DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
K. Provide Local Wound Care; Offload Pressure and Weight, As Indicated
OBJECTIVE
Provide care of an uncomplicated minor lesion.
RECOMMENDATIONS
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
1. Patients with diabetes with uncomplicated minor lesions should receive local wound care. Primary care
providers should attempt to offload weight-bearing on the affected extremity.
2. Patients with diabetes with uncomplicated minor lesions must be followed at least monthly.
DISCUSSION
The following are simple guidelines for the care of uncomplicated minor lesions:
• Provide local wound care: cleanse wound with saline, remove necrotic and callus tissue, apply appropriate
dressing, and other indicated treatments.
• Offload pressure and weight, as indicated: consider lesion site and then provide pressure relief (e.g.,
special shoes and insoles and bed rest). To avoid further trauma to the lesion site, use a post-operative
shoe, offloading, or depressurization footwear based on the lesion site(s).
• Follow-up on a specified schedule: VA facility specific patients with active lesions need to be followed at
least monthly.
• Review the Self-Management and Education Module (Module S): reinforce nutrition, exercise and diabetes
self-management. Avoid initiation of a calorie restriction diet for weight loss in patients with foot lesions.
• Provide patient and family education.
• Refer for foot care assistance, as needed, for patients unable to carry-out local wound care. Educate a
family member on local wound care or refer the patient to a home health service.
EVIDENCE
Recommendation Sources LE QE SR
1 Local wound care. ADA, 2000
III Poor I
Brodsky, 1991
Caputo et al., 1994
Eckman et al., 1995
LE-Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation (see Appendix A).
L. Has Wound Healed Within 4 Weeks?
OBJECTIVE
Determine appropriateness of the treatment outcome.
RECOMMENDATIONS
1. Patients with diabetes treated for an uncomplicated wound should be assessed within four weeks from the
initial wound assessment for appropriate reduction in lesion size and depth and appearance of healthy
granulating tissue with no evidence of infection.
EVIDENCE
Recommendation Sources LE QE SR
1 Assessment of wound healing
progress within 4 weeks.
ADA, 2000 III Poor I
LE-Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation (see Appendix A).
Module F – Foot Care Page 104