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Diabetes limb loss 'unnecessary'

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Mar 29, 2006.

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  1. NewsBot

    NewsBot The Admin that posts the news.


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    The BBC are reporting:
    Diabetes limb loss 'unnecessary'
    Full story
     
  2. Cameron

    Cameron Well-Known Member

    Netizens

    I have a typeII diabtetic patient who has recently bumped the end of his foot against a step. The resultant lesion became infected and ulcerated. The infection has since cleared but the trophic ulcer on the apex of the great toe is now reached stasis with sloughpreventing healing. The ischaemic specialist wants to amputate and will decide in four weeks depending on what we can do meantime.

    The lesion is currently debrided and washed with 0.9% sodium chloride solution and dressed with a dry sterile dressing. Reviewed every two days.

    Any suggestions ?

    Thank you in anticipation

    Cameron
     
  3. Erp

    Erp Member

    Preventing amputation

    This could become a long answer, but I will try to keep it brief.
    1. Complete assessment of neurovascular status: have they had ABI's and TBI's, this will indicate whether debridement of slough is viable. If they have critical limb ischaemia it is best left to the vascular surgeon to revascularise or amputate.
    2. If vessels are patent, I would then check the cause: could more pressure from foowear be prevention healing: we now go to a CAM walker or air walker to completely off load the forefoot pressure, otherwise the open toed post op shoe could be a temporary option.
    3. Dressings for this type of would wound involve a desloughing agent: a hydrogel such as intrasite gel or solosite gel(smith & nephew) would break this down if you can't debride it with a scalpel. We would then apply an absorbing dressing such as a foam (allevyn or biatain) to absorb exudate and protect the area. Secure with hypafix tape or whatever the patient is not allergic to.
    4. Educate the patient until they can repeat back what you have told them and have it all written down as they can show carers, nurses, etc to confirm the treatment required.
    5. If not already done, swab the wound and check for microbes which could delay healing even if the wound is not showing signs of clinical infection, it could be colonised.

    This is the tip of the iceberg, but it's important to communicate with all parties involved to ensure best practice and prevent the amputation.
    The international consensus on the diabetic foot is a great reference to use for supporting what you are doing and why.
    www.iwgdf.org

    Good luck!
    ERP.
     
  4. Cameron

    Cameron Well-Known Member

    Many thanks ERP and I will keep you posted of developments

    Cameron
     
  5. Tuckersm

    Tuckersm Well-Known Member

    Cameron,

    We have found the use of Cadexomer Iodine very useful in desloughing areas

    more info from Smith & Nephew
     
  6. Cameron

    Cameron Well-Known Member

    Cheers

    Cameron
     
  7. dbelyea

    dbelyea Member

    x-ray

    I would also send the pt off for bilateral x-rays, if not already done. There is always a chance of osteomyelitis, which will delay healing. Periostial reaction and bony destruction can take several weeks to show up on x-rays. It’s always good to have baseline films.

    If there is any doubt the pt should then be sent for technetium and labelled white cell bone scans.
     
  8. Cameron

    Cameron Well-Known Member

    Many thanks dbelyea and everyone else who has corresponded

    Cheers
    Cameron
     
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