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
Am J Clin Dermatol (2013) 14:449-459
• 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
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 ABSORBENT PAD

• Absorbs exudates
• 3000% absorption power
DR. WOUND POWDER
• Granulation
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!