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Diabetic Ulcer
definition
Diabetic ulcer is an open lesion on
the surface of the skin due to
angiopathy complications resulting
in
vascular
insufficiency
and
neuropathy, which in further there
is a lesion in patients which is often
not perceived, and can progress to
an infection caused by aerobic and
anaerobic bacteria.
epidemiology
Indonesia 15% of diabetic
patient
Foot diabetic ulcer Most causes
of hospitalization by 80% to
diabetic patient
mortality rate 32%
amputation 30%
diabetic
patient
with
post
amputation 14,3% will be die
Etiology
The
etiologies
of
diabetic
ulceration include neuropathy,
arterial disease, pressure, and foot
deformity.
Diabetic
peripheral
neuropathy, present in 60% of
diabetic persons and 80% of
diabetic persons with foot ulcers,
confers the greatest risk of foot
ulceration; microvascular disease
classification
Risk factor
Risk factors that can not be changed:
1. age 60 years old
2. Diabetic periods 10 tahun
. The risk factors that can be changed
(including habits and lifestyle):
1. neuropathy (sensory, motor, peripheral)
2. Obesity
3. Hypertension
4. Uncontrolled Glycosylated hemoglobin
(HbA1C)
5. Uncontrolled blood glucose
Pathogenesis
Atherosclerosis is a condition in
which the arteries thicken and
narrow due to the buildup of fat on
the inside of blood vessels.
Frequent tingling
Leg pain at rest
diminished sensoric perception
Tissue damage (necrosis)
Decreased pulse of the dorsalis
pedis, tibial and popliteal arteries
Leg atrophy
dry skin
Examination in Diabetic
Ulcer
Whean treating patient wit diabetic
ulcer, there are a few steps that can be
done to determine the wound status :
1. Wound Asessment
a) Determine the wound location : this is
useful as an indicator to what caused
the wound, therefore minimizes the
probability of the wound from occuring,
by eliminating the cause of the wound.
Indications of ABI
Intermittent claudication
Diagnosing a patient suspected of a lower
extremity arterial disease with wound on the
lower extremity
People over 70 years
People over 50 years with a history of smoking
and diabetes.
To evaluate the arterial flow of the lower
extremity, and to determine the process for
compression therapy, or wound debridement.
To determine the wound healing potential.
Contraindication of ABI
Severe pain on the leg
Deep vein thrombosis
Severe pain linked to wound of the
lower extremity.
ABI Procedure
Place the patient at a supine position for 20
minutes
Make sure the toe area is not blocked or
obstructed by clothing
Cover the wound with cuff
Place the measurement cuff above the ankle
Doppler probe is placed in the anterior tibial
and dorsalis pedis arteries (with connecting
gel) directions of probe is set to 450
ABI score
Perfusion Status
>1.3
Elevated, incompressible
vessels
>1.0
Normal
<0.9
<0.6 to 0.8
Borderline
<0.5
Severe Ischemia
<0.4
Treatment
a. correction of vascular abnormalities
b. Improve circulation
c. Manage the problems that arises (infections,
necrosis)
d. Foot care education.
e. The provision of appropriate medications for
infections (according to laboratory results) and
eliminate symptoms and compklications of diabetes.
f. Regular excercise to maintain an ideal body weight
g. Stop smoking
Debridement
One of the most important action in
wound care
Debridement is an action to dispose
the necrotic tissue, callus and fibrotic
tissue around 2-3 mm from the wound
edges. Debridement increases the
growth factors which helps the wound
to heal. Frequent debridement
methods are : Surgical, autolytic,
chemical, and mechanical
Debridement cont.
Surgical, autolytic, and chemical
debridement only removes the
necrotic tissues (selective
debridement), while mechanical
debridement removes both the
necrotic tissue and healthy tissue
around the wound (non-selective
debridement)
Offloading
Is a reduction in pressure on the ulcer,
diabetic ulcers usually occurs on
lacations receiving high pressure, bed
rest is the best way to reduce
pressure.