A Summary of Guidelines for Managing the Diabetic Foot

1. A Summary of Guidelines for Managing the Diabetic Foot Robert G. Frykberg, DPM, MPH, FAPWCA • Chief • Podiatry Section • Carl T. Hayden VA Medical Center • Phoenix, AZ Advances in skin & wound care 2005.05 謝宜蓁

2. PURPOSE • To familiarize the physician and registered professional nurse with an overview of updated guidelines for the prevention and/or management of pressure ulcers, diabetic foot ulcers, and surgical site infections.

3. TARGET AUDIENCE • This continuing education activity is intended for physicians and nurses with an interest in learning about evidence-based prevention and management of wounds.

4. OBJECTIVES • After reading the article and taking the test, the participant should be able to: 1. Discuss the origins and use of the updated guidelines presented. 2. Describe patients at risk for incurring wounds and state preventive measures as identified in the guidelines. 3. Identify techniques used to prevent and treat chronic or infected wounds as described in the guidelines.

5. RATIONALE FOR TREATMENT

6. RATIONALE FOR TREATMENT • Perhaps the best reason to aggressively treat a diabetic foot ulcer is because it is the leading risk factor for lower-extremity amputation.

7. RISK FACTORS • Minor trauma • Neuropathy • Previous ulcer • Infection • Hypoxia • Protein glycosylation

9. WOUND ASSESSMENT AND CLASSIFICATION • Laboratory parameters • Wound assessment • Neurologic examination • Vascular examination • Infection

11. WOUND CLASSIFICATION • University of Texas diabetic classification system This scale start at : Grade 0—3(傷口深度) stage A (no infection) /stage B (infection) stage C (PAOD) stage D (infection +PAOD)

12. ADA的文獻醫治建議一個有系統的評估,如下列問題︰ADA的文獻醫治建議一個有系統的評估,如下列問題︰ • 病患有潰瘍經驗嗎？ • 潰瘍是因穿刺傷? 鈍傷? 燙傷？ • 傷口持續多久？ 急性? 慢性? • 局部或系統症狀有無擴散？ • 傷口正改善? 穩定的? 還是正惡化？ • 病患之前做過傷口處理嗎？做過哪些處置？ • 何種治療有效? 何種失敗？失敗原因?

13. WOUND TREATMENT Before selecting an appropriate treatment for a wound, the practitioner should remove or correct the etiologic cause. After debridement has been performed, off-loading has been instituted, and ischemia and infection managed, the focus can turn to wound care.

14. Treatment • Sharp debridement ,ultrasound , enzyme…/Maggots … • 減壓:TCC,Itcc • Medical management • 敷料:gels,creams,solutions, anti….

15. The goal is to develop a simple approach that would allow practitioners to quickly classify these wounds and determine whether the patient needs to be admitted to the hospital or referred to a specialist. This classification system ranges from Grade 0 (a preulcer lesion at risk) to Grade 4 (a superficial fullthickness deep ulcer with complications). The basic parameter for prevention is education. Patients are not the only ones who need to be educated, however; providers need education as well. Not every health care practitioner is cognizant of current standards of wound care. With the rapid advances in this area of practice, even wound care practitioners need to ensure that they are consistently updating their knowledge. PREVENTION • The basic parameter for prevention is education. • Patients are not the only ones who need to be educated, however ; providers need education as well. • Not every health care practitioner is cognizant of current standards of wound care. • With the rapid advances in this area of practice, even wound care practitioners need to ensure that they are consistently updating their knowledge.

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