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FOOT ULCERS

FOOT ULCERS. Dr.B.BALAGOBI Registrar/Surgery. Chronic Foot ulcers. Diabetic ulcer Vascular Arterial Venous Infection:COM Malignant. Arterial ulcers . Pulse evaluations . Neuropathic ulcers . Neuropathic ulcers. OSTEOMYLITIS. Pathogenesis. Venous Arterial Neuropathic.

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FOOT ULCERS

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  1. FOOT ULCERS Dr.B.BALAGOBI Registrar/Surgery

  2. Chronic Foot ulcers • Diabetic ulcer • Vascular • Arterial • Venous • Infection:COM • Malignant

  3. Arterial ulcers

  4. Pulse evaluations

  5. Neuropathic ulcers

  6. Neuropathic ulcers

  7. OSTEOMYLITIS

  8. Pathogenesis Venous Arterial Neuropathic

  9. Treatment:Venous ulcer

  10. VV Treatment Surgical • V Vs surgery: • High tie • Stripping • Perforators ligation • Multiple avulsions

  11. Treatment:Arterial ulcer • Arterial bypass. • Debridment. • Skin Graft.

  12. Arterial Bypass

  13. Skin graft

  14. Treatment:Neuropathic ulcers

  15. Off load the pressure !

  16. Wound dressing

  17. BASICS • Treat the aetiology • Hb • FBS control • VitC,Zn • Protein • Respect VIP • Vascular • Infection • Pressure

  18. Methodes of Debridement • Surgery • Hydro therapy • Biological:Maggots • Enzymatic:Proteolytic enzyme • Autolytic:Hydrogel

  19. Surgical debridement

  20. Bedside procedure

  21. Mechanical

  22. Debridement

  23. Maggots

  24. Reduce bacterial load

  25. Moisture

  26. VAC therapy

  27. VAC

  28. VAC

  29. VERY TASTY!!!!!!

  30. Diabetic Foot ulcer

  31. Latest Figures • Prevalence for Sri Lankans aged ≥20 years – 10.3% • Prevalence of pre-diabetes in urban and rural population was 11.5% • Overall prevalence of some form of dysglycaemia (sugar problems) was 21.8% 2008*- Katulanda P. Constantine G.R. , Mahesh J. G. etal., Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka- Sri Lanka Diabetes , Cardiovascular Study (SLDCS)

  32. Epidemiology • DM largest cause of neuropathy • Half don’t know • Foot ulcerations is most common cause of hospital admissions for Diabetics. • Expensive to treat • may lead to amputation.

  33. Pathophysiology • Vascular disease • Neuropathy • Sensory • Motor  Foot deformities • Autonomic • Hyperglycaemia • Immune deficiency

  34. STAGES OF ULCER DEVELOPMENT

  35. STAGES OF ULCER DEVELOPMENT

  36. RISK STRATIFICATION • Previous ulceration/Amputation • Sensory neuropathy • Foot deformities/Callous • PVD

  37. RISK STRATIFICATION • Low risk • no risk factors and no previous ulceration • High risk • one risk factor and no previous ulceration • Foot emergencies • ulcerated, injured or infected foot

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