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Extent/depth of ulcer debridement

Discussion in 'Diabetic Foot & Wound Management' started by B. Englund, Oct 19, 2008.

  1. B. Englund

    B. Englund Active Member


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    Hi

    I’m currently doing my senior-year clinical rotation and noticed big differences when it comes to diabetic foot-ulcer revision/debridement between the podiatric and orthopaedic profession. We as podiatrist tend to have a more “conservative” approach where we rather debride no more then necessary and have the patient come in for treatment more regularly meanwhile the orthopaedic clinicians have a more aggressive approach where they under LA debride with quite a big margin to the boarder of the ulcer.

    Is these differences universal or is it just coincidence that I have made this observations?

    I’m also wondering if there is any research made of the outcomes between different approaches?

    what do you say about the pros/cons of the different approaches

    Hope you all have a nice Sunday

    Björn Englund
    3:rd year student
    Karolinska Institute
    Stockholm. Sweden
     
  2. Byron Perrin

    Byron Perrin Member

  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    In my experience, most podiatrists are very timid and shy with surgical debridement of wounds. This is most likely because they have had next to no (surgical) training on how to do this safely and appropriately in an outpatient setting, and are more use to thinking in the midset of debridement of hyperkeratosis.

    The link to the excellent CLEAR instructional video should be an absolute must for any podiatrist to become familiar with. It is a quick, simple chairside procedure that is essential for all neuropathic, and most vascular, wounds.

    Appropriate sharp wound debridement should be a core fundamental skill that all podiatrists have, but very few do.

    This is why you will see this generally done much better (and more aggressively) by an orthopaedic or vascular surgeon.

    LL
     
  4. Lee

    Lee Active Member

    This is highly dependant on where you work and your experience. It is my experience that podiatrists provide the most appropriate debridement from clinic to surgery. It's also dependant on the medical and vascular status of the patient, but the video's alright as an illustration for debriding a neuropathic ulcer - although they don't seem to bother about the base of the ulcer for some reason?

    Locally, nearly all diabetic foot surgery is performed by podiatric surgeons and the orthopods are happier to scope knees and reconstruct ACL's, while vascular's always on hand for angioplasties.

    :cool: :butcher:
     
  5. Tuckersm

    Tuckersm Well-Known Member

    While I tend to agree that agressive debridement is better, the evidence is not yet there.

    From
    A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes
    R. J. Hinchliffe et.al
    Diabetes Metab Res Rev 2008; 24(Suppl 1): S119–S144


     
  6. heleneaustin

    heleneaustin Active Member

    I have been treating a long standing, fortunately neuropathic, diabetic ulcer for some weeks now and i must admit when it first broke down and i started to debride it i was extremely worried as it seemed to me i was debriding flesh and deep tissues as well as highly vascular callus. The only thing that bothered me was how far do i go down with this debridement as i feel i could carry on quite easily to the bone. In fact i have stopped just short of this and begun to palliatively dress and pad with felt. The patient and the wound are responding well to this treatment and the wound has decreased in diametre and depth to 50% what it was. I would agree that not enough training is given to this area and i would have found it most beneficial to have seen an ortho or podiatric surgeon tackle the same, just to compare.
     
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