Document Detail


Wound-healing protocols for diabetic foot and pressure ulcers.
MedLine Citation:
PMID:  12931288     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Diabetic foot and pressure ulcers are chronic wounds by definition. They share similar pathogeneses; i.e., a combination of increased pressure and decreased angiogenic response. Neuropathy, trauma, and deformity also often contribute to development of both types of ulcers. Early intervention and proper treatment should result in complete healing of non-ischemic diabetic foot and pressure ulcers, as defined by 100% epithelialization and no drainage (if no osteomyelitis is present). The authors developed the following paradigm, which has proved to be highly effective for complete healing of these wounds: 1) recognition that all patients with limited mobility are at risk for a sacral, ischial, trochanteric, or heel pressure ulcer; 2) daily self-examination of the sacral, ischium, buttocks, hips, and heels of all bed-bound patients and the feet of patients with diabetes with risk factors (e.g., neuropathy); 3) initiation of a treatment protocol immediately upon recognition of a break in the skin (i.e., emergence of a new wound); 4) objective measurement by planimetry of every wound (at a minimum, weekly) and documentation of its progress; 5) establishment of a moist wound-healing environment; 6) relief of pressure from the wound; 7) debridement of all non-viable tissue in the wound; 8) elimination of all drainage and cellulitis; 9) cellular therapy or growth factors for patients with wounds that do not heal rapidly after initial treatment; and 10) continuous physical and psychosocial support for all patients. If this paradigm is followed, most diabetic foot and pressure ulcers are expected to heal.
Authors:
Harold Brem; Tom Jacobs; Loretta Vileikyte; Sarah Weinberger; Mark Gibber; Kiran Gill; Alina Tarnovskaya; Hyacinth Entero; Andrew J M Boulton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Surgical technology international     Volume:  11     ISSN:  1090-3941     ISO Abbreviation:  Surg Technol Int     Publication Date:  2003  
Date Detail:
Created Date:  2003-08-21     Completed Date:  2004-05-19     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9604509     Medline TA:  Surg Technol Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-92     Citation Subset:  IM    
Affiliation:
Wound Healing Program, Angiogenesis and Wound Healing Laboratory, The Mount Sinai Medical Center, New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anti-Infective Agents / therapeutic use
Biological Dressings
Biological Therapy / methods
Chronic Disease
Combined Modality Therapy
Debridement / methods
Diabetic Foot / diagnosis,  therapy*
Female
Follow-Up Studies
Humans
Male
Pressure Ulcer / diagnosis,  therapy*
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Skin Transplantation / methods
Wound Healing / physiology*
Grant Support
ID/Acronym/Agency:
DK 59424/DK/NIDDK NIH HHS; DK 60214/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Infective Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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