When Diabetic Foot Ulcers Can Be Managed At Home

Author(s): 
By Ronald A. Sage, DPM

Keep in mind that even if the patient has adequate perfusion and the infection has been controlled, the ulcer may still fail to heal if the patient has a poor metabolic status. Anemia, poor control of diabetes and nutritional deficits contribute to faulty wound healing. To address these issues, have the patient see a primary physician, internist or endocrinologist.7
Once one has controlled the infection, obtained adequate vascular status and initiated attempts at metabolic control, the wound is ready for home care. Non-infected, neuropathic, non-ischemic ulcerations may present in this condition. Sometimes hospitalization may be required for surgical debridement, initiation of antibiotics or bypass surgery to achieve this appearance. However, once one has brought the wound to a viable appearance, the home is a very acceptable setting for further care.

What One Illustrative Case Study Reveals
In one case, the patient was a 60-year-old male, who had suffered from type II diabetes for over 20 years. He presented with an infected deep necrotic ulceration of the hallux, which we classified as a III-D ulcer. We performed a hallux and partial first metatarsal amputation to stabilize an acute limb-threatening infection. Our peripheral vascular consultation concurred with the diagnosis of vascular disease, but felt the patient had adequate perfusion for healing. An infectious disease consult recommended six weeks of IV antibiotic therapy based on deep cultures that were taken during surgery and were consistent with osteomyelitis.
We stabilized the wound in the hospital to the appearance shown in the above photo with wet to dry saline dressings. The visiting nurse performed wound cleansing and calcium alginate dressing changes every one to two days and monitored for signs of infection. The podiatrist performed debridement every one to two weeks as necessary to maintain a viable wound. The patient used a walker and wheelchair for mobility. In the bottom right photo, one can see the patient’s wound after three weeks of home care. In the bottom left photo, one can see the almost healed wound after six weeks of home care.

A Closer Look At Debridement, Dressings
And Topicals In The Home Setting
Debridement, dressings and offloading are well-established principles of wound healing. These latter measures may not require hospitalization and can be performed in a home care setting.

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