Diabetic Wound Care Measures

Stabilizing blood sugar is the basic premise, debridement and dressing changes in line with the wound stage are the core, and avoiding stress, infection and other triggering factors is the long-term guarantee. All three are indispensable. Failure in any link may lead to delayed wound healing, or even serious consequences such as gangrene and amputation.

The 62-year-old Zhou who I picked up at the outpatient clinic last month is a typical example. After retiring, he went to the park every day. He wore a pair of new old Beijing cloth shoes and rubbed out the blisters on the soles of his feet. He picked out unsterilized sewing needles at home and applied some purple lotion. He thought it would be fine in two days, but half the result was Months later, not only did the wound not grow, but it turned into a pit as deep as 1 cm, and pus leaked out when pressed. When he came here, his fasting blood sugar was measured at 13.7mmol/L. He felt aggrieved, saying that the cut on his hand had healed in two days, but why was the wound on his foot so difficult to treat?

In fact, the reason is very simple. People with diabetes have long-term high blood sugar, high blood viscosity, poor peripheral circulation, and the local nutrient supply in the wound cannot keep up. In addition, high blood sugar is equivalent to providing a "natural culture medium" for bacteria. A small break can easily breed infection, just like growing crops in saline-alkali soil. No matter how much water you pour and how much fertilizer you apply, the foundation is not good and it will not grow.

The first thing many patients ask me when they come to me is, "Doctor, please give me the best medicine to help the wound grow faster." To be honest, if you can't control your blood sugar, a dressing worth hundreds of dollars a piece will be useless. My first request to Lao Zhou was to find an endocrinologist to adjust his blood sugar first, and stabilize his fasting blood sugar within 7mmol/L, and his postprandial blood sugar not to exceed 10mmol/L. This is the basis for all subsequent treatments. There is also a controversial point in the industry. Some clinical scholars believe that for chronic wounds that are extremely difficult to heal, as well as elderly patients over 75 years old, the blood sugar threshold can be appropriately relaxed to 8mmol/L on an empty stomach to avoid the risk of hypoglycemia. It is safer to not be too stuck. In clinical operations, we will also adjust according to the actual situation of the patient. There is really no one-size-fits-all standard.

After the blood sugar has stabilized, it is time to treat the wound. The treatment of debridement in the industry is actually divided into two groups: one group is the traditional surgical debridement idea, which advocates scraping off all the necrotic slough and scab in the first dressing change to expose fresh bleeding wounds. The advantage is that the removal is thorough and subsequent granulation will grow quickly. The disadvantage is that it is painful. It is not suitable for the elderly with poor tolerance and those with neuropathy who are not sensitive to pain.； The other school is the idea of ​​conservative sharp debridement + wet healing that has been promoted in recent years. Instead of cleaning it all at once, first use wet dressings such as hydrogel and foam dressings to slowly dissolve the necrotic tissue. Each time the dressing is changed, only the softened slough is removed. This is less painful, but the healing cycle will be slightly longer. Lao Zhou was afraid of pain, so he chose the second method. After changing the medicine three times, the rotten flesh was basically clean, revealing pink fresh granulation.

When it comes to changing dressings, I have really seen too many people do it at home. Some people pour alcohol or iodine directly on the wound, saying that it will be clean, but in the end, all the tender granules that have just grown are burned out.； There are also people who soak their wounds with salt water every day, euphemistically claiming to kill bacteria and activate blood circulation. As a result, the wounds become edematous and white, and the wounds do not grow well. The correct approach is actually to use mild iodine for small superficial wounds. It is best to see a specialist nurse to treat deeper wounds with a lot of exudation. Choose the corresponding dressing according to whether the wound is in the exudation stage or the granulation growth stage. The more expensive the better, the more suitable the dressing is.

It took less than a month for Lao Zhou's wound to heal. When I left, I told him repeatedly that he should never wear shoes that abrade his feet or walk barefoot at home. Many people with diabetes have peripheral neuropathy. They can't feel blisters or pricks on their feet. By the time they are discovered, they are already rotten. Oh, yes, don’t cut your nails too hard, and don’t cut into the nail groove. Last month, I received a patient whose toenails were cut a little bit, but I didn’t take it seriously. In the end, the entire toe became swollen, and he almost had to have his leg amputated.

In fact, diabetic wounds are scary and terrible, and simple and easy. Many people become seriously ill because they don't pay attention to them at the beginning, thinking that it is just a small wound and can be treated casually. If you really encounter a wound that has not grown for more than a week, or is even red, swollen and oozing pus, don't delay and seek professional treatment as soon as possible. It is much better than trying to figure it out at home.