|
Section 7:
FOOT ULCERS
CLICK HERE
for printer friendly
version of this page |
|
|
|||||
|
Type |
Indicator/descriptor |
Management aims |
Treatment Options |
Other Considerations |
|
|
|
|
1st line |
2nd line |
|
|
||||
|
|
Necrotic layer of
devitalized tissue
May be black/brown
May be soft/hard
May produce offensive
odour |
Rehydration and removal of necrotic tissue |
If vascular insufficiency or if wound requires sharp
debridement contact wound management/diabetes specialist
podiatrist:
See Tissue Viability Pathway |
Patients with active diabetic foot disease should be referred
to podiatry, see Tayside Diabetes MCN Handbook Screening and
Management of Foot Complications
–
Click Here
Assess vascular status
to ensure adequate blood supply.
Refer to vascular service if:
- ischaemic tissue loss
- pain at rest
Wounds should be closely monitored and dressing changed
regularly.
Debride necrotic/dead tissue using the most suitable form of
wound debridement. Sharp debridement should only be carried
out by appropriately trained practitioners.
Dressings used to rehydrate wounds, e.g.
Flaminal Hydro should be applied cautiously to patients
with limb ischaemia or dry gangrene.
Dry gangrene can rapidly progress to wet gangrene with
serious consequences.
Dry gangrene should be kept as dry as possible especially at
the line of demarcation with sharp debridement to this area to
remove dead material.
If patient has loss of protective sensation then regular wound
inspection is required to detect any changes.
It is important to check the wound for signs of infection –
Please note the clinical signs of infection may be absent
in patients with neurological deficits.
Avoid occlusive dressings on infected wounds.
Offload pressure from wound site – please see
NHST guidance for the use of small devices in the treatment
and prevention of grade 1 pressure ulcers
(Docstore link)
For guidance on dressing selection for infected wounds see
section 12: Wound Infection.
For systemic treatment of wound infection refer to the Tayside
Area Formulary Primary Care Antibiotic Man or Diabetes
handbook for information on antibiotic
choice.
Notes:
If patients is on Biologics or Methotrexate and you suspect
infection, contact patients GP or Biologics Specialist Nurse
for advice as temporary withdrawal may be required.
Soft silicone foam dressing are the preferred choice on the
foot as they effectively mould
and conform to uneven contours, provide thermal properties and
provide protection from footwear for bony vulnerable areas.
References:
1. NHS Tayside
Diabetes Managed Clinical Network Handbook
-
click here
2. 36
Wound Essentials 2016, Vol 11 No 1
3.
www.nice.org.uk/guidance/ng19
4. Foot Ulcer
management in the Community –
36
Wound Essentials 2015, Vol 10 No 1 |
|||
|
Hydro |
Medihoney |
||||||
|
Secondary dressing
|
|||||||
|
Sloughy
|
Layer of dead tissue
May be yellow/green
Dry or Wet
May produce offensive
odour |
To remove all debris |
Forte-wet/Hydro-dry |
low/mod exudate
hydrofibre -
High |
|||
|
Fibrous hydrocolloid with foam
If moderate to high exudate
Do not occlude |
|||||||
|
Secondary dressing
Not required with fibrous hydrocolloid with foam dressing
|
|||||||
|
Granulating
|
Wound has 'granular'
appearance and looks
red and
moist |
Protect from trauma
and
maintain moist, warm
environment |
If wound infection suspected consider an antimicrobial
dressing see section 12 |
||||
|
Epithelialising
|
Red/pink, new skin
cover
extending from wound
edges,
may have islands of
new
epithelium in main
areas of the
wound bed
|
Protect and maintain optimal wound healing environment |
|
||||
