Local wound care in the diabetic.
Since wounds in patients with diabetes will heal slowly at best, and since they are so much more susceptible to infection and the infection will be more devastating, the old adage of "first do no harm" must be adhered to. Diabetics have poor circulation, poor resistance to infection, and poor local nutrition. Their white blood cell killing power is decreased by the hypoxia from poor circulation and by the periodic hyperglycemia. The periodic hypoglycemia and decreased insulin interferes with the energy for healing and for host defenses. Because of this poor healing and low resistance, the use of strong, toxic chemicals should be avoided. They all inhibit healing and/or increase the risk of infection. Vigorous, repeated debridement of necrotic, devitalized tissue along with old blood, exudates, and tissue fluids is essential. This includes sharp debridement and mechanical debridement through high-pressure irrigation and frequent wet to dry fine mesh gauze dressings. The choice of bandaging material should be determined by the desired action on the wound, such as protection, debridement, and so on. The idea is to restore the conditions in the wound to normal physiology.
D001207:Asepsis; D001458:Bandages; D003646:Debridement / Q000379:methods; D003920:Diabetes Mellitus / Q000503:physiopathology; D005534:Foot Diseases / Q000628:therapy*; D006801:Humans; D014945:Wound Healing; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*