Diabetic Wounds Care and Healing

If you have a wound or cut that is taking too long to heal, or your wounds and cuts easily get infected, it could be one of the signs of diabetes(“Slow Healing of Wounds and Cuts – Causes and Treatment,” n.d.). In diabetes, there is decreased sensation due to neuropathy (damaged nerves). Thus the person is more prone to various wounds and inability to see or feel them early. In fact, diabetes is one of the leading causes of chronic ulcers on foot, gangrene, leading to amputation in a significant number of cases.A person with diabetes has 15 times higher chances of amputations(“Diabetes and Amputation,” n.d.). Thus wounds in diabetes require special attention and care.

Why wounds heal slowly in diabetes?

In a diabetic person, wounds heal slowly due to the presence of many reasons at the same time. People with diabetes have poor blood circulation to some parts, and blood is essential for healing. Due to poor blood circulation, there is decreased in the flow of oxygen to the wound, which is critical to quick healing. People with diabetes have reduced sensation. Thus they may notice the injury late, and it also slows down healing. Increased blood glucose also increases the chances of infection and suppresses the local immunity. Once the bacterial or fungal infection has infected the wound or cut, it becomes challenging to treat(“Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy : Figure 1,” n.d., “Slow Healing of Wounds and Cuts – Causes and Treatment,” n.d.).

Diabetic wounds treatment and care

Timely wound care in people with diabetes is vital, due to high chances of getting slow healing wound and having much greater chances of foot amputations. One fourth of people with diabetes would at least once in their lifetime suffer from such problem, and around 12% of people with diabetes in the long term go through foot amputation(Greer et al., 2012a). Thus, will your wound heal quickly or lead to chronic infection or even worse to amputation depends on how early you seek medical care.

With proper care and medical treatment,most of these wounds would heal promptly(Zimny, Schatz, & Pfohl, 2002). Lots of methods used in wound healing and care are similar to what are used in non-diabetics. Several advanced techniques are emerging which are reserved for the cases when a wound fail to heal by using traditional methods, called advanced therapies in diabetic wound care, which would be discussed in the next section of the article.

For proper treatment, first one has to identify the reason of injury, which is helpful both for treatment and future avoidance of any such problem. One has to understand if the wound is due to poor blood flow or is rather due to sensory loss. Quite often it may be caused by a combination of both(“6 Key Factors in Treating a Diabetic Wound,” 2016).

One of the most important steps in wound care is called debridement. It is a term used for removal of dead and infected tissues from the wound,which is necessary to promote the quick healing of the wound. It can be done by using the surgical methods or using various enzymes and medicaments. In fact, some doctors even experimented with maggots (kind of insect larva), though this approach is not widely used for reasons well understood(Alexiadou & Doupis, 2012).

Another important thing to do, especially in foot ulcers is called offloading. Which means removing the pressure from the area of wound or ulcer, it accelerates the healing processes. The doctor may choose various options from removing the pressure from wound area; it could be a temporary use of plaster to using special shoes(Dg & La, 1998). In some cases, the doctor may also recommend keeping the foot at a higher place and giving it more rest, to decrease edema (especially in venous ulcers). The doctor may recommend special procedures to improve blood flow towards the wound, in the case when the artery is blocked; procedure maybe needed to open it(Greer et al., 2012a).

Next step to wound care is choosing and applying the right kind of medications and dressings. They are targeted at controlling the infection, and quick wound healing. There are many factors which are taken into consideration when choosing a dressing, and is best done by the specialist, as maintaining the proper moisture balance of wound is highly essential for quick healing(“6 Key Factors in Treating a Diabetic Wound,” 2016). Choice of dressing will depend on factor like how much is wound infected, the quantity of dead tissue, its debt and location, there are tens of different kinds of dressings to choose from(Kavitha et al., 2014).

Last but the most important thing to remember is the need of tight blood glucose control in cases of diabetic wounds and ulcers. Whether pressure causes them, trauma or surgery, accurate control of blood sugar levels have shown to make a marked difference in the quick healing of wounds(Rubinstein & Pierce, 1988; Saad et al., 2008).

Advanced therapies in diabetic wound care

In this section, we will introduce some advanced approaches towards diabetes wound care. One has to understand that the choice of these methods is made by a specialist, and they are mostly reserved for refractory, difficult to heal wounds. These methods are not equally effective in all the cases,and the list of these methods is also increasing, thus contributing to better outcomes.

Growth factors: they help in faster healing and resolution of infection(Alexiadou & Doupis, 2012).
Bioengineered skin substitutes:they are considered to be useful in particular kind of wounds(Alexiadou & Doupis, 2012).
MMP modulators: they help to maintain the balance between construction and destruction of extracellular matrix(Alexiadou & Doupis, 2012).
Hyperbaric oxygen therapy (HBOT) and Ozone-Oxygen therapy: they have shown to accelerate wound healing in particular cases(Greer et al., 2012b; Lipsky & Berendt, 2010).
Phototherapy or laser therapy: still an experimental treatment, but can be useful in some cases(“Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy : Figure 1,” n.d.).

Wound prevention and diabetes

When it comes to health, Prevention is better than cure. For wound prevention, check your feet regularly, keep them moist, if you have deformities, then buy the shoes accordingly to avoid the pressure sores and ulcers.

Keep sugar in check and regularly get tested for the neuropathy (loss of sensation). Avoid walking barefoot. If some wound has developed, keep it clean and change dressing frequently. Treat fungal infections on time and develop good foot and wound care habits(“13 Tips for Healthy Feet,” n.d., “Diabetic Wound Care | Foot Health | Learn About Feet | APMA,” n.d.; Armstrong & Lavery, 1998).

References

6 Key Factors in Treating a Diabetic Wound. (2016, February 29). Retrieved May 26, 2017, from https://www.advancedtissue.com/6-key-factors-in-treating-a-diabetic-wound/
13 Tips for Healthy Feet. (n.d.). Retrieved May 26, 2017, from http://www.diabetesforecast.org/2014/07-jul/13-tips-for-healthy-feet.html
Alexiadou, K., & Doupis, J. (2012). Management of Diabetic Foot Ulcers. Diabetes Therapy, 3(1). https://doi.org/10.1007/s13300-012-0004-9
Armstrong, D. G., & Lavery, L. A. (1998). Diabetic Foot Ulcers: Prevention, Diagnosis and Classification. American Family Physician, 57(6), 1325.
Dg, A., & La, L. (1998). Evidence-based options for off-loading diabetic wounds. Clinics in Podiatric Medicine and Surgery, 15(1), 95–104.
Diabetes and Amputation. (n.d.). Retrieved May 26, 2017, from http://www.diabetes.co.uk/diabetes-and-amputation.html
Diabetic Wound Care | Foot Health | Learn About Feet | APMA. (n.d.). Retrieved May 26, 2017, from http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=981
Greer, N., Foman, N., Dorrian, J., Fitzgerald, P., MacDonald, R., Rutks, I., & Wilt, T. (2012a). Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial Ulcers: A Systematic Review. Washington (DC): Department of Veterans Affairs. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK132238/
Greer, N., Foman, N., Dorrian, J., Fitzgerald, P., MacDonald, R., Rutks, I., & Wilt, T. (2012b). EXECUTIVE SUMMARY. PubMed Health. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0054962/
Kavitha, K. V., Tiwari, S., Purandare, V. B., Khedkar, S., Bhosale, S. S., & Unnikrishnan, A. G. (2014). Choice of wound care in diabetic foot ulcer: A practical approach. World Journal of Diabetes, 5(4), 546–556. https://doi.org/10.4239/wjd.v5.i4.546
Lipsky, B. A., & Berendt, A. R. (2010). Hyperbaric Oxygen Therapy for Diabetic Foot Wounds. Diabetes Care, 33(5), 1143–1145. https://doi.org/10.2337/dc10-0393
Rubinstein, A., & Pierce, C. E. (1988). Rapid healing of diabetic foot ulcers with meticulous blood glucose control. Acta Diabetologica Latina, 25(1), 25–32.
Saad, E., Shwaihet, N., Mousa, A., Kalloghlian, A., Afrane, B., Guy, M., & Canver, C. (2008). Tight blood glucose control decreases surgical wound infection in the cardiac surgical patient population in the ICU. Critical Care, 12(Suppl 2), P150. https://doi.org/10.1186/cc6371
Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy : Figure 1. (n.d.). Retrieved May 26, 2017, from https://www.hindawi.com/journals/tswj/2014/398412/fig1/
Slow Healing of Wounds and Cuts – Causes and Treatment. (n.d.). Retrieved May 26, 2017, from http://www.diabetes.co.uk/symptoms/slow-healing-of-wounds.html
Zimny, S., Schatz, H., & Pfohl, M. (2002). Determinants and estimation of healing times in diabetic foot ulcers. Journal of Diabetes and Its Complications, 16(5), 327–332.

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