Diabetic Foot Debridement in Mandsaur

Diabetic foot debridement is the procedure done to remove the necrotic tissue, foreign particles, callus, microorganisms (mostly bacterial), and wound edge from a chronic foot ulcer if you are suffering from uncontrolled diabetes. Foot ulcers are a common complication of diabetes (increased blood sugar levels in the body) that cannot be managed through conservative methods like diet, exercise, and insulin (a hormone created by your pancreas that controls the amount of sugar/glucose in your bloodstream) treatment. 
 

Debridement is a procedure of complete removal of dead (necrotic) tissue, foreign debris, and callus (a rough, thickened area of the skin that occurs due to repeated pressure to an area of skin) from chronic (long-lasting) wounds such as diabetic foot ulcers. Diabetic foot is the most common complication of diabetes that occurs due to a disturbance in the natural wound-healing process.  Uncontrolled diabetes increases your risk of ulcers resulting from skin tissue breaking down, exposing the underlying skin layers and tissues.

A prolonged inflammatory phase in diabetic wounds causes a delay in the formation of mature granulation tissue (a new connective tissue and blood vessels that form on the surface of the wound during the healing process) and a reduction in wound tensile strength (refers to the maximum burst strength of a wound). Debridement is a standard mode of treatment that helps stimulate or accelerate wound healing that is otherwise impaired due to uncontrolled diabetes.

Diabetes usually impairs wound healing, spreading the infection deep into the skin layers, thereby exposing the bone underneath. This is mainly due to poor blood circulation to the existing wound, which impairs your body's natural healing mechanism, thereby reducing oxygen supply to the wound tissues. As a result, this leads to a favorable environment (anaerobic) for the bacteria that increase the inflammation in the body cells, which delays wound healing. 

A diabetic foot ulcer is a common complication of uncontrolled diabetes that is classified into the following stages:

• Stage 1- Normal foot with no risk factors
• Stage 2- High-risk foot (who are at increased risk of developing foot ulcers)
• Stage 3- Ulcerated foot (open sores/ulcers develop)
• Stage 4- Cellulitis foot (a severe bacterial skin infection develops)
• Stage 5- Necrotic foot (ulceration with dead tissue)
• Stage 6- Foot that cannot be rescued (needs to be cut off from the body)

Debridement is an important procedure to clean the wound thoroughly and speed up the healing process by promoting granulation tissue formation. Thus, it prevents any further growth of bacteria and prevents the wound from spreading to the deeper tissue layers.
 

Diabetic foot debridement is a standard procedure used to remove dead tissues and bacteria from a diabetic foot to promote healing. This can be performed using several methods discussed below. 

Surgical debridement

This is also known as sharp debridement and has been the gold standard of wound debridement performed under anesthesia (a numbing agent or solution). This procedure utilizes a surgical instrument known as a scalpel or curette that scrapes out dead and devitalized wound tissues. 

Advantage- It mainly removes non-vital tissues and does not involve healthy tissues. 

Autolytic debridement

This is the simplest form of diabetic foot debridement that uses hydrogels and hydrocolloids. These three-dimensional chemical dressings help regenerate granulation tissue and aid in the revascularization of the wound (promoting blood supply) by locking moisture within the wound. The accumulated moisture causes the old tissues to swell up and separate from the wound. The cells within the damaged tissues are broken down or lysed by the enzymes that digest specific components of the wound tissues. 

Advantage- It is a non-surgical method of debridement with minimal risks involved. 

Mechanical debridement

It is a type of debridement that removes damaged tissues through mechanical or moving forces. Types of mechanical debridement include:

Hydrotherapy

• This method uses running water through a syringe or catheter tube to wash away the old and damaged wound tissues. 

Wet-to-dry dressing

• A wet surgical gauze or dressing is placed over the wound and removed when dried. This makes the wound tissues stick to the dried gauze, which is then removed by the surgeon. 

Monofilament debridement pads

• A gentle polyester pad is brushed over the wound to remove the dead and necrotic tissues.

Advantage- This method can be effectively used for both infected and non-infected wounds. 

Biochemical/Enzymatic debridement

This is also known as chemical debridement, which uses an ointment or gel with special enzymes that soften the unhealthy wound tissues. This is used for smaller ulcer wounds that are applied once or twice a day.

Advantage- Ideal for bleeding problems and if you are at high risk for surgical debridement. 

Biologic debridement

This method, known as larval therapy, maggot debridement therapy, or biosurgery, uses sterile maggots, a common green bottle fly, as a treatment. The maggots are used in a mesh bag and kept in place for 24 to 72 hours, releasing antibacterial substances that control infection and promote wound healing. 

This method is used for large, infected wounds that cannot be surgically treated.

Debridement is the most commonly used method to treat a diabetic foot ulcer, which involves the removal of dead and damaged wound tissues to promote healing. It is usually an outpatient procedure performed under anesthesia (most often general since the procedure is very painful), depending on the severity of the ulcer and the type of debridement method. 

• The skin surrounding the wound will be cleansed using an antiseptic solution. 
• Your doctor will administer anesthesia to numb the area so you do not feel pain or discomfort.
• The dead and necrotic tissues will be removed depending on the method chosen according to your individual condition.
• Once the dead tissue is removed, the ulcer is thoroughly cleaned with the antiseptic solution to remove residual bacteria. 
• The ulcer will be packed with medicated gauze (containing hydrogels etc.) to promote wound healing. 
• A moist dressing is important to promote the migration of healthy cells and growth factors around the ulcer to promote healing. 
• The debridement procedure would usually take around 20 to 30 minutes, depending on the severity of the diabetic foot ulcer and the method chosen. 

It is important to prepare before a diabetic foot debridement, which depends on the severity of the ulcer, the type of debridement, and your overall health condition. This aids in preventing any complications that may occur during or after the debridement procedure. 

Preparation may include:

• A physical exam of the diabetic foot ulcer will be done by your surgeon to evaluate the severity of the wound.
• Discuss with your surgeon  any medical conditions that you may have, like diabetes, asthma, hypertension (high blood pressure), lung and heart diseases, and other blood disorders. 
• Inform your surgeon if you have any history of allergies to anesthesia, latex, etc., that may affect the course of the treatment.
• You will be asked to discontinue medications like blood thinners, anti-inflammatory drugs, and other herbal supplements that may increase your risk of bleeding during and after the procedure. 
• You will be asked to sign a consent form that gives your surgeon formal permission to perform the debridement procedure. 
• You will be asked to arrange for someone to help you drive back home as it is an outpatient procedure, and you can return home the same day. 

Following diabetic foot debridement, it is normal to experience mild pain and swelling around the treated site, which will resolve gradually. You will be allowed to go home the same day with a bandage or a moist dressing to protect the treated wound. Following your doctor's instructions, post-procedure is important to speed up the recovery. 

Wound care

• You must change your dressing regularly.
• Keep the dressing dry by avoiding activities like swimming, baths, and hot tubs until instructed by your doctor.
• Do not apply pressure on your wound; use crutches to move around.
• You must take pain medications as your doctor prescribes to relieve pain and discomfort.

Nutritious diet

• Eat a well-balanced, healthy diet that must include fresh fruits and vegetables, along with proteins (eggs, lean meat). 
• Be sure to hydrate yourself well.
• Limit your sugar intake to keep your diabetes under control.

Leg elevation

• You must prop up your operated foot with the help of a stool or pillows. 
• This enables proper blood circulation and controls swelling. 

Quit unhealthy habits

• Avoid smoking and alcohol intake for the initial few weeks following the debridement since they may delay wound healing. 

Regular follow-up appointments

• You must attend your follow-up appointments to evaluate the wound healing and the success of the debridement procedure. 

Recovery may usually take around 4 to 6 weeks, depending on the following factors:

• Size of the diabetic foot ulcer
• The severity of the condition
• Your blood sugar levels
• The exact location of the foot ulcer
• The type of debridement method chosen

Diabetic foot debridement is a safe and standard treatment modality for a diabetic foot ulcer; however, as with any medical procedure, some possible risks could be associated. These include:

• Damage to the healthy tissues around the wound.
• Risk of bacterial infection, especially if proper wound care and hygiene are not followed.
• Allergic reactions to anesthesia that cause rash, hives, nausea, dizziness, confusion, and breathing difficulties.
• Persistent pain due to failure to clean the wound properly, leaving behind dead and necrotic tissue.
• Numbness and a tingling sensation around the treated area are due to damage to nearby nerves.
• Skin irritation, redness, and itching are caused by persistent inflammation.
• Excessive bleeding near the wound.

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