This Diabetic Wound Evidence Based Treatment Pathway Is based from documents such as the RNAO and WOCN guidelines. I have revised them in a time related format that is based on predictive modeling evidence.
Week 1 of Diabetic Wound Evidence Based Treatment
- Relieve Pressure Offloading Devices
- Manage Infection Antimicrobials
- Remove Callus Debride Callus
- Remove Avascular Tissue Debride Non-Viable Tissue
- Optimize Nutrition Glucose Control
- Protect Surrounding Tissue Barrier Paste
- Control Moisture Absorbent dressing
Week 4 of Diabetic Wound Evidence Based Treatment: If the diabetic foot ulcer heals less than 50% over the first 4 weeks* then consider the following adjunctive therapies or treatments:
- Assess Circulation T-com study
- Sponsor Granulation NPWT
- Introduce Growth Factors Skin Substitute / Regranex
- Improve Microcirculation Hyperbaric Oxygen Therapy (Wagner 3 or Greater Diabetic Wounds)
20 Week Diabetic Wound Benchmark: 67% of diabetic foot ulcers remain unhealed after 20 weeks of care¹.
*Note: “50% percentage area reduction at four weeks was significantly associated with healing at 12 weeks”².
1. Kantor J, Margolis DJ. Expected healing rates for chronic wounds. WOUNDS. 2000;12(6):155-158.
2. Snyder R, Kirsner R, Warriner R, Lavery L, Hanft J, & Sheehan P, 2010. Consensus Recommendations on Advancing the Standard of Care for Treating Neuropathic Foot Ulcers in Patients with Diabetes. Ostomy Wound Management. 2010;56 (suppl 4):S1-S24.
Matthew Livingston R.N. C.W.S.
