How do diabetic foot ulcers develop?
Over the years, poorly controlled diabetes mellitus can often lead to nerve damage and/or serious circulation problems. The result: the development of foot lesions.
Neuropathy
Damaged nerves cause numbness and a reduced ability to feel pain, heat or cold. Pressure points, e.g. due to shoes which are too tight, remain unnoticed.
Furthermore, nerve damage changes the patient’s gait. The forefoot bears more of the body’s weight and is susceptible to pressure sores.
Angiopathy
Increased blood glucose levels ultimately may cause calcification, and thereby obstruction of the arterial and capillary vessels (macro-/microangiopathy). This results in an inadequate supply of nutrients and oxygen to the depending tissue with the risk of developing necroses.
In addition to local wound management arterial surgery may be appropriate.
Why is it so important to control infection?
As a rule, frequent susceptibility to infections is an indication for “undiscovered” diabetes. Even if this disease has been diagnosed, particular attention should be paid to infections. This is due to the weakened immune system of diabetics which is further acerbated by poor blood circulation due to angiopathies: the poorly circulated skin becomes porous and can be penetrated by bacteria and fungi. The result is infections which can spread quickly without thorough treatment.
What are the specific challenges of diabetic wounds?
A differentiation is generally made between two wound types for the wound care of diabetic foot ulcers. Both must be individually treated by the wound manager.
Pre-OP wounds
Wound healing complications are all too common amongst diabetic patients. Impaired wound healing and the increased number of infections impede the healing process. Modern therapies offer innovative and effective solutions – e.g. bacteria-binding dressings which attract and remove bacteria and fungi and help reduce the bacterial load.
Post-OP wounds
If gangrene or a deep ulcer have developed and there is a certain risk of spreading infection, then surgical intervention can no longer be avoided. The subsequent wound treatment is then based on the wound healing phases. At the same time, it must be ensured that the wound area is not subjected to any pressure at all.
