Diabetic wound care measures

Strict glucose control to stabilize the foundation of healing, precise debridement to reduce the residue of necrotic tissue, targeted anti-infection to avoid the spread of infection, wound decompression to reduce secondary damage, and dynamic monitoring to timely detect the risk of deterioration. The absence of any link may lead to the development of gangrene in small wounds and even the risk of amputation.

In the past three years that I have been working as a consultant in the endocrinology department of a tertiary hospital, I have seen too many cases of patients with diabetes dragging wounds as big as millet grains to the point of amputation. The one that impressed me most was the case of 62-year-old Aunt Zhang who developed a blister on her heel while wearing new shoes. Many people think that as long as blood sugar is lowered, wounds will naturally heal. This view is not completely wrong. After all, in a high-sugar environment, the phagocytic ability of white blood cells decreases, and infection cannot be suppressed at all. However, clinical data shows that nearly 30% of people with diabetes whose glycosylated hemoglobin is stable below 7% still have wounds that heal 3-5 times slower than ordinary people. The core reason is mostly due to insufficient blood supply in the lower limbs - if the blood vessels in the legs are blocked with only a slit left, nutrients cannot be delivered to the wound, and no matter how you control your sugar, it will be in vain. So when I encounter a wound that has not healed for more than 3 days, I usually remind everyone to feel the dorsalis pedis artery first. If the pulse is very weak or even cannot be touched, don’t change the dressing blindly. First, do a lower limb blood vessel ultrasound to see if there is any blockage. This is a key step that many people miss.

When it comes to dressing wounds, the standard solution in many families is povidone iodine + band-aid. This operation can really cause trouble for people with diabetes. There are actually two different tendencies in the current wound care circle. One group advocates "wet healing", covering the wound with foam dressings and hydrocolloid dressings to maintain a moist environment to help granulation grow. The other group prefers "dry management" and believes that the wounds of patients with diabetes are prone to breed anaerobic bacteria. It is safer to use iodophor gauze to open the wound and wet it. I have talked with a wound ostomy doctor, and both of these are actually correct. The key depends on the condition of the wound: if the wound is clean and does not exudate much, you can suffer less by using wet healing, and the newly grown granules will not be painful when changing the dressing. If the wound is already smelly and the edges are black, then it is better to change the dressing honestly and control the infection first. By the way, don’t just sprinkle Yunnan Baiyao or cephalosporin powder on the wound. The powder is mixed with exudate and forms a scab. Although it looks healed on the outside, it may be rotten into a cavity on the inside. I have seen too many cases of this kind of pitting.

Two months ago, there was an old man whose toes were abraded by shoes. He heard from his neighbor that soaking his feet in hot water can disinfect and activate blood circulation. He soaked his feet for 20 minutes a day. After three days of soaking, his whole foot was swollen like a steamed bun. When he came here, his toes were already black, and he almost had half of his foot amputated. A word of warning, people with diabetes have weak senses in their lower limbs. They may not feel the hot water. Contact with raw water will only make the infection spread faster. Even if you want to wash your feet, the water temperature must be tested by family members first. Do not exceed 37 degrees. Immediately after washing, use a clean soft cloth to dry it, especially between the toes, so as not to leave water stains.

Another point that many people overlook is stress reduction. Someone with diabetes asked me before, if my foot is broken, will I have to lie in bed every day and not be able to move? In fact, there are two opinions now. Most doctors in the endocrinology department recommend walking less to avoid repeated friction and pressure on the wound, which may not heal and lead to infection; doctors in the rehabilitation department will instead recommend wearing customized decompression shoes and walking slowly for ten minutes every day. Otherwise, lying down for a long time will easily cause blood clots in the lower limbs, which will aggravate the problem of insufficient blood supply. I generally suggest that you make a compromise. Try to walk as little as possible in the first two weeks when the infection is not under control. When the wound starts to grow granulation, you can wear pressure-reducing shoes and move appropriately. Don't walk around with pain, that will definitely not work.

Finally, the most easily overlooked thing is not to judge the quality of a wound by whether it hurts or not. Most people with diabetes have peripheral neuropathy, and the pain is much weaker than that of ordinary people. Even if the wound is rotten to the bone, you may only feel a little itchy and numb, but not hurt at all. I generally recommend sugar friends with wounds to take photos of the wounds every day and compare them. If the wound becomes larger, the exudate becomes more smelly, and the surrounding skin becomes red and black, even if it doesn't hurt at all, go to the hospital immediately. Don't delay.

To put it bluntly, there is no standard answer for diabetic wound care. Everyone’s blood sugar, blood supply, and wound status are different. Don’t copy ordinary people’s homework, and don’t believe in any folk remedies. If you are not sure, go to the wound and ostomy clinic of a regular hospital and spend more than ten yuan to register. It is much safer than messing around at home.