the wound scab-friend or foe

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Debridement of the wound was recently discussed or answered in this forum and it reminded me of the question ,Is the wound scab a friend or foe ? All the evidence and opinion is for debridement of the diabetic foot wound being necessary to speed healing. I remember a diabetic patient with wound on apex of toe,with bone visible, which would not heal despite frequent debridement and application of cadexomer iodine. The debridement was mostly of the cadeomer iodine crust that was formed. After a few weeks of failiure i decided to leave the crust in place for a few weeks and finaly decided to remove the crust and found that the toe was healed.
The theory is that such a crust or scab when left in place will slow healing. my message from this is that slow healing is better than no healing,as long as the scab is not weight bearing or is thick.

 

I believe that the reapplication of cadexomer iodine post debridement hindered the communication of the healthy cells to initiate the full healing cycle. Was the wound infected? I'm glad to hear the toe healed.

 

Hi Jakbennet -thanks for taking interest in my post. I used cadexomer iodine over many years and found no detrimental effects. where it did not work there was usually a vascular or infection or mechanical stress reason to be addressed. in this case at the apex of the toe there was probably peripheral vascular problem which was compounded by the fact that it was down to non-infected bone. the literature over many years has changed its mind about iodine of course -does its toxic effect outweigh its antimicrobial effect . my experience puts me firmly in favor of various forms of iodine in various forms

 

I too agree that cadexomer iodine does a great job in reducing the microbial burden. It's so hard to comment without seeing the wound. I almost hesitate to mention it. I too often see patients who have been serially treated for infection either topically or orally for a non-healing wound - long after all evidence of infection is gone. Your suspicion of vascular damage is all too common and it reminded me of a pitch from a vascular surgeon I saw lecture at a conference last summer "every vascular surgeon should have a podiatrist on speed dial and visa versa."

 

Hi Jak bennet
the opinion that surgeons and physicians dealing with Diabetic foot problems should have a podiatrist/chiropodist to hand was established at Kings College hospital as far back as 1986(a Landmark study) when they demonstrated in a admittedly small scale study that such multidisciplinary working reduced amputations by 50%. 3 years later the St vincent decleration called for health services in all countries to organize to achieve this. This work by professor Mike Edmunds was one of many studies to make him world famous in this field. Many studies woere produced with him working together with Leading british podiatrist Ali Foster (now deceased). One of my favorite studies in the British medical journal described that Arterial calcification was usually present in the presence of severe neuropathy.(march 82).
I suspect you are communicating from USA where things maybe are not organised this.
Warm Regards
Peter Evans