IntroductionA wound by true definition is a breakdown in the protective function of the skin. It is important to treat wounds as soon as it happens as improper wound care management may lead to a serious infection especially for diabetic patients. Diabetes is a metabolic disease which disrupts normal wound healing mechanism.
Hence, it is especially crucial to treat foot injuries right away as it could turn into terrible foot ulcers and may even cost a leg. According to Abdelatif, Yakoot, and Etmaan (2008), foot ulcers necessitate more hospital admissions that any other complication of diabetes, and are the main risk factor for non-traumatic lower extremity amputations of which up to 60% occur in patients with diabetes. Self care is necessary for diabetes everyday and if complications arise, diabetes can significantly influence quality of life and increase morbidity.
The purpose of this review is to analyse the proper wound care management techniques and dressings in diabetics foot ulcer. As nurses, we need to be educated in this area as we are the first line of care for patients and should be well-versed in treating as well as managing wounds and wound infections so as to prevent any further complications from arising. Causes of Diabetic Foot UlcersHaving diabetes means that you have high blood glucose levels. Elevated levels of blood glucose causes the arteries to harden and thins the blood vessels, restricting the delivery of blood and oxygen to the body needed to support its natural healing abilities. Due to diabetes, your nerves will get damaged. Thus, when you hurt your feet, you may not even feel it.
This is called neuropathy. A small cut, blister or even a stone in the shoe will go unnoticed and untreated. Apart from that, diabetes can slow a person’s immune system, which affects the body’s ability to send white blood cells to fight bacteria in an infected wound, worsening it and resulting in diabetic foot ulcers (UnityPoint Health, (2014, October 27). Top 5 Causes of Non-Healing Diabetic Foot Ulcers And How to Prevent Them)Local Signs and Characteristics of Wound Infection and Diabetic Foot UlcersIn the pilot randomized, controlled study done by Tsang, Kwong, To, Chung, and Wong (2017), Infectious Diseases Society of Singapore (IDSA) and International Working Group on Diabetic Foot (IWGDF) classification of diabetic foot infection was used. Five categories which are perfusion, depth or loss of tissue, infection, extent or size, and sensation or neuropathy were identified. The examination is further value added by the prospective, observational study done by Truchetet, Guibon, and Meaume (2012) where wounds were systematically checked for ten local signs compatible with wound infection mainly abscesses, purulent or copious wound exudate, increase in local warmth, pain between dressing change, delayed wound healing, oedema, lymphangitis or satellite adenitis. The condition of wound were also assessed by analysing the wound’s largest axis, and odour. Comparing both of the studies, the similarities in characteristics between wound infection and diabetic foot ulcers would be the delayed wound healing, and size of wound.
Types of Dressings that are Effective in Managing Wound Infections and UlcersBased on Abdelatif’s et al. (2008) prospective non-randomised open-label pilot study where a new ointment prepared from natural royal jelly and panthenol in an ointment was used in treating diabetic foot infections in a sample size of consecutively selected 60 participants, 96% responded well to the treatment within a 6 month follow up period, with all ulcers closing completely. No ulcer recurrences were reported in these patients. Ulcers were graded by the Wagner scoring system:Grade 1: Superficial Diabetic UlcerGrade 2: Ulcer extensionInvolves ligament, tendon, joint capsule or fasciaNo abscess or OsteomyelitisGrade 3: Deep ulcer with abscess or OsteomyelitisGrade 4: Gangrene to portion of forefootGrade 5: Extensive gangrene of footThe ointment used in the Abdelatif’s et al. (2008) study promoted healing by creating an alkaline environment in the wound, while the antimicrobial, immunomodulating and nutritional properties of royal jelly and panthenol help eradicate infection and promote healing. This is further reinforced by Tsang’s et al. (2017) study on 31 participants, chosen through stratified sampling, where the clinical effectiveness of different types of dressings, Manuka honey being one of them, were investigated. In terms of proportion of complete wound healing by the end of 12 weeks, Manuka honey was in second place with a percentage of 50%, with an 86.
24% of ulcer reduction rate and a decreasing trend in bacteriology, whereas conventional dressing was in last place.However, nanocrystalline silver (nAg) was the most effective in healing diabetic foot ulcer with a score of 81.8% and an ulcer reduction rate of 97.45%. This is further supported by Trebuchet’s et al. (2012) prospective observational study on 794 patients where local tolerability was reported as ‘excellent’ in 97% of patients and 98% of the time, investigators judged their overall satisfaction with their silver releasing dressing’s performance as ‘good’ or ‘very good’. This could be due to nAg’s unique antibacterial action through anchoring to the bacterial cell wall, causing structural damage altering the membrane permeability.
It’s anti-inflammatory properties which also potentially aids in healing foot infections (Tsang, et al., 2017).The number of participants in Tsang’s et al. and Abdelatif’s et al. studies were small, 31 and 60 people respectively, and this could be a hindrance to the reliability of the results. In my opinion, a larger sample size, perhaps more than 100, would have been a more preferable option in judging the effectiveness of the different types of dressings as there would be narrower margin of errors and greater level of confidence in outcomes and results. Hence, this is something that could be improved on in the future.
ConclusionI have discovered that there are more ingenious ways in which we can treat diabetic foot ulcers or wounds in general. Studies above has been useful in providing wound care management methods and ideas in which we could use to improve our dressings in order to benefit the good of mankind and the healthcare sector. The outcomes of the studies have shown that silver dressing and honey are invaluable and helpful in facilitating the healing of wounds. Hence, we should implement aspects of such material slowly into our sterile dressings instead of the usual hydrocolloid, hydrogel, alginate, and collagen dressings. Silver-based or honey-based dressing would prove meaningful and more effective in restorative factors of wounds in general.