DIABETIC FOOT

50 %
50 %
Information about DIABETIC FOOT
Science-Technology

Published on February 3, 2009

Author: aSGuest12035

Source: authorstream.com

DIABETIC FOOTbyDr. Li Wei Hao : DIABETIC FOOTbyDr. Li Wei Hao Diabetic foot characteristics Sensory neuropathie. Motor neuropathie. Autonomic neuropathies: may lead to islands of cutaneous ischaemia,caused by alterations in blood flow : Diabetic foot characteristics Sensory neuropathie. Motor neuropathie. Autonomic neuropathies: may lead to islands of cutaneous ischaemia,caused by alterations in blood flow Foot deformities.Alteration of pressure distribution.Ulcerations & Infections.Classical "mal perforans" ulcer.Caused by loss of sensation & painless trauma. Can occur in absence of ischaemia.Frequently heals with conservative measures.Aggressive wound management.Unweighting : Foot deformities.Alteration of pressure distribution.Ulcerations & Infections.Classical "mal perforans" ulcer.Caused by loss of sensation & painless trauma. Can occur in absence of ischaemia.Frequently heals with conservative measures.Aggressive wound management.Unweighting Diabetes mellitus important risk factor Diabetic vasculopathy:sustained by macroangiopathy ,sustained by impairment in flow in small vessels,sustained by innervation of vascular bed. : Diabetes mellitus important risk factor Diabetic vasculopathy:sustained by macroangiopathy ,sustained by impairment in flow in small vessels,sustained by innervation of vascular bed. Basic mechanism of problem woundsTissue hypoperuIision, ischaemia & infection ,Ischaemia caused by hypoperfusion. Defective cellular immunity.Defective humoral immunity.Synergistic effect of ischaemia & impaired immune response .Atherosclerosis.Decreased chemotaxis.Decreased phagocytosis.Decreased chemotactic response.Reduced inflammatory reaction. Abnormal lymphocytic function : Basic mechanism of problem woundsTissue hypoperuIision, ischaemia & infection ,Ischaemia caused by hypoperfusion. Defective cellular immunity.Defective humoral immunity.Synergistic effect of ischaemia & impaired immune response .Atherosclerosis.Decreased chemotaxis.Decreased phagocytosis.Decreased chemotactic response.Reduced inflammatory reaction. Abnormal lymphocytic function Areas of low flow & hypoxiaEven possible in presence of palpable arterial pulses.Feet & ankles. Contributing factors:increased blood viscosity,decreased red blood cell deformability,platelet aggregation,accelerated capillary endothelial growth,hypoperfusion possible mechanism of injury to subendothelial area of vessels,capillary wall hyalinization leading to capillary obstruction.Even restored circulation can fail wound healing.Non-diabetics respond to local tissue stress with inflammation .Diabetics respond to local tissue stress with thrombosis & necrosis : Areas of low flow & hypoxiaEven possible in presence of palpable arterial pulses.Feet & ankles. Contributing factors:increased blood viscosity,decreased red blood cell deformability,platelet aggregation,accelerated capillary endothelial growth,hypoperfusion possible mechanism of injury to subendothelial area of vessels,capillary wall hyalinization leading to capillary obstruction.Even restored circulation can fail wound healing.Non-diabetics respond to local tissue stress with inflammation .Diabetics respond to local tissue stress with thrombosis & necrosis Hyperbaric oxygen in wound healing Fundamental role of oxygen in physiology of wound healing .Hypoxia impairs wound healing. : Hyperbaric oxygen in wound healing Fundamental role of oxygen in physiology of wound healing .Hypoxia impairs wound healing. Hypoxia impairs leucocyte bacterial killing functionDiabetic wounds are polymicrobial.High incidence of anaerobic organisms.HBO:Increases killing ability of leucocytes Lethal to certain anaerobic bacteria.Inhibits toxin formation by certain anaerobes : Hypoxia impairs leucocyte bacterial killing functionDiabetic wounds are polymicrobial.High incidence of anaerobic organisms.HBO:Increases killing ability of leucocytes Lethal to certain anaerobic bacteria.Inhibits toxin formation by certain anaerobes Oxygen tension determinant of wound healingTcpO2 in non-healing diabetic wounds:Far below wound healing level.Breathing 100 % O2 not enough.HBO:TcpO2 elevation .TcpO2 levels stay above baseline next 3 - 4 hours.Generation of oxygen free radicals. No increase tissue damage .No vasoconstrictive effect in ischemic or hypoxic tissue : Oxygen tension determinant of wound healingTcpO2 in non-healing diabetic wounds:Far below wound healing level.Breathing 100 % O2 not enough.HBO:TcpO2 elevation .TcpO2 levels stay above baseline next 3 - 4 hours.Generation of oxygen free radicals. No increase tissue damage .No vasoconstrictive effect in ischemic or hypoxic tissue Perfusion delivery of oxygen to wound areaMany factors cause impaired oxygenation in diabetic foot : Perfusion delivery of oxygen to wound areaMany factors cause impaired oxygenation in diabetic foot HBO:Oxygen delivery along partial pressure gradient.Increases flexibility of red blood cells.Acts synergistically on blood flow with pentoxifylline .Reduces tissue edema .Preserves intracellular adenosine triphosphate .Maintains tissue oxygenation in absence of hemoglobin .Stimulates fibroblast growth.Increases collagen formation & deposition.Promotes more rapid growth of capillaries Terminates lipid peroxidation : HBO:Oxygen delivery along partial pressure gradient.Increases flexibility of red blood cells.Acts synergistically on blood flow with pentoxifylline .Reduces tissue edema .Preserves intracellular adenosine triphosphate .Maintains tissue oxygenation in absence of hemoglobin .Stimulates fibroblast growth.Increases collagen formation & deposition.Promotes more rapid growth of capillaries Terminates lipid peroxidation HBO can not:Substitute surgical revascularization in advanced arterial insufficiency.Reverse an inadequate microvascular circulation : HBO can not:Substitute surgical revascularization in advanced arterial insufficiency.Reverse an inadequate microvascular circulation Pathophysiology HBO is application of physical laws in a known pathophysiologic process. Indication is pathophysiology of local & focal hypoxia.HBO is able to reverse hypoxia : Pathophysiology HBO is application of physical laws in a known pathophysiologic process. Indication is pathophysiology of local & focal hypoxia.HBO is able to reverse hypoxia When to consider HBO in diabetic foot ulcers? Foot & ankle ulcers with Wagner grading 3, 4 or 5.Amputation seems unavoidable : When to consider HBO in diabetic foot ulcers? Foot & ankle ulcers with Wagner grading 3, 4 or 5.Amputation seems unavoidable Classification of problem woundsWagner grading system .later adapted by Boulton .0 obvious ulcer in a foot at risk.5 gangrene of whole foot.Ulcers grades 1 - 3 tend to be neuropathic.Ulcer grades 4 & 5 are mainly vascular : Classification of problem woundsWagner grading system .later adapted by Boulton .0 obvious ulcer in a foot at risk.5 gangrene of whole foot.Ulcers grades 1 - 3 tend to be neuropathic.Ulcer grades 4 & 5 are mainly vascular Wounds unsuccessfully treated for weeks or months:Local wound care.Surgical débridements.Antibiotics. Reconstructive vascular surgery.Adequate metabolic control of diabetes mellitus.Control of infection. Non-invasive vascular evaluation.Angiographic vascular evaluation.Judge peripheral perfusion. If possible arterial reconstructive surgery : Wounds unsuccessfully treated for weeks or months:Local wound care.Surgical débridements.Antibiotics. Reconstructive vascular surgery.Adequate metabolic control of diabetes mellitus.Control of infection. Non-invasive vascular evaluation.Angiographic vascular evaluation.Judge peripheral perfusion. If possible arterial reconstructive surgery Transcutaneous oxygen mappingPatient selection by oxygen challenge test:Measure TcpO2 while breathing normoxic air.100 % normobaric O2 advocated.100 % hyperbaric O2 advocated : Transcutaneous oxygen mappingPatient selection by oxygen challenge test:Measure TcpO2 while breathing normoxic air.100 % normobaric O2 advocated.100 % hyperbaric O2 advocated TcpO2 predictive value for HBO outcome188 patients with diabetic leg or foot ulcers .TcpO2 < 20 mm Hg.Significantly more ulcers.Significantly more amputations : TcpO2 predictive value for HBO outcome188 patients with diabetic leg or foot ulcers .TcpO2 < 20 mm Hg.Significantly more ulcers.Significantly more amputations Successful wound healing after amputation .TcpO2 > 40 mm Hg required.TcpO2 > 100 mm Hg all wounds healed. Wound aggravation .TcpO2 < 100 mm Hg no improvement.Great likelihood healing .TcpO2 > 400 mm Hg : Successful wound healing after amputation .TcpO2 > 40 mm Hg required.TcpO2 > 100 mm Hg all wounds healed. Wound aggravation .TcpO2 < 100 mm Hg no improvement.Great likelihood healing .TcpO2 > 400 mm Hg Healing chances :TcpO2 < 5 mm Hg healing chances 0% amputation. TcpO2 > 20 mm Hg healing chances 20 %.TcpO2 > 35 mm Hg healing chances : Healing chances :TcpO2 < 5 mm Hg healing chances 0% amputation. TcpO2 > 20 mm Hg healing chances 20 %.TcpO2 > 35 mm Hg healing chances Indication for HBO treatment .Lille Consensus meeting 1994 100 % O2 breathing at 2,5 ATA.Toe TcpO2 > 30 mm Hg.Ankle TcpO2 > 75 mm Hg : Indication for HBO treatment .Lille Consensus meeting 1994 100 % O2 breathing at 2,5 ATA.Toe TcpO2 > 30 mm Hg.Ankle TcpO2 > 75 mm Hg HBO selection criteria (8).Jefferson C. Davis Wound Care & Hyperbaric Medicine Center.San Antonio, Texas.Normoxic air breathing.IF TcpO2 > 40 mm Hg.THEN no HBO. Normoxic air breathing.IF TcpO2 10 - 40 mm HgTHEN test 100 % O2 breathing at 1 ATA.IF TcpO2 rise > 50 %THEN HBO. Normoxic air breathing.IF TcpO2 < 20 mm HgTHEN test 100 % O2 breathing at 1 ATA.IF TcpO2 rise = 0%.THEN no HBO amputation unavoidable : HBO selection criteria (8).Jefferson C. Davis Wound Care & Hyperbaric Medicine Center.San Antonio, Texas.Normoxic air breathing.IF TcpO2 > 40 mm Hg.THEN no HBO. Normoxic air breathing.IF TcpO2 10 - 40 mm HgTHEN test 100 % O2 breathing at 1 ATA.IF TcpO2 rise > 50 %THEN HBO. Normoxic air breathing.IF TcpO2 < 20 mm HgTHEN test 100 % O2 breathing at 1 ATA.IF TcpO2 rise = 0%.THEN no HBO amputation unavoidable TcpO2 value predicts wound healing .Literature review by Matos and Nuñez. ± 350 patients. 161 healthy volunteers. Objective criterium.Reliable method to predict wound healing.Determine level of amputation in advance. : TcpO2 value predicts wound healing .Literature review by Matos and Nuñez. ± 350 patients. 161 healthy volunteers. Objective criterium.Reliable method to predict wound healing.Determine level of amputation in advance. Slide 30: ALL WORK and NO PLAY; MAKES a dull DOCTOR

Add a comment

Related presentations

Related pages

Diabetic foot - Wikipedia, the free encyclopedia

Epidemiology of diabetic foot syndrome. Around 15% of diabetics encounter a foot ulcer at some point in their lives. The reported incidence and prevalence ...
Read more

Diabetic Foot: MedlinePlus - National Library of Medicine

Diabetes: Good Diabetes Management and Regular Foot Care Help Prevent Severe Foot Sores (Mayo Foundation for Medical Education and Research ...
Read more

Diabetic Foot | 8th international symposium on the ...

Impressions of the 7th international symposium on the diabetic foot | May 20-23, 2015 | The Hague, The Netherlands.
Read more

Diabetic foot ulcer - Wikipedia, the free encyclopedia

Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. Wound healing is an innate ...
Read more

Diabetic Foot Care: Education & Tips on Foot Problems

Read about diabetic foot care. Causes of foot problems in people with diabetes include footwear, nerve damage, poor circulation, trauma, infections, and ...
Read more

Foot Complications: American Diabetes Association®

Foot Complications. People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.
Read more

Diabetic Foot Infections: Practice Essentials, Background ...

Foot infections are the most common problems in persons with diabetes. These individuals are predisposed to foot infections because of a ...
Read more

# Diabetic Foot - diabetes signs

★ Diabetic Foot ★ ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ DIABETIC FOOT ] The REAL cause of Diabetes (and the ...
Read more

Management of Diabetic Foot Ulcers - PubMed Central (PMC)

Diabetic foot is a serious complication of diabetes which aggravates the patient’s condition whilst also having significant socioeconomic ...
Read more

Diabetes and Foot Problems - MedicineNet

Learn more about diabetes related foot problems. For people with diabetes, too much glucose in the blood can cause serious foot complications such as nerve ...
Read more