Members do not see these Ads. Sign Up.

Hi

whilst on placement I cam across something new and I was wondering if I could get your views on this.

The patient is a male late 30's who has a neuropathic ulcer to the heel. This has been on going for best part of a year, with it showing signs of improvement then deteriorating again. The patient, is a smoker and type 2 diabetic, with not the best self control with regards to diet etc.

He has been in for debridement twice a week and re dressings, but is also under the care of a local orthopaedic consultant. Now this consultant has decided they do not want the wound debrided at all, until their next appointment with them (around 7 weeks). The podiatrist has gone along with this, despite not being happy with the decision. I saw the patient again more recently and his ulcer seems to have gotten a lot worse, with bleeding under the callus as well as the area being very dry.

The podiatrist at this point offered debridement, but the patient has refused as he wants to go with his consultants advice. The consultant has also failed to reply to emails or any other form of contact.

Now from what I have read, debridement seems to be a major part of neuropathic ulcer management, so im intrigued by the consultants decision.

Has anyone experienced this before, if so could you shed light on their decision and how you would manage this situation.

kind regards

ben

 

Sounds odd to me, all literature and experience indicates frequent debridement and offloading of the affected area plus consideration of the consequences of infection and the appropriate action to be taken. I.E. leaving the wound undebrided would increase the potential for critical colonisation and infection by contaminating microbes.

Dave