Wound Assessment and Evaluation: Diabetic Ulcer Protocol

Jan Cuzzell

Disclosures

Dermatology Nursing. 2003;15(2) 

Introduction

Successful treatment of diabetic ulcers requires an understanding of the underlying disease process. Angiopathic changes in both the large and small vessels of diabetic patients can reduce tissue perfusion significantly, increasing the likelihood of delayed healing and ulcer recurrence. Alterations in blood flow combined with hyperglycemia-induced white blood cell dysfunction also increase the risk of wound infections in this patient population. Aggressive measures to correct vascular insufficiency and control blood glucose levels can often mean the difference between limb salvage and amputation.

For optimal clinical outcomes, select local wound care interventions that promote a balance between moisture retention and bacterial control. Timely debridement of necrotic tissue and aggressive cleansing help reduce the bacterial load on the wound surface. For noninfected wounds, choose moisture-retentive dressings that absorb excess exudate without causing desiccation of viable surface cells. If infection is present, opt for antimicrobial therapy until bacterial control is obtained.

Finally, don't underestimate the importance of teaching good foot care. Daily foot inspections combined with proper-fitting shoes will not only promote healing but help prevent recurrence.

Diabetic Ulcer Protocol

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