Diabetic foot syndrome

We humans need the medium of locomotion for, among other things, our independence and satisfaction. Therefore, healthy feet, with all their dynamic and static functions, should be everyone’s goal.

Table of contents

  • Introduction
  • clinical picture neuropathy
  • Sensory neuropathy
  • Characteristics of a sensitive neuropathic foot
  • Sensorimotor neuropathy
  • Autonomic neuropathy
  • Diagnostics
  • clinical picture diabetic angiopathy
  • Characteristics of angiopathic foot
  • Diagnostics, classification of pavk
  • Summary
  • Measures to restore the blood circulation situation
  • clinical picture of charcot arthropathy
  • Diagnostics
  • symptoms of a patient with charcot arthropathy
  • Measures for recovery
  • Videos: diabetic foot syndrome
  • Diagnostics – early detection of polyneuropathy
  • Video: diabetic foot syndrome – diagnosis, early detection polyneuropathy
  • Optimal treatment in autumn – the DRACO® videoblog
  • Video: diabetic foot syndrome – optimal treatment in autumn
  • Classification
  • Case studies of wagner-armstrong classifications
  • Treatment and therapy
  • Dracohydrogel
  • Pain therapy
  • Course of healing
  • The phases of wound healing
  • Prevention diabetic foot
  • Risk reduction
  • Check-up intervals of the feet
  • Foot care
  • Walking training and adequate footwear
  • Training
  • Other precautions

Introduction

In the meantime, one in four diabetics has been diagnosed with diabetic foot syndrome (DFS).

In germany alone, approx. Eight million people affected by the diagnosis of diabetes mellitus. The affected suffer from too high blood sugar levels. This metabolic disease can cause severe late complications throughout life. Mostly permanent, elevated levels over decades, damage tiny blood vessels, z. B. In the eyes (retino- and maculopathy), kidneys (nephropathy), nerves (peripheral and vegetative diabetic neuropathy), but also the large arteries as they occur in the heart, brain and legs. The metabolic disease diabetes mellitus can therefore cause serious late complications in the course of life if blood sugar control is poor.

Damage that is not yet visible, especially in the area of the foot, remains unnoticed by the affected person for a long period of time. In the new phenomenology, this is called "body island atrophy" and means that the affected person has a discrepancy between the parts of the body that can be felt and those that can be palpated. The foot is not mapped as a body part in the brain. The feet are seen, but as an island of the body they have disappeared. 1

Diabetic foot syndrome often starts with a small, superficial poorly healing wound, which can then progress to a deeply ulcerated wound with infection due to various unfavorable factors. Preventable would be ca. 60% of amputations eliminated by adherence to multidisciplinary therapy concepts.

The following factors are responsible for the development of diabetic foot syndrome (DFS):

  • Diabetes mellitus (duration, course)
  • Sensitive neuropathy
  • Senso-motor neuropathy
  • Autonomic neuropathy
  • Vascular damage with circulatory problems
  • Inadequate footwear
  • Barefoot walking
  • Calluses
  • Wrong foot care
  • Smoking
  • Adiposity
  • Previous amputations

The most common cause of a toe, foot or even a lower leg or foot injury is a. transfemoral amputation is diabetic foot syndrome.

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clinical picture neuropathy

The brain transmits control signals through the nerves to all parts of the body. Long-term high blood sugar levels damage the nerves.

In diabetes disease, different areas of the nervous system can be affected, so neuropathies are divided into two categories:

  1. Peripheral diabetic neuropathy (nerves responsible for movement of the muscles and touch sensation of the skin are affected)
  2. Vegetative diabetic neuropathy (nerves that control organs in the body are affected)

The affected areas have different effects on the patient. On the one hand, numbness and also pain in the feet can occur, on the other hand, the heart, digestion and also the bladder function can be affected. In the early stages of the disease, however, the disease often goes unnoticed.

Diabetic neuropathy includes very different clinical pictures in which certain bodily functions that are controlled by nerves no longer function.

Sensory neuropathy

this disease starts at the tips of the toes. The longest nerves are located here. Prolonged high blood glucose levels damage nerve fibers throughout the body of a diabetic patient.

This is especially noticeable in the feet, toes and hands. A special feature of this form of neuropathy is that the loss of sensation occurs in the form of "socks" on both sides of the feet. Sensory loss slowly progresses to the torso (proximally), meaning that hands and arms may also be affected. The patients have a reduced or even absent sensation of pain and temperature.

While a healthy person feels a pain at approx. 45° celsius hot water on the skin, a patient with a polyneuropathic foot feels pain at over 100°celsius. Burns up to the third degree are therefore not uncommon. For this reason, the use of hot water bottles and blankets, footbaths without thermometer control, walks on the beach on hot days (heated asphalt) without shoes is not recommended. Even small stones, paper clips, thumbtacks and also fish hooks are not perceived by the patient in a shoe.

This unawareness inevitably leads from small to deep ulcerations, which are only noticed when the sock or the inner sole in the shoe shows a stain. A lot of time has elapsed before this perception, necessary therapeutic measures are thus considerably delayed. The risk of the wound becoming infected is very high.

Sensory neuropathy also means that the affected person will feel sensation loss in their feet. Characteristic features such as numbness, ants running, launching pain, tingling and restlessness in the feet, especially at rest and at night. A nightly bed rest seems to be almost impossible. Affected persons have to get up and walk around during the night in order for the above mentioned sensations to subside temporarily. In contrast to arterial occlusive disease, this is a differential diagnostic criterion. Because in the case of arterial occlusive disease, the affected person avoids walking, because otherwise there is an increase in pain.

  • Feet dry and rosy
  • Warm feet
  • Corneal calluses, increased corneal formation
  • Foot pulses easily palpable on all floors
  • Vibration sensation can be significantly disturbed or even eliminated with the help of the tuning fork according to rydel seiffer
  • Pointed/blunt and warm/cold sensations may be limited or even absent

If there are several paraesthesias, one also speaks of diabetic polyneuropathy (PNP).

Senso-motor neuropathy

Disturbed conduction of stimuli to the nerves leads to muscle atrophy, especially in the small foot muscles, which means that the typical claw and hammer toes develop.

Typical hammer and claw toes bds. with pronounced nail deformations and mycoses, as well as pressure point (D1 crest left) due to inadequate shoe

Typical hammer and claw toe bds. With pronounced nail deformities and mycoses, as well as pressure sores (D1 tip on the left) due to inadequate shoes.

This deformation causes disturbances in the rolling process of the entire foot with the resulting pathological pressure loads on the toe caps, metatarsal heads and heel. Tendons and ligaments of the joints also change, there is an increased water retention, the elasticity is lost and the mobility of the foot becomes gradually more limited. The muscular dysfunction results in an altered gait pattern. Various changes in the foot result in a changed pressure load. The rolling pressure on the foot is significantly increased, a blister forms, and the tissue begins to bleed in due to the heavy load. Any further pressure on the foot means the destruction and in the worst case the destruction of tissue.

sensory neuropathy: scheme of small foot muscles – small foot muscles potentially affected by sensory neuropathy/muscular dystrophy

Hyperkeratosis diabetic foot wound on the toe

Hyperkeratosis caused by inadequate footwear. Shoe presses on tissue, hyperkeratosis develops, tissue cannot withstand the pressure and bleeds in, wound not visible.

Hyperkeratosis is removed by a doctor, underneath clearly larger wound than the hyperkeratosis itself, danger of infection and in the further course, if no pressure relief is ensured: danger of destruction of tissue.

Due to the strong change of the toes and the entire foot, it becomes clear to everyone that ready-made shoes can no longer be the appropriate footwear for motor-disturbed feet. Inadequate footwear is the most common cause of diabetic foot ulceration.

Extreme caution should be taken with the slightest hyperkeratosis formation. For the affected person and also for relatives, these hemorrhages are often not visible due to the overlying hyperkeratosis.

Autonomic neuropathy

The damage of an autonomic neuropathy can affect almost all organs (heart, eyes (sicca syndrome), gastro- and urogenital tract, etc.).) concern.

The function of sweat secretion, which is normal and important in healthy people, is also reduced or completely lost in diabetics over the years. The lack of sweat formation leads to considerable rhagades and cupping in the affected persons. Due to the existing dryness of the skin and the pathological pressure load, small, sometimes invisible crack formations occur, e.g., hammer and claw cracks. B. In the area of the heel. These hairline cracks are excellent entry points for microorganisms. erysipelas (bacterial infection and inflammation of the upper skin layers) on the lower legs, often inexplicable to the therapist, occur due to the entry of germs.

In summary, inadequate footwear is responsible for the development of diabetic foot ulceration in the vast majority of cases. Next in line are incorrect foot and nail care, injuries caused by sharp objects and unnoticed scalds and burns caused by sensitive neuropathy.

Dry heel due to lack of sweat formation: rhagade with hemorrhage (entry point for germs)

dry heel due to lack of perspiration: rhagade with hemorrhage (gateway for germs)

Due to the severity of the clinical picture, timely detection in trained practices is particularly important. Adequate therapy must be initiated very quickly following a targeted diagnosis.

There are timely signs of impending charcot foot. If the patient develops a flat foot over the years, extreme caution is advised.

Autonomic neuropathy is an early identifier of multi-layered diabetic vegetative neuropathy.

Diagnostics

The following points should be included in the diagnosis:

A basal, targeted diagnosis is the best prevention.

Detailed anamnesis

  • Diabetes duration
  • complaints of the affected
  • Additional diabetes-associated symptoms such as numbness, tingling, sensory disturbances, furry feet
  • Onset, lancinating pain at rest

Foot inspection

  • Absence of sweating
  • Callus formation
  • Corns
  • Rhagades
  • Fissures
  • skin redness
  • Mycotic infestation
  • Deformities
  • skin temperature,
  • Foot pulses

Gait

  • limp
  • Misalignment
  • Rolling
  • Toe stand
  • Mobility

Polyneuropathy screening

  • Rydell-seiffer tuning fork (testing of vibration sensation)
  • Semmes-weinstein-filament (monofilament=verification of touch sensitivity)
  • warm/cold sensation (tiptherm)
  • Pointed stump sensation

Polyneuropathy screening with Rydell-Seiffer tuning fork, monofilament, and TipTherm

polyneuropathy screening with rydell-seiffer tuning fork, monofilament and tiptherm

clinical picture diabetic angiopathy

not only the neuropathies described above can lead to a wound, in many cases vascular damage (diabetic angiopathy) is also a significant factor in poorly healing wounds.

The frequency of the interaction of polyneuropathy and angiopathy occurs in ca. 35% of diseased diabetic foot complications on. Peripheral diabetic neuropathy means that the typical pain of an advanced circulatory disorder, such as rest pain or intermittent claudication, is not perceived.

The suspicion that the person concerned has already acquired an angiopathy is unfortunately often not recognized early enough. Diabetic angiopathic wounds are noticed too late or are not treated adequately. Due to the lack of pain in the feet, there is no sparing of the wound, resp. of the foot induced by the affected person. This resulting lack of protection leads to further spread of bacteria into the depth of the wound, which in turn leads to infections involving soft tissues, joints and bones and to tissue death (gangrene). In the worst case it comes then to the toe, lower leg and/or. transfemoral amputation.

Vascular damage with circulatory disturbance: vascular damage (diabetic angiopathy) is often a significant factor in poorly healing wounds.

Characteristics of angiopathic foot

Toenails with angiopathic foot nail mycosis

Typical looking angiopathic foot with nail mycosis and diabetic, already infected foot ulcer at D3 left nail fold medial

  • Mostly cold, pale, bluish-livid discolored foot
  • Dry and shiny skin
  • Loss of hair in the area of the lower leg and toes
  • Slowed growth of the toenails
  • Poor palpation to complete absence of foot pulses

Diagnostics, classification of pavk

This staging of the circulatory disorder of the lower extremities is based exclusively on the clinical symptoms. Vascular diagnostic equipment is not required for this staging according to the french surgeon rene fontaine.

Classification of pavk according to fontaine/rutherford changes
stage I no symptoms, but pavk already diagnosable
stage iia max. walking distance> 200m
stage iib max. Walking distance< 200m
stage III pain at rest
stage IV constant pain, ulcer, necrosis, gangrene
  • ABI measurement (Doppler pressure measurement)
  • Color-coded duplex sonography
  • Magnetic resonance angiography (MRA) of the pelvic and leg vessels

Summary

Lesions caused by peripheral diabetic neuropathies develop more slowly when the cause is pressure load from z. B. Inadequate footwear is. Mostly the lesions are found under the metatarsal bones or at the tips of the toes.

Lesions caused by a reduced or even completely absent blood supply heal very poorly. The wounds expand rapidly because the sensation of pain is also absent due to the polyneuropathy and there is no timely warning to the affected person.

Measures to restore the circulation situation

If there is evidence of peripheral arterial occlusive disease in the patient and there is a risk of amputation, then revascularization (restoration of blood flow) of the arteries is the main priority. Wound healing can only be expected when there is sufficient blood supply in the arteries.

According to a press release dated 16. April 2020, the joint federal committee (G-BA) decided the following:

"In future, patients with diabetic foot syndrome will be able to obtain an independent second medical opinion before an amputation of the lower extremities. Here, a qualified second opinion physician reviews the medical necessity of the planned procedure and advises on conservative and less invasive treatment options."

clinical picture of charcot arthropathy

Charcot foot ulcer with a wound on the ball of the foot

Charcot foot with ulcer under the metatarsal bone

Charcot arthropathy (diabetic neuropathic osteo-arthro-pathy, DNOAP)

Patients with demonstrable nerve damage (peripheral and autonomic diabetic neuropathies) may experience a softening of the foot bones, or. Of the arch of the foot come. Due to long-standing diabetes mellitus, charcot arthropathy is also a late consequence of a poorly controlled metabolism.

But not only patients with diabetes can get this disease, also other nerve diseases can cause this clinical picture. Finally, it is a joint disease as a consequence of neurological diseases. The sensory disturbance and the resulting no longer perceptible pain perception have a significant influence on this clinical picture. If the joints in the feet are overloaded, the skeleton of the foot breaks down with tiny fractures of the bone structure. The increased blood supply (hyperfusion) does the rest, the bone softens, the metabolism in the bones is disturbed, loss of substance of the bone mass causes the bones to become brittle.

The arch of the foot is overtired, the foot collapses spontaneously, the patient feels no pain due to the polyneuropathy and has no memory of a trauma. Due to the complete loss of sensation and feeling in the feet, the affected person continues to walk around on their broken arch of the foot. deformities of the foot occur, especially under the sole of the foot (cradle-rocking foot, see photo below). Pressure sores with pronounced hyperkeratosis as well as ulcerations then frequently develop on the sole of the foot. Foot and, in the worst case, leg amputations can then be the consequence.

Swollen foot with Charcot arthropathy

Charcot arthropathy (weighing resp. Rocking foot)

Typical charcot foot with ulcer (at predisposed site) and very pronounced toe deformity

Foot ulcer viewed from the front of the foot

Flatfoot with Charcot arthropathy

Pronounced flatfoot and incipient charcot arthropathy with lateral wound due to inadequately fitting orthopedic shoe

Due to the severity of the disease, early detection in trained practices is particularly important. An adequate therapy must be initiated very quickly after a targeted diagnosis.

There are timely signs of impending charcot foot. If the patient develops a flatfoot over the years, extreme caution is advised.

See also:

symptoms of a patient with charcot arthropathy

After a long walk, a trauma that is vaguely remembered, or even dropping an object on the foot, the arch of the foot can collapse. Symptoms are:

  • Foot overheated (feels warmer than the other)
  • Slight redness
  • Swelling of the foot
  • Conditionally painful

Only immediate complete relief of the diseased foot and targeted further diagnostics are the most important prerequisites for successful treatment.

  • X-ray
  • MRI/CT
  • Lab

Restorative measures

The first measure for recovery is the absolute immobilization of the foot, also in order to avoid further fracture or dislocation of the foot. Prevent collapse of the bones. Immobilization of the bones should cause them to repair themselves again. Now the patience of the patient is needed, because the immobilization with a total contact cast (TCC) or a two-shell orthosis and a simultaneous use of a wheelchair can take several months. Depending on the severity of the destruction of the arch of the foot, surgery by a surgeon may be necessary. In order to avoid complications after such an operation, the blood circulation situation is also decisive. After completion of immobilization, the patient’s foot is fitted with a custom shoe made over the ankle and diabetes-adapted insoles. Careful thought must also be given to the activities of the affected person in future daily life. The possibility of the other foot suffering the same fate is not uncommon.

Two-shell orthosis made of synthetic plaster (cast) in the finished state (perfect fit for the affected, already forefoot amputee foot with removable upper part for daily wound care)

Two-shell orthosis with velcro fasteners for fixation of the upper shaft

Further measures for the completion of a two-shell orthosis, such as the modeling of a sole, are worked on by a master orthopedic shoemaker.

In any case, it is important that the affected person keeps his or her feet under close supervision by the physician throughout his or her life (see the table below for the intervals between check-ups).

The goal of a patient with charcot’s arthropathy is to achieve a stable, weight-bearing foot with appropriate orthopedic footwear.

Videos: diabetic foot syndrome

Diagnostics – early detection of polyneuropathy

Video: Diabetic foot syndrome, preview image

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optimal treatment in autumn – the DRACO® videoblog

Video: Diabetic foot in autumn

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Classification

A diabetic foot with ulceration is classified according to the extent of tissue destruction and the presence of infection and/or ischemia according to the combined wagner/armstrong table.

Classification according to wagner: wagner grade

  • Wagner 0: risk foot, no injury
  • Wagner 1: superficial lesion
  • Wagner 2: deeper lesion to tendons and capsules
  • Wagner 3: lesion with involvement of the bone and/or joint
  • Wagner 4: the entire fore-, resp. hindfoot is affected
  • Wagner 5: the whole foot is affected

Classification according to armstrongarmstrong stages of diabetic foot syndrome

  • stage A: without infection
  • Stage B: with infection
  • Stage C: with ischemia
  • Stage D: with infection and ischemia.

Combined classification according to wagner/armstrong

The wagner/armstrong classification is divided into wagner grade and armstrong stages. The wagner grades from 0 to 5 indicate the depth of a wound on the foot, which has arisen as a result of the diabetic foot syndrome. The armstrong stages (A-D) are the additional aspects of an infection or/and a reduced blood supply to the foot. The following table has been established in the German-speaking countries.

Ischemic diabetic foot

Toes and heels are ischemic diabetic foot poorly supplied with oxygenated blood. Injuries heal particularly poorly, so that an open ulcer quickly develops and the surrounding tissue becomes inflamed or dies off.

Armstrong stages /
wagner grade abcd0 1 2 3 4 5
pre- and postoperative foot with infection with ischemia with infection and ischemia
surface. Wound with infection with ischemia with infection and ischemia
wound to the level of tendon u. Capsule with infection with ischemia with infection and ischemia
wound to the level of bone u. joints with infection with ischemia with infection and ischemia
necrosis of parts of the foot with infection with ischemia with infection and ischemia
necrosis of the whole foot with infection with ischemia with infection and ischemia

case examples of wagner-armstrong classifications

Foot with Wagner-Armstrong grade 0A

Wagner-armstrong grade 0A: pre/postoperative foot, risk foot: here condition after amputation D2 left, no visible foot wound present

Wagner/armstrong 1A: superficial wound on D2 r. Palmar (condition after amputation D3 re.)

Wagner/armstrong 1B: superficial wound on D3 left side. Palmar with infection and ischemia (dark colored nail)

Wagner/armstrong 2C: condition n. Amputation D2 – D5 re. Wound on metatarsal bone (MFK) 1 with view of tendon

Foot with Wagner/Armstrong 3C

Wagner/armstrong 3C,: very deep, infected wound at MFK 1 left (after probing: bone contact)

Foot with Wagner/Armstrong 4D

Wagner/armstrong 4D: partial necrosis at D2 re with infection and ischemia

In this visual, the difference between classification 1A and 1B is clear: wagner/armstrong grade 1A, wagner/armstrong grade 1B.

Treatment and therapy

The most important and essential treatment of diabetic foot ulcerations is metabolic optimization.

This is followed by infection control, debridement of dead tissue, modern wound treatment, absolute pressure relief of the foot, therapy of vascular diseases, foot surgery toe correction (tenotomy) and not to forget patient education.

Possible complications

Particularly in the case of foot wounds, the usually daily showering, footbaths or going to a swimming pool can cause undesirable microorganisms (e.g., fungi, fungi, fungi, fungi, fungi, fungi, fungi, fungi, fungi, fungi) to enter the wound.B. Pseudomonas aeruginosa and staphylococcus aureus) penetrate into the injured tissue, which can cause an infection. The extent of infection in diabetic foot syndrome is classified as mild, moderate, severe and life-threatening. Depending on the infection situation, hospitalization may be necessary in order to be able to perform surgical measures, but also to give the affected person the opportunity to completely relieve the foot with its ulcer (absolute bed rest).

Wound healing

During wound healing, many processes take place in the formation of capillaries and connective tissue.

Basically, it can be said that diabetic wounds are slower in healing. Many factors influence delayed wound healing, such as z. B.:

  • Too high blood glucose levels
  • Impaired immune defense
  • Increased susceptibility to infections
  • circulatory problems

Wound debridement:

Diabetic foot wounds are usually heavily covered with fibrin or/and a biofilm (coating of numerous microorganisms), scab and in the worst case also with necrosis.

the expansion and spreading of the important epithelial cells are strongly hindered by it. This is why debridement plays such a crucial role in the wound healing of a diabetic foot. This o.G. "foreign bodies" can usually only be removed from the wound by treatment with a curette or sharp spoon. Healthy tissue should be spared as far as possible. Unfortunately, it is often the case that healthy tissue is also damaged. In order to be able to gently remove necroses and fibrin coatings, the treating physician can apply a hydrogel at specific points.

More than 60% of amputations could be avoided by adherence to multidisciplinary therapy concepts.

Dracohydrogel

Sterile, moisturizing gel for moistening and supporting autolytic debridement of chronic and acute problem wounds.

Anesthesia or local anesthesia of the foot can be avoided as far as possible because of the polyneuropathy that has usually already been acquired.

Mechanical debridement with bio maggots (biosurgical debridement) has been used for some years now only in inpatient treatment.

Infection therapy:

Only an infection-free wound can heal. Therefore, the swabbing of a wound is essential so that a targeted antibiotic therapy can be started promptly.

Antibacterial wound dressings with polihexanide or silver have proven effective. At the same time the ideal moist milieu is ensured.

Promoting granulation

The important granulation and epithelization phase of a wound should be promoted by targeted products. If a wound is bleeding or exuding heavily, the use of alginates (e.g., algae) can be recommended. B. Dracoalgin) and hydrofibers (z. B. Dracohydrofiber) can be very helpful. A PU foam (e.g., polyurethane foam) can be used as a secondary dressing. B. Dracofoam/dracofoam infect) on. This absorbs toxic components from the wound together with the exudate due to its strong absorption capacity. The foam remains dimensionally stable, adapts to the wound and at the same time maintains the ideal moist environment which is so important for the wound.

Pressure Relief:

For patients with a current foot ulcer, immediate pressure relief is the key to further treatment success.

There are several options for relieving pressure on a diabetic foot with an ulcer:

  • Relief shoes
  • Dressing shoes
  • Wheelchair
  • Crutches
  • Total contact cast (TCC)
  • Orthosis with vacuum cushion, two-shell orthosis
  • Removal of corneal calluses

Pain therapy

Pain can always play a role in the treatment and care of diabetic foot syndrome. The cause of the pain varies from person to person and always depends on the underlying disease, other diseases, the wound itself and its treatment, and the patient’s overall condition.

A distinction must be made between the pain of acute treatment, z. B. The wound cleansing, and basically existing pain. Depending on the underlying disease, patients have more or less severe pain. These can have a negative impact on wound care and overall recovery because they are associated with increased stress levels. The blood circulation is further worsened, the oxygen supply in the tissue is reduced. These factors can then further delay wound healing. In addition, pain leads to fear of treatment and reduces the quality of life of those affected. More detailed information can be found in the article "Wound and pain".

Polyneuropathy, a nerve damage, often occurs in diabetics. These patients often have a disturbed, in particular reduced, sensation of pain in relation to the wound. Due to the limited perception of pain caused by diabetic polyneuropathy, minor injuries or pressure sores often go unnoticed and can become infected and develop into chronic wounds. If diabetic angiopathy plays an additional role, then low pain wound care can be very valuable for the patient.

Treatment of the underlying disease is of fundamental importance, in the case of diabetic foot syndrome the correct adjustment of the blood glucose level. When changing dressings, the use of modern wound dressings also offers the possibility of making this as painless as possible. Even with minor injuries, wound spacers prevent z. B. compresses stick to the wound and have to be painfully torn off when removed. Especially in chronic wounds, atraumatic dressings should be used that do not stick to the wound and can remain on the wound for several days at a time. This promotes wound dormancy and thus healing.

Healing process

With proper treatment, d.H. The wound can heal within a few weeks with treatment of the previous disease, pressure relief and a suitable wound dressing. This depends on the size and depth of the wound.

However, if the blood supply to the region cannot be restored, if the bone is affected or if there is a risk of sepsis, it may be necessary to amputate parts of the foot. The diabetic foot syndrome is responsible for ca. responsible for 70% of amputations in germany. With dedicated therapy and the cooperation of the affected person, it should be possible to reduce this number in the future.

Generally, chronic wounds occur because there is a certain underlying disease that prevents the wound from healing. Very often, circulatory disturbances are responsible for this. A wound can only heal if it is supplied with sufficient nutrients and oxygen. This is often not the case with circulatory disorders. Therefore, the treatment of the underlying disease is essential.

All wounds heal in the same sequence, although the duration of the phases may vary from individual to individual. In the beginning, wounds are always in the cleansing phase (exudation phase). In this phase, the body tries to flush foreign bodies and bacteria out of the wound by increasing the amount of fluid. Chronic wounds often get stuck in this phase and do not manage to fight a possible wound infection on their own. This can be supported by the use of antiseptic irrigation solutions and wound dressings (s. infected wounds).

When wound cleansing is complete, granulation tissue is formed. In this second phase, the lost tissue is formed anew. This occurs through the formation of a supporting structure and the formation of new vessels. Fibroblasts migrate from the wound environment and form the new tissue. This tissue will later remain visible as a scar. The granulation tissue fills the wound from bottom to top and from the outside to the inside. This can take several weeks to months, depending on the size and depth of the wound. The tissue then forms the basis for the subsequent epithelialization phase.

In this phase the final skin is formed, which finally closes the wound. The cells migrate in from the wound edges and cover the wound from the outside to the inside. This scar tissue will also remain visible as such. The epithelial tissue closes the wound.

During the healing of a chronic wound, or. A wound with a major loss of tissue always heals with scarring. The body cannot regenerate the lost tissue, but only replace it. However, this filler or scar tissue no longer achieves the functionality or stability of normal skin. Therefore, new wounds often develop at these sites. Such a scar takes at least 12 months to stabilize and mature. Care and protection of the scar are important to prevent the formation of a new wound.

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Christina Cherry
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