MANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING DR NORLIZAH PAIDI FAMILY MEDICINE SPECIALIST KLINIK KESIHATAN BANDAR MAS KOTA TINGGI JOHOR
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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!
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