title: Wound-healing protocols for diabetic foot and pressure ulcers.
abstract: Diabetic foot and pressure ulcers are chronic wounds by definition. They share similar pathogeneses; i.e., a combination of increased pressure and decreased angiogenic response. Neuropathy, trauma, and deformity also often contribute to development of both types of ulcers. Early intervention and proper treatment should result in complete healing of non-ischemic diabetic foot and pressure ulcers, as defined by 100% epithelialization and no drainage (if no osteomyelitis is present). The authors developed the following paradigm, which has proved to be highly effective for complete healing of these wounds: 1) recognition that all patients with limited mobility are at risk for a sacral, ischial, trochanteric, or heel pressure ulcer; 2) daily self-examination of the sacral, ischium, buttocks, hips, and heels of all bed-bound patients and the feet of patients with diabetes with risk factors (e.g., neuropathy); 3) initiation of a treatment protocol immediately upon recognition of a break in the skin (i.e., emergence of a new wound); 4) objective measurement by planimetry of every wound (at a minimum, weekly) and documentation of its progress; 5) establishment of a moist wound-healing environment; 6) relief of pressure from the wound; 7) debridement of all non-viable tissue in the wound; 8) elimination of all drainage and cellulitis; 9) cellular therapy or growth factors for patients with wounds that do not heal rapidly after initial treatment; and 10) continuous physical and psychosocial support for all patients. If this paradigm is followed, most diabetic foot and pressure ulcers are expected to heal.
authors.affiliation: Wound Healing Program, Angiogenesis and Wound Healing Laboratory, The Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Brem
authors.forename: Tom
authors.initials: T
authors.lastname: Jacobs
authors.forename: Loretta
authors.initials: L
authors.lastname: Vileikyte
authors.forename: Sarah
authors.initials: S
authors.lastname: Weinberger
authors.forename: Mark
authors.initials: M
authors.lastname: Gibber
authors.forename: Kiran
authors.initials: K
authors.lastname: Gill
authors.forename: Alina
authors.initials: A
authors.lastname: Tarnovskaya
authors.forename: Hyacinth
authors.initials: H
authors.lastname: Entero
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000208:Acute Disease; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001684:Biological Dressings; D001691:Biological Therapy / Q000379:methods; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D003668:Pressure Ulcer / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000890:Anti-Infective Agents