best practice guidelines: wound management in diabetic foot ulcers

GLOBAL WOUNDCARE PLANSteps to avoid amputation: implementing a global wound care planA Diagnosis of diabetes (+/_ peripheral sensory neuropathy)AIM: Prevent the development of a DFU1. Implement DFU prevention care plan that includes treatment of co-morbidities, good glycaemiccontrol and pressure offloading2. Annually perform general foot examination:— Use 10g monofilament to assess sensory status— Inspection of the feet for deformities— Inspection of footwear for wear and tear and foreign objects that may traumatise foot— Maintain skin hydration (consider emollient therapy) for skin health— Offer patient education on checking feet for trauma3. Ensure regular review and provide patient educationBCDevelopment of DFUAIM: Treat the ulcer and prevent infection1. Determine cause of ulcer2. Agree treatment aims with patient and implement wound care plan:— Debride and regularly cleanse the wound— Take appropriate tissue samples for culture if infection is suspected— Select dressings to maintain moist wound environment and manage exudate effectively3. Initiate antibiotic treatment if infection suspected and consider topical antimicrobial therapyif increased bioburden is suspected4. Review offloading device and ensure footwear accommodates dressing5. Optimise glycaemic control for diabetes management6. Refer for vascular assessment if clinically significant limb ischaemia is suspected7. Offer patient education on how to self-manage and when to raise concernsDevelopment of vascular diseaseAIM: Prevent complications associated with ischaemia1. Ensure early referral to vascular specialist for arterial reconstruction to improve blood flow inpatients with an ischaemic or neuroischaemic ulcer2. Optimise diabetes controlD Ulcer becomes infectedAIM: Prevent life- or limb-threatening complications1. For superficial (mild) infections — treat with systemic antibiotics and consider topicalantimicrobials in selected cases2. For deep (moderate or severe) infections — treat with appropriately selected empiric systemicantibiotics, modified by the results of culture and sensitivity reports3. Offload pressure correctly and optimise glycaemic control for diabetes management4. Consider therapy directed at biofilm in wounds that are slow to healACTIVE MANAGEMENT OF THE ULCER AND CO-MORBIDITIES SHOULD AIM TO PREVENT AMPUTATIONWhere amputation is not avoidable:1. Implement skin and wound care plan to manage surgical wound and optimise healing2. Review regularly and implement prevention care plan to reduce risk of recurrence or further DFUon contralateral limb320 BEST PRACTICEBEST PRACTICEGUIDELINESGUIDELINES:FOR SKINWOUNDAND WOUNDMANAGEMENTCARE ININEPIDERMOLYSISDIABETIC FOOTBULLOSAULCERS