MANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING

DR NORLIZAH PAIDI

FAMILY MEDICINE SPECIALIST

KLINIK KESIHATAN BANDAR MAS

KOTA TINGGI JOHOR

OUTLINE

•DEFINITION

•FACTORS CONTRIBUTING TO WOUND DEVELOPMENT

•WOUND HEALING PROCESS

•TYPES OF WOUND IN PRIMARY CARE

•SHARING EXPERIENCE

FACTORS CONTRIBUTING TO WOUND

• Impaired circulation: • Ischemia or stasis.

• Ischemia : Reduced blood supply due to the narrowing or blockage of blood vessels

• Stasis : immobilization for long periods or failure of the regulating valves in the veins

• Neuropathy:

•This is seen mostly in cases of prolonged uncontrolled diabetes mellitus

• Medical illness: •such as hypertension, hyperlipidemia, arthrosclerosis, diabetes mellitus,

•AIDS, malignancy, morbid obesity, hepatitis C virus, etc.)

•medical illnesses can lead to impairment of the immune system functions, diminishing the circulation

and damaging other organs and systems.

DIABETIC WOUNDS

• External

• Skin Cuts

• Burns

• Bumps

• Bruises

• Internal

• Ulcers

• Ingrowing toenails

• calluses

DIABETIC FOOT ULCER

Approximately 15-20% of the estimated 16 million

persons in the US with Diabetes Mellitus will be

hospitalized with a foot complication at some

time during the course of their disease

It has been estimated that every 20 seconds a lower limb

is amputated due to complications of diabetes

WHERE ARE WE?

NHMS 2015

“Prevalence of diabetes in Malaysia had increase a relative 15%”

15.2% in 2011, 17.5% in 2015

“every one DIANGNOSED DM , there is one UNDIAGNOSED”

WHERE ARE WE?

Major limb amputations in Seremban Hospital: a review of 204 cases from 1997-1999.

Medical Journal Of Malaysia;2001

“Non traumatic amputations constitute 85.8% of the cases mainly due

to diabetic ulcers or gangrene (91%)

followed by peripheral vascular disease (7%) and malignancy (2%).”

PHYSIOLOGY OF WOUND HEALING

“the primary goal of wound care is not the

technical repair of the wound;

it is providing optimal conditions

for the natural reparative processes

of the wound to proceed”

– Richard L. Lammers (Roberts and Hedges)

FACTORS AFFECTING WOUND HEALING

• Extrinsic Factors • Mechanical stress

• Debris

• Temperature

• Desiccation and maceration

• Infection

• Chemical stress

• Medications

• Other factors such as alcohol abuse, smoking, and radiation therapy

FACTORS AFFECTING WOUND HEALING

• Intrinsic Factors • Health status

• Age factors

• Body build

• Nutritional status

TYPES OF WOUND IN PRIMARY CARE

PKD KOTA TINGGI 2016

HOW DIABETIC WOUND IS MANAGED?

CARTA ALIR

„CLERKING SHEET‟

CONT.

WOUND ASSESSMENT

IDEAL WOUND DRESSING

• GENERAL

• Easy to apply and maintain

• Aesthetically pleasing

• Cost permissive

• Easily stored

• Non allergenic

• Facilitate healing

• Maintain moist environment

• Minimize trauma/maceration

• Retention of heat

• Facilitate gas exchange

• Minimize risk of infection

• Debride necrotic tissue

• Absorb exudate

• Minimize external contamination

• Remove excess exudate

• Waterproof

• Maintain moist wound healing environment

• Trauma protection

• Allows gaseous exchange if appropriate

• Non adherent

• Provide barrier to pathogens

• Safe and easy to use

• Provide thermal insulation

Am J Clin Dermatol (2013) 14:449-459 MOH Wound Care Manual Firt Edition (2014)

DR. WOUND SILVER ANTISEPTIC

SPRAY

• Antiseptic/cleaning

DR. WOUND CHITOHEAL GEL

• Faster wound healing

• Moisture balance

DR. WOUND DEBRID GEL

• Autolytic debridement

• No pain, no bleeding

DR. WOUND POWDER

• Granulation

DR. WOUND ABSORBENT PAD

• Absorbs exudates

• 3000% absorption power

SILVER ANTISEPTIC Spray Kills bacteria, fungus & viruses +

CHITOHEAL Gel Fasten wound healing process

USAGE METHOD

For clean to medium infection wound (low–mild level of exudate) :

1. Spray Silver Antiseptic Spray thoroughly on the wound bed

2. Leave it for 45 secs – 1 min

3. Apply ChitoHeal gel

4. Cover wound with any secondary dressing (if necessary)

(example : Normal gauze / Paraffin gauze)

USAGE METHOD

For challenging wound :

(presence of slough or necrotic tissues)

1. Spray Silver Antiseptic Spray thoroughly on the wound bed

2. Leave it for 45 secs – 1 min

3. Apply Dr Wound Debrid gel

4. Cover the wound with any secondary dressing

(example : Normal gauze / Paraffin gauze)

USAGE METHOD

For challenging wound :

(wound with cavity / tunnel / pocket)

1. Spray Silver Antiseptic Spray thoroughly on the wound bed

2. Leave it for 45 secs – 1 min

3. Apply Dr Wound powder

4. Apply ChitoHeal gel

5. Cover the wound with secondary dressing

(example : Normal gauze/ Paraffin gauze)

USAGE METHOD

For highly exudative wound :

1. Spray Silver Antiseptic Spray thoroughly on the wound bed

2. Leave it for 45 secs – 1 min

3. Cover the wound with Dr Wound Absorbent Pad

ADVANTAGES OF CHITOSAN DRESSINGS

CASE SHARING

MZM/45/MALAY/MALE/DM NAIL PRICK OVER RT FOOT

DA Y 1 DA Y 15 DA Y 50 DA Y 53

RM/64/MALAY/FEMALE/DM DFU OF RIGHT FOOT

2/6/2016-DAY 1 15/9/2016-DAY 73

4/10/2016-DAY 89

7/10/2016-DAY92

20/10/2016-DAY 123

5/12/2016

8/1/2017 – LAST REVIEW

AA/MALAY/MALE/DM DFU OF RIGHT LEG

22/9/2016- DAY 1

2/10/2016- DAY 10

14/10/2016- DAY 24

7/11/2016- DAY 48

23/11/2016 – DAY 65

MSK/78/MALAY/MALE/DM ALLEGED MVA (MB EXZOS) RT LEG

DAY 1 DAY 3

PRACTICAL TIME!