best practice guidelines: wound management in diabetic foot ulcers

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DFU WOUNDMANAGEMENTTABLE 5: Types of wound dressings availableType Actions Indications/use Precautions/contraindicationsAlginates/CMC*FoamsHoneyHydrocolloidsHydrogelsAbsorb fluidPromote autolyticdebridementMoisture controlConformability to wound bedAbsorb fluidMoisture controlConformability to wound bedRehydrate wound bedPromote autolyticdebridementAntimicrobial actionAbsorb fluidPromote autolyticdebridementRehydrate wound bedMoisture controlPromote autolytic debridementCoolingModerate to high exuding woundsSpecial cavity presentations in the form of ropeor ribbonCombined presentation with silver forantimicrobial activityModerate to high exuding woundsSpecial cavity presentations in the form ofstrips or ribbonLow adherent versions available for patientswith fragile skinCombined presentation with silver or PHMB forantimicrobial activitySloughy, low to moderate exuding woundsCritically colonised wounds or clinical signs ofinfectionClean, low to moderate exuding woundsCombined presentation with silver forantimicrobial activityDry/low to moderate exuding woundsCombined presentation with silver forantimicrobial activityIodine Antimicrobial action Critically colonised wounds or clinical signs ofinfectionLow to high exuding woundsLow-adherentwound contactlayer (silicone)Protect new tissue growthAtraumatic to periwound skinConformable to body contoursLow to high exuding woundsUse as contact layer on superficial low exudingwoundsDo not use on dry/necrotic woundsUse with caution on friable tissue (maycause bleeding)Do not pack cavity wounds tightlyDo not use on dry/necrotic wounds orthose with minimal exudateMay cause 'drawing' pain (osmoticeffect)Known sensitivityDo not use on dry/necrotic wounds orhigh exuding woundsMay encourage overgranulationMay cause macerationDo not use on highly exuding woundsor where anaerobic infection is suspectedMay cause macerationDo not use on dry necrotictissueKnown sensitivity to iodineShort-term use recommended (risk ofsystemic absorption)May dry out if left in place for too longKnown sensitivity to siliconePHMB Antimicrobial action Low to high exuding woundsCritically colonised wounds or clinical signs ofinfectionMay require secondary dressingDo not use on dry/necrotic woundsKnown sensitivityOdour control(eg activatedcharcoal)ProteasemodulatingOdour absorptionActive or passive control ofwound protease levelsMalodorous wounds (due to excess exudate)May require antimicrobial if due to increasedbioburdenClean wounds that are not progressing despitecorrection of underlying causes, exclusion ofinfection and optimal wound careSilver Antimicrobial action Critically colonised wounds or clinical signs ofinfectionLow to high exuding woundsCombined presentation with foam and alginates/CMC for increased absorbency. Also in paste formPolyurethane filmMoisture controlBreathable bacterial barrierTransparent (allowvisualisation of wound)Primary dressing over superficial low exudingwoundsSecondary dressing over alginate or hydrogelfor rehydration of wound bedDo not use on dry woundsDo not use on dry wounds or those withleathery escharSome may cause discolourationKnown sensitivityDiscontinue after 2 weeks if noimprovement and re-evaluateDo not use on patients with fragile/compromised periwound skinDo not use on moderate to high exudingwoundsOther more advanced dressings (eg collagen and bioengineered tissue products) may be considered for wounds that are hard to heal 94 .*Wound dressings may contain alginates or CMC only; alginates may also be combined with CMC.314 BEST PRACTICEBEST PRACTICEGUIDELINESGUIDELINES:FOR SKINWOUNDAND WOUNDMANAGEMENTCARE ININEPIDERMOLYSISDIABETIC FOOTBULLOSAULCERS
DFU WOUNDMANAGEMENTTABLE 6: Wound management dressing guideType of tissue in thewoundNecrotic, black,drySloughy,yellow, brown,black or greyDry to lowexudateSloughy,yellow, brown,black or greyModerate to highexudateGranulating,clean, redDry to lowexudateGranulating,clean, redModerate to highexudateEpithelialising,red, pinkNo to lowexudateInfectedLow to highexudateTherapeutic goal Role of dressing Treatment optionsRemove devitalisedtissueDo not attemptdebridement if vascularinsufficiency suspectedKeep dry and refer forvascular assessmentRemove sloughProvide clean woundbed for granulationtissueRemove sloughProvide clean woundbed for granulationtissueExudate managementPromote granulationProvide healthy woundbed for epithelialisationExudate managementProvide healthy woundbed for epithelialisationPromote epithelialisationand wound maturation(contraction)Reduce bacterial loadExudate managementOdour controlHydration of woundbedPromote autolyticdebridementRehydrate woundbedControl moisturebalancePromote autolyticdebridementAbsorb excess fluidProtect periwoundskin to preventmacerationPromote autolyticdebridementMaintain moisturebalanceProtect newtissue growthMaintain moisturebalanceProtect newtissue growthProtect new tissuegrowthAntimicrobial actionMoist wound healingOdour absorptionWound bedpreparationSurgical or mechnicaldebridementSurgical or mechanicaldebridement ifappropriateWound cleansing(consider antisepticwound cleansingsolution)Surgical ormechanical debridementif appropriateWound cleansing(consider antisepticwound cleansingsolution)Considerbarrier productsWound cleansingWound cleansingConsiderbarrier productsWound cleansing(consider antisepticwound cleansingsolution)Consider barrierproductsPrimarydressingHydrogelHoneyHydrogelHoneyAbsorbent dressing(alginate/CMC/foam)For deep wounds, usecavity strips, rope orribbon versionsHydrogelLow adherent (silicone)dressingFor deep wounds usecavity strips, rope orribbon versionsAbsorbent dressing(alginate/CMC/foam)Low adherent (silicone)dressingFor deep wounds, usecavity strips, rope orribbon versionsHydrocolloid (thin)Polyurethane filmdressingLow adherent (silicone)dressingAntimicrobial dressing(see Table 5 for combinedpresentations)SecondarydressingPolyurethane filmdressingPolyurethane filmdressingLow adherent(silicone)dressingRetention bandageor polyurethanefilm dressingPad and/orretention bandage.Avoid bandagesthat may causeocclusion andmaceration. Tapesshould be usedwith caution dueto allergy potentialand secondarycomplicationsThe purpose of this table is to provide guidance about appropriate dressings and should be used in conjunction with clinical judgement andlocal protocols. Where wounds contain mixed tissue types, it is important to consider the predominant factors affecting healing and addressaccordingly. Where infection is suspected it is important to regularly inspect the wound and to change the dressing frequently.Wound dressings should be used in combination with appropriate wound bed preparation, systemic antibiotic therapy, pressure offloadingand diabetic controlBEST PRACTICE GUIDELINES: WOUND MANAGEMENT IN DIABETIC FOOT ULCERS 15
Page 1 and 2: INTERNATIONAL BEST PRACTICEBEST PRA
Page 3 and 4: INTRODUCTIONIntroductionDFUs are co
Page 5 and 6: AETIOLOGY OFDFUsAetiology of DFUsTh
Page 7 and 8: ASSESSING DFUsFIGURE 5: Procedure f
Page 9 and 10: ASSESSING DFUsBOX 1: Signs of sprea
Page 11 and 12: DFU WOUNDMANAGEMENTDFU wound manage
Page 13 and 14: DFU WOUNDMANAGEMENTHydrosurgical de
Page 15: DFU WOUNDMANAGEMENTantimicrobial ag
Page 19 and 20: DFU WOUNDMANAGEMENTexclusion of inf
Page 21 and 22: Integrated care approachINTEGRATEDC
Page 23 and 24: REFERENCES1. National Institute for
Page 25 and 26: REFERENCES94. International Consens

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