WOUND BLOG by Matthew Livingston RN

Diabetic Etiology Wound Evidence Based Research

Diabetic Etiology 20 week of healing benchmark

Research indicates that 67% of diabetic foot ulcers remain unhealed after 20 weeks of care. (Note: Average healed at 20 weeks is 33%)

Kantor J, Margolis DJ. Expected healing rates for chronic wounds. WOUNDS. 2000;12(6):155-158

RESULTS—Wound area measurements at baseline and after 4 weeks were performed in 203 patients. The midpoint between the percentage area reduction from baseline at 4 weeks in patients healed versus those not healed at 12 weeks was found to be 53%. Subjects with a reduction in ulcer area greater than the 4-week median had a 12-week healing rate of 58%, whereas those with reduction in ulcer area less than the 4-week median had a healing rate of only 9% (P < 0.01). The absolute change in ulcer area at 4 weeks was significantly greater in healers versus nonhealers (1.5 vs. 0.8 cm2, P < 0.02). The percent change in wound area at 4 weeks in those who healed was 82% (95% CI 70–94), whereas in those who failed to heal, the percent change in wound area was 25% (15–35; P < 0.001).

Percent Change in Wound Area of Diabetic Foot Ulcers Over a 4-Week Period Is a Robust Predictor of Complete Healing in a 12-Week Prospective Trial Peter Sheehan, MD1,Peter Jones, MSC2,Antonella Caselli, MD3 John M. Giurini, DPM3 and Aristidis Veves, MD3

10.2337/diacare.26.6.1879 Diabetes Care June 2003 vol. 26 no. 6 1879-1882

Nutrition

“Basic principles of nutritional management of a patient with diabetes mellitus to control glucose, hyperlipidemia, and hypertension should be applied to the patient who has developed neuropathic foot ulcers.”

Level of Evidence=C

WOCNS, 2004. Guideline for Management of Wounds in Patients with Lower-Extremity Neuropathic Disease. Pg. 24

Offloading

“Ensure adequate offloading of pressure through wound closure. Utilize assistive devices to provide support, balance, and offloading of the affected site.”

Recommendation

WOCNS, 2004. Guideline for Management of Wounds in Patients with Lower-Extremity Neuropathic Disease. Pg. 17

TCOM

A transcutaneous oxygen monitor study “is indicated to assess tissue perfusion when the lower extremity wound is not healing or an ABI or toe pressures can not be done due to incompressible arteries” (Grolman et.al. 2001: Hopf et al., 2006: Stalc & Poderos, 2002).

Level of Evidence = A

WOCNS, 2008. Guideline for Management of Wounds in Patients with Lower-Extremity Arterial Disease. Pg. 14

Negative Pressure Wound Therapy

Negative Pressure Wound Therapy  “has been demonstrated to be effective for the treatment of neuropathic/diabetic ulcers and skin graft and donor sites.”

Level of Evidence = B

WOCNS, 2004. Guideline for Management of Wounds in Patients with Lower-Extremity Neuropathic Disease. Pg. 27

Skin Substitutes

Skin Substitutes have the potential to stimulate, through topical activation the normal or enhanced activity of mechanisms involved in tissue repair.

(Gentzkow, Iwasaki, Hershon, Mengel, Prendergast, Ricotta et al., 1996; Gentzkow, Jensen, Pollak, Kroeker, Lerner, Lerner et al., 1999; Marston, Hanft, Norwood & Pollak, 2003)

Level of Evidence = 1b

Hyperbaric

“Hyperbaric oxygen therapy may be clinically effective in treating patients with limb-threatening diabetic wounds of the lower extremity (Wagner grades III and IV)

Level of Evidence = A

WOCNS, 2004. Guideline for Management of Wounds in Patients with Lower-Extremity Neuropathic Disease. Pg. 27