Question

Diabetics with poor lower limb circulation often have slow-healing pressure ulcers on the bottom of their feet. In speeding up the healing process, surgical removal (debridement) of dead tissue from an ulcerative area would encourage increased __________.

Answer 1

Explanation:

The treatment of ulceration in the foot of diabetic patients should initially be directed against their cause, specifically against pressure. The relief of plantar pressure can be achieved with bed rest and avoiding as much as possible supporting the foot.

 

In addition to pressure relief, the ulcer should be debrided regularly, with the removal of all callus and non-viable tissue formed around the ulcer. This facilitates the formation of a wound with healthy granulation tissue that heals from the base and not merely from the edges

 

In case of evidence of vascular insufficiency, the patient should be sent to a vascular surgeon for evaluation. This is particularly important in the absence of signs of healing after 6 weeks. X-rays should be performed to evaluate the foot early in the course of the ulcer and repeated if clinically indicated, due to lack of cure or presence of a deep infection, to detect an osteomyelitis disorder.

The usual attitude is to establish antibiotic treatment with the slightest clinical suspicion of infection. It is likely that the ulcer is colonized by multiple microorganisms, some of which are probably the real cause of an invasive infection, so the wound smears they usually provide little benefit Broad-spectrum antibiotics with aerobic and anaerobic coverage are required, including streptococci and staphylococci, such as amoxicillin-acidoclavulanic, clindamycin or ciprofloxacin (although the latter has poor antistaphylococcal coverage and limited antistareptococcal, penetrates tissues perfectly)