"Ideal" treatment for foot ulcers?

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I am a graduate student conducting research into the market for wound healing therapies for diabetic foot ulcers. I'm trying to determine if there is treatment that is considered ideal among those that specialize in this area. If such a treatment does not exist, could you charaterize what an ideal treatment would look like to you.

Thank you in advance for any assistance.

Crista Gallagher

 

I remember we r told to choose the product based on the characteristics of the wound Like moisture lv , infection sign erc so I suppose there is no ideal tx dressing for a diabetic Ulcer rather individual case?

 

Neuropathic ulceration ideal treatments:

1. Offload
2. Offload
3. Offload

 

What Ian said

 

Agree that offloading is priority. Would also add swab and sharp debridement of non-viable tissue.

 

After thirty two years of experience, I would say, debtors, clean with spirit, then swab with gentian violet (crystal violet an aniline dye used for millennia) Sterile, dry dressing. See after two weeks, and be amazed.

 

After thirty two years of experience, I would say,deb ride with spirit, then swab with gentian violet (crystal violet an aniline dye used for millennia) Sterile, dry dressing. See after two weeks, and be amazed.

 

Pressure deflection using semi compressed felt is always my method. You can add topical agents if required and a dressing over the top. I've used this on patients who've been treated by nurses unsuccessfully for months even years, and I often see complete healing within six weeks.

 

1. Good arterial supply or venous return for venous ulceration ( not within our control really)
2. Good blood glucose control
3. Offloading/pressure relief
4. Patient Compliance (are we allowed to say that these days)
5. Good wound care management ie: appropriate dressings etc
6. Good GP/Consultant involvement medication - abx, control of immunosuppressant drugs etc
7. Consistency amongst multi-dsciplinary approaches

blah blah... could go on an on really

 

4 pieces of guidance issued in 2011

• NICE CD119 management in hospitals
• NICE Quality Standards Programme
• New QOF targets
• National minimum skills framework

Important to keep up to date with guidance as it is used as a baseline in litigation

QOF targets now include risk assessments – Low, increased and high risk

You may also want to check out
WWW.FOOTINDIABETES.ORG

 

My top 12, in no specific order except for the first one, are:

Offloading
Multi-disciplinary working, including patient and/or carer
Early, and appropriate, referral
Vascular assessment (if necessary)
Neurological assessment
Identification and management of infection
Optimal blood glucose control
Appropriate dressing for wound bed status/exudate/infection
Consistency amongst multi-dsciplinary approaches
Education of Health Care Professionals
Education of patients and/or carers, AND finally
DO NO HARM


Regards
Sandra J

 

Should also have said :

Number 13 should be good communication between all involved in the care of the patient with a foot ulcer.

sandra J

 

All the above and i also use Bactgras.

 

How can you be certain that your off loading is enough and hasn't put too much force to another area? just maybe moving and possibly creating another potential problem.

l dont know that l have the answer either, but l feel confident by using an in-shoe pressure measurement system to see what l have or have not done with the use of TCO's and rocker soles.

By using this in-shoe measuring system(Fscan) l am able to check & correct things if need be before they leave the clinic.

 

Ditto to Ian G and prontosan wound gel/irrigation, excellent deslougher/wound healer!