
peripheral arterial disease, are appropriately diagnosed and treated.
A diabetic foot ulcer is an open sore or wound on the foot of a person
with diabetes, most commonly located on the plantar surface, or bottom
of the foot.
Dr Payal Sindel
3. The annual incidence of diabetic foot ulcer worldwide is
between 9.1 to 26.1 million.
Around 15 to 25% of patients with diabetes mellitus will
develop a diabetic foot ulcer during their lifetime.
As the number of newly diagnosed diabetics are
increasing yearly, the incidence of diabetic foot ulcer is
also bound to increase.
Diabetic foot ulcers can occur at any age but are most
prevalent in patients with diabetes mellitus ages 45 and
over.
Latinos, African Americans, and Native Americans have
the highest incidence of foot ulcers in the US.
Epidemiology
Dr Payal Sindel
4. Slight injury to glucose laden tissue may cause chronic infection and
ulcer formation.
Ulceration in diabetes may be precipitated by ischaemia due to diabetic
atherosclerosis.
More prone to infection of glucose ladden tissue may cause ulceration.
Diabetic polyneuropathy or peripheral neuritis may also cause ulcer
formation.
The etiology for diabetic foot ulcer is multifactorial. The common
underlying causes are poor glycemic control, calluses, foot deformities,
improper foot care, ill-fitting footwear, underlying peripheral
neuropathy and poor circulation, dry skin, etc.
About 60% of diabetics will develop neuropathy, eventually leading to a
foot ulcer. The risk of a foot ulcer is increased in individuals with a flat
foot as they have disproportionate stress across the foot, leading to
tissue inflammation in high risk areas of the foot.
Peripheral neuropathy (nerve damage) and lower extremity ischemia
(lack of blood flow) due to peripheral artery disease are the primary
causes of diabetic foot ulcers.
Aetiology
Dr Payal Sindel
5. Diabetic peripheral neuropathy is a precipitating factor in almost 90% of diabetic foot ulcers.
Chronically high glucose (blood sugar) levels damage nerves, including the sensory, motor and autonomic
nerves.
Diabetic neuropathy also damages the immune system and impairs the body's ability to fight infection.
Sensory nerves enable people to feel pain, temperature, and other sensations. When sensory nerves of a
diabetic person are damaged (sensory neuropathy), they may no longer be able to feel heat, cold, or pain
in their feet.
A cut or foot sore, a burn from hot water, or exposure to extreme cold might go completely unnoticed
because of numbness and lack of sensation.
Diabetic Peripheral Neuropathy
Dr Payal Sindel
6. The sore or exposed area may then become infected and not heal
properly due to the body's impaired ability to fight infection.
Peripheral neuropathy also causes muscle weakness and loss of
reflexes, especially at the ankle.
This may change the way a person walks and lead to foot
abnormalities and deformities such as bunions, hammertoes, and
charcot foot.
These play an important role in the pathway of diabetic foot ulcers
since they contribute to abnormal pressures in the plantar area
(heel and bottom) of the foot, predisposing it to ulceration.
Shoes that no longer fit due to abnormalities and deformed foot
structure may rub against toes causing blisters and ulcers on areas
of the foot that are numb due to sensory neuropathy.
If not treated promptly, an ulcer may become infected and spread
to the bone causing osteomyelitis, a serious complication that
might require surgery.
Autonomic dysfunction causes decreased sweating resulting in
cracked skin and ulceration, making the skin vulnerable to infection.
Diabetic Peripheral Neuropathy
Dr Payal Sindel
7. Diabetes also damages blood vessels by causing inflammation and
atherosclerosis, or hardening of the arteries. Narrowing of the arteries causes
ischemia, a condition in which the blood circulation in the arteries is
restricted and the availability of oxygen, glucose, and critical nutrients to
tissues in the body is substantially reduced. When poor circulation affects
the arteries of the feet and hands, it is called peripheral artery disease, or
PAD.
By restricting the supply of oxygenated, nutrient-rich blood to the site of the
ulcer, peripheral artery disease increases the risk an ulcer will become
infected and heal slowly--or not at all.
Peripheral artery disease (PAD) is 2–8 times more common in patients with
diabetes, and about half of patients with a diabetic foot ulcer will also be
found to have co-existing PAD.
Identifying PAD in patients with foot ulceration is important because its
presence is associated with slower (or lack of) healing of foot ulcers as well as
other serious complications.
Diagnosing PAD is challenging in patients with diabetes, as they frequently
lack typical symptoms, such as intermittent claudication (rest pain), even in
the presence of severe tissue loss.
Peripheral Artery Disease
Dr Payal Sindel
8. The development of a diabetic ulcer is usually in 3 stages. The initial stage is the development of a callus. The
callus results from neuropathy.
The motor neuropathy causes physical deformity of the foot, and sensory neuropathy causes sensory loss
which leads to ongoing trauma.
Drying of the skin because of autonomic neuropathy is also another contributing factor.
Finally, frequent trauma of the callus results in subcutaneous hemorrhage and eventually, it erodes and
becomes an ulcer.[2]
Patients with diabetes mellitus also develop severe atherosclerosis of the small blood vessels in the legs and
feet, leading to vascular compromise, which is another cause for diabetic foot infections.
Because blood is not able to reach the wound, healing is delayed, eventually leading to necrosis and gangrene.
Pathophysiology
Dr Payal Sindel
9. Neuropathic ulcers occur where there is peripheral diabetic neuropathy, but no ischemia
caused by peripheral artery disease.
Ischemic ulcers occur where there is peripheral artery disease present without the
involvement of diabetic peripheral neuropathy.
Neuroischemic ulcers occur where the person has both peripheral neuropathy and
ischemia resulting from peripheral artery disease.
1.
2.
3.
Types of Diabetic Ulcers
Dr Payal Sindel
10. Diabetic peripheral neuropathy and peripheral artery
disease (PAD) are strong risk factors associated with the
development of diabetic foot ulcers.
Other risk factors include cigarette smoking, poor
glycemic (sugar) control, and previous foot ulcerations.
In addition, certain groups have a greater risk of
developing foot ulcers including Native Americans,
African Americans, Hispanics, older men, insulin-
dependent diabetics, and persons with diabetes-related
kidney, eye, and heart disease.
Risk Factors
Toes and feet particularly the sole is the
commonest site.
Leg is also affected.
Any other part of the body may be affected.
Sites
1.
2.
3.
Dr Payal Sindel
11. Appearance of drainage on the person's socks
Redness and swelling in the area
Odor if the ulcer has progressed significantly
Diabetic ulcer is deep and spreading.
Signs and Symptoms
Dr Payal Sindel
12. After the diagnosis of the ulcer, it should undergo
staging. One of the commonly used classifications is by
Wagner from 1981. It classifies wounds into six grades
based on the depth
Grade/ Features
This classification, though, has been criticized as
grading merely the depth of the ulceration and not
incorporating other factors known to influence the
outcome. Among others, one of the most commonly
used classification today is The University of Texas
Classification, which not only includes assessment of
the depth, but also the type of infection, and ischemia
based on the eventual outcome of the wound.
1/Superficial ulcer
2/Deep ulcer involving tendon bone or joint
3/Deep ulcer with abscess or osteomyelitis
4/Gangrene involving the forefoot
5/Gangrene involving the entire Foot
Staging
Dr Payal Sindel
13. Getting a good history is vital in the care of patients with a diabetic ulcer. The history
should include the duration of diabetes, glycemic control, other pre-existing complications
of diabetes including sensory neuropathy, history of peripheral vascular disease, callus,
previous ulcer, prior treatment, and the outcome. The detailed history should also include
information regarding the footwear and foot.
The clinical examination should include examining the peripheral pulses of the feet, looking
for any anatomical anomalies, the presence of callus, signs of vascular insufficiency, which
may indicate loss of hair, muscle atrophy, and location of the ulcer. Also assess for the
presence of purulence, scabs, and evidence of neuropathy by examining with a
monofilament.
Features indication neuropathy include:
Paresthesia
Hypo or hyperesthesia
Dysesthesia
Anhydrosis
Ulcers are most common in the weight-bearing areas such as the plantar metatarsal head,
heel, tips of hammer toes and other prominent areas. Other physical features include
hammertoes, brittle nails, calluses, and fissures.
1.
2.
3.
4.
History and Physical
Dr Payal Sindel
14. The most common laboratory investigations done during evaluation of the ulcer include a
fasting blood sugar,
glycated hemoglobin levels,
complete metabolic panel,
a complete blood count,
erythrocyte sedimentation rate (ESR),
C-reactive protein (CRP).
Recent guidelines and the literature suggest that in patients with diabetic foot ulcers, results of specimens
for culture taken by swabbing do not correlate well with those obtained by deep tissue sampling; this
suggests that superficial swab specimens may be less reliable for guiding antimicrobial therapy than deep
tissue specimens.
Radiological investigations include plain x-rays to look for any underlying osteomyelitis, the presence of air
in the subcutaneous tissue, any signs of underlying fractures, and presence of a foreign body.
If osteomyelitis is suspected, MRI is the most preferred test.
A bone scan with technetium can also be used to diagnose underlying osteomyelitis.
Arterial Doppler with ankle-brachial index (ABI) is useful to rule out underlying peripheral vascular disease.
The probe-to-bone test (PTB) is performed by probing the ulcer with a sterile metal probe is a bedside test
that can help with the diagnosis of underlying osteomyelitis. If the probe hits the bone, it is a positive test.
Positive probe-to-bone test results are helpful especially when conducted on patients with diabetes mellitus.
1.
2.
3.
4.
5.
6.
7.
Evaluation
Dr Payal Sindel
15. A diabetic foot ulcer acts as a portal for systemic infections such as cellulitis, infected foot ulcers, and
osteomyelitis. These are especially dangerous to patients with diabetes, whose impaired immunity
increases their risk for local and systemic infection. Therefore, debridement and antibiotic therapy should
be initiated as soon as possible.
Blood sugar should also be monitored closely and controlled, because hyperglycemia may increase the
virulence of infectious microorganisms.
The goal of treatment is to accelerate the healing process and decrease the chance for infection (or
prevent a recurrence of infection). Treatment usually consists of:
Optimal glucose control.
Debridement - removal of all hyperkeratotic (thickened) skin, infected and nonviable, including necrotic
(dead), tissue, slough, foreign debris, and residual material from dressings.
Systemic antibiotics for deep infection, drainage, and cellulitis.
Off-loading - Relieving the pressure from the ulcerated areas by having the patient wear special foot gear, a
brace, specialized castings, or using a wheelchair or crutches.
Creating a moist wound environment.
Treatment with growth factors and/or cellular therapy if the wound is not healing.
1.
2.
3.
Treatment / Management
Dr Payal Sindel
16. STEP 1 Treatment of diabetic foot ulcer should be systematic for an optimal outcome. The most important
point is to identify if there is any evidence of ongoing infection, by obtaining a history of chills, fever, looking
for the presence of purulence or presence of at least two signs of inflammation that includes, pain, warmth,
erythema or induration of the ulcer. It should is noteworthy that even in the presence of severe diabetic foot
infection, there can be minimal systemic signs of infection.
The next step is to decide if the patient’s ulcer can is manageable in the outpatient setting or inpatient
setting. Need for parenteral antibiotics, concern for noncompliance, inability to care for the wound, ability to
offload pressure, are few points to be considered for hospitalization. Both categories of patients should have
treatment with antibiotics.
The common organisms seen in a diabetic foot ulcer are Staphylococcus aureus, Streptococcus,
Pseudomonas aeruginosa, and rarely E. coli. Diabetes patients have higher carriage rate of Staphylococcus
aureus in the nares and skin, and this increases the chances of infection of the ulcer. Antibiotics are only
needed if there is a concern for infection. The severity of the infection dictates the dose, duration, and the
type of antibiotic.
The typical outpatient antibiotics regimen includes oral cephalosporins, and amoxicillin-clavulanic acid
combination, (If MRSA is not of concern). If MRSA is suspected, then the oral regimens include linezolid,
clindamycin or cephalexin plus doxycycline or a trimethoprim-sulphamethoxazole combination.
Treatment / Management
Dr Payal Sindel
17. Parenteral antibiotic regimens include piperacillin-tazobactam, ampicillin-sulbactam, and if penicillin-allergic,
then carbapenems including ertapenem or meropenem. The other combinations regimen including adding
metronidazole for anaerobic coverage along with quinolones like ciprofloxacin or levofloxacin, or with
cephalosporins like ceftriaxone, cefepime or ceftazidime. Intravenous agents which cover MRSA include
vancomycin, linezolid or daptomycin.
The next therapeutic step is to treat any underlying peripheral vascular disease. Inadequate blood supply limits
the oxygen supply and the delivery of the antibiotics to the ulcer; hence revascularization improves both, and
there is a better chance for the healing of the ulcer. The subsequent step is to perform local debridement or
removal of calluses.
Vacuum assisted closure can be undertaken for clean non healing wounds. Others may benefit from
hydrotherapy to get rid of infected debris.
If the patient has charcot foot, then the initial treatment is immobilization with braces or specially made shoes,
but most will require a surgical procedure like arthrodesis or an osteotomy.
Finally, efforts should be made for the prevention of new ulcers or worsening of the existing ulcer, which occurs
by offloading the pressure from the site by using walkers or therapeutic shoes.If the wound fails to heal in 30
days, then hyperbaric oxygen therapy can be considered. Since the wound has low oxygen supply, there is often
delay in healing of the wound. Hyperbaric oxygen therapy improves the rate of wound healing and also reduces
the rate of complications.
To have the best outcome a team of health care providers including primary care physician, podiatrist, a vascular
surgeon, an infectious disease specialist and wound care nursing staff are imperative.
Treatment / Management
Dr Payal Sindel
18. Wounds and ulcers heal faster and have a lower risk of infection if they are kept covered and
moist, using dressings and topically-applied medications.
Products including saline, growth factors, ulcer dressings, and skin substitutes are highly
effective in healing foot ulcers.
There should be adequate circulation to the ulcerated area.
Tight control of blood glucose is critical during to the effect treatment of a diabetic foot ulcer.
This will enhance healing and reduce the risk of complications.
Wound Care
Dr Payal Sindel
19. Surgical Options
Many non-infected foot ulcers are treatable without surgery.
However, surgery may be required to:
Remove pressure on the affected area, including shaving or
excision of bone(s).
Correct deformities, such as hammertoes, bunions, or bony
“bumps.”
Treat infections such as osteomyelitis, an infection of the
bone, by surgically removing the infected bone.
Healing time may range from weeks to several months,
depending on:
Wound size and location
Pressure on the wound from walking or standing
Degree of swelling
Issues with proper circulation
Blood glucose levels
Dr Payal Sindel
20. Prognosis
The prognosis these ulcers is good if identified early and
optimal treatment initiated. Unfortunately, delays in care can
have detrimental effects which can lead even to amputation of
the foot. Patients who have chronic diabetic ulcer have a high
risk of rehospitalization and prolonged hospitalization.
Complications
The most feared complication is amputation of the extremity.
The other complications include gangrene of the foot,
osteomyelitis, permanent deformity, and risk of sepsis.
Postoperative and Rehabilitation Care
Patients who end up with amputation will need comprehensive
therapy including physical therapy, occupational therapy and
also will need a prosthesis.
Dr Payal Sindel
21. The risk of developing a foot ulcer can be reduced by:
Smoking cessation
Lowering consumption of alcohol
Reducing high cholesterol
Controlling blood glucose levels
Wearing the appropriate shoes and socks
Inspecting feet every day—especially the sole and between
the toes—for cuts, bruises, cracks, blisters, redness, ulcers,
and other signs of abnormality
Risk Reduction
Dr Payal Sindel
22. Prameha Piḍakā are complications occuring in patients afflicted with Prameha due to prolonged
presence of vitiated Doṣas. Prameha Piḍakā are diabetic carbuncles / boils.
Prameha pidika
Bheda: (Ā. Sushruta & Ā. Vāgbhaṭa)
1) Sharāvikā are the boils which resemble Sharāva (curved earthen pan) in shape.
2) Sarṣapikā are the boils which resemble white mustard in colour and size.
3) Kacchapikā are the boils which are elevated like a tortoise shell, with a rough surface, and causing
burning sensation.
4) Jālinī are the boils which cause severe burning sensation and appear like a network of fibres on the
skin.
5) Vinatā are the boils which are deep rooted, large, painful, moist and appear on the back and
abdomen.
6) Putriṇī are the boils which are spread over a large area with multiple blisters at the center.
7) Masūrikā are the boils which resemble red lentils.
8) Alajī are the boils which are red or white in color, appear as they are about to rupture and cause
severe pain.
9) Vidārikā are the boils which resemble the tubers of Vidārī.
10) Vidradhikā are the boils which possess similar features like Vidradhi Roga.
Dr Payal Sindel
23. Prameha pidika
Sādhya -> Sarṣapikā, Vinatā, Masūrikā, Alajī, Vidradhikā
Kṛcchrasādhya -> Sharāvikā, Kacchapikā, Jālinī, Putriṇī, Vidārikā; Piḍakā which are associated with burning
sensation, excessive thirst, fever, hallucinations, which spread easily, and have red or black
discolouration.
Prameha should be controlled.
Apakva Piḍakā -> Raktamokṣaṇa / Jalaukāvacharaṇa
Pakva Piḍakā -> Pāṭana & Vraṇa Chikitsā
Nyagrodhādi Gaṇa Kaṣāya with Gomūtra is administered internally.
Āragvadhādi Gaṇa Kaṣāya should be used internally and externally for Udvartana.
Mudgaparṇyādi Kvātha, Anantādi Kvātha
Prameha Piḍakāhara Lepa (Udumbara kṣīra & Bākuchī chūrṇa)
Gandhaka chūrṇa with Guḍa is taken internally; it cures 20 types of Prameha and 10 types of Prameha
Piḍakā.
Sārivādi Lauha (250-500 mg) with Madhu and Ghṛta is indicated in 10 types of Prameha Piḍakā, all types
of Ashas, and Tvak vikāra.
Sādhyāsādhyatā
Chikitsā
Dr Payal Sindel
24. Ayurvedic texts
describes the ulcers of diabetic patients as
‘Madhumehaj vrana
In Madhumeha ,the lower limbs vessels become weakened and unable to
expel
This leads to accumulation of doshas(meda and rakta along with other
Ayurvedic Perspective
Samprapti of diabetic ulcer
doshas.
dosha-dushyas)followed by formation of Prameha Pidika which converts into
wounds after purification i.e. Diabetic Ulcer.( This samprapti has been presumed
on bases of samprapti of madhumeha as prameha pidika is a complication of
madhumeha and they arecommonly found over lower limbs clinically.)
Prognosis:
During description of prognosis of vrana, Acharya Sushruta hasstated that
“madhumehaja vrana” i.ediabetic ulcers are kashtsadhya (difficult or management).
Further, Sushruta
specified that the wounds over the lowerlimbs too delays its healing.
Dr Payal Sindel
25. Leech therapy (Jalauka avacharan) has been mentioned as a type
of bloodletting ( Raktavsechan ).It is aneffective, safer and non-
surgical way ofblood-letting and can be used in children,females,
pregnant patients and elderly7
Leech therapy
References of Leech Therapy in wounds
Sushruta has advocated that bloodletting by means of Leech can
bepractised in all inflammatory, suppurative and painful conditions to
relieve pain andinhibit suppuration including that ofdiabetic
ulcerative lesions8.Sushrutafurther describes that in case of
diabetes, ifsanshodhan is not done,the doshas get
aggravated ,vitiates blood and muscles andproduce swelling or other
complications.
The treatment prescribed for swelling anvene-puncture should be
done. If these are
not done, the swelling increases greatly,give rise to pain and burning
sensation,then it should be treated by sharpinstruments followed
by treatment ofwound
Dr Payal Sindel
26. Vrana Shodhak Effect: expulsion of impure blood leads to removal of
local vitiated doshas (dushit rakta ,toxins,metabolites ,etc).
Vrana Ropan: fresh blood supply is facilitated which promotes healing
andhealthier, newer tissues.
Madhumeha Pacifying Effect: Bloodletting with leech applicationpacifies
madhumeha i.e. it breaks thepathogenesis at cellular level andinhibition
of infection, thus promotes wound healing(in diabetes, the tissues
areglucose laden which promotes propensityof bacteria to multiply).
Leech therapy
Probable Mechanism of Action of LeechTherapy
Leech application improves blood circulation and reduces congestiondue to
presence of carboxy-peptidase-A inhibitor, histamine like substances andAch;
thus it corrects Diabetic Microangiopathy.It has peripheralvasodilator effect
due to presence ofvasodilator constituent in saliva, whichimproves blood
circulation and correctsischaemia due to diabetic atherosclerosis.Ithas anti-
inflammatory action on nerves,hence corrects diabetic neuropathy.
Probable Mechanism of Action of LeechTherapy (Ayurvedic Perspective)
Dr Payal Sindel
27. M. Sriram bhatt,:SRB’s manual of surgery 4th edition
Boon Nicholas A., Colledge Nicki R., Walker Brian R.: Davidson’s principles and
practice of medicine
Charak Samhita , By Dr BrahmaNand Tripathi , Chaukhambha Surbharati
Prakashan ,Var anasi
Kaviraj Ambikadatta Shastri. Sushruta Samhita, Varanasi, Chaukhambha
Sanskrit Sansthan,
Vagbhata, Astanga Hridayam (Vidyotani Hindi commentary of Kaviraj Atrideva
Gupta).
International Journal of Applied Ayurved Research ISSN: 2347- 6362
WIKIPEDIA
REFERENCES
1.
2.
3.
4.
5.
6.
7.
Dr Payal Sindel