How Should Wound Care Be For Diabetes Patients?
What should a diabetic do if a wound is still opened on his foot despite all his efforts to control his diabetes and all his protective attempts to prevent scarring? How should he behave to close this wound? Perhaps more importantly, what should not be done to worsen the wound?
No matter how many years the patient has been diabetic, there is always a reason that opens the wound, regardless of the level of circulatory and sensory defects in the foot. This is a simple cut, ingrown toenails, shoe hurt, etc. First of all, it is clear that the wound will not close, and even worse, unless the factor that causes the wound is removed. Continuing to use a shoe that hits the foot of the patient will deepen and aggravate the wound. If a patient is injured while cutting their toenails, the wound will worsen if it continues to tamper with the wound. If a patient burns his foot and continues to apply heat, the wound will not heal, and of course, it will get more severe.
The first condition for healing a standing wound is the so-called “unloading” procedure. This can be briefly defined as not stepping on the wound. However, it is necessary to never put any weight on the wound, not only while walking but also while lying or sitting. So the wound must always stay up.
The main reason for the wound opening may be a circulatory disturbance. In this case, unless the circulation is corrected, the wound will not heal unless blood is supplied. The wound should be taken seriously and evaluated as soon as it is opened by a healthcare professional or team specialized in wound care.
Who Should Perform Wound Care for Diabetes Patients?
Wound occurring in diabetic patients is not a simple problem. It must be taken very seriously. A simple wound can lead to serious consequences. For this reason, the patient may lose his / her tissues, limbs, and even his / her life. Even if it does not necessarily end badly, the treatment may be prolonged. It can take the days and months of the patient, and he can get rid of his work. Therefore, wherever the wound is, no matter how simple its appearance, it should be taken very seriously and treated appropriately.
The wounds of diabetics are not the same. Even the same wound is not the same day after day. It is ideal to be treated by a healthcare professional who knows the difference between wounds and the needs of the wound. This could be wound centers in hospitals, wound councils in large hospitals, a family doctor who carries out wound care, or a healthcare professional dealing with wound care in-home care teams. Wound care provided by the patient himself or his relatives often cannot meet the changing needs of the wound. Goodwill efforts can cause the wound to become infected and worsen. However, both diabetics and their relatives must know the principles of wound care.
Wound cleansing (care) for diabetes patients
The wound should be cleaned regularly. Thus, the microbes settling on the wound can be removed, the wound can be moistened, the excess discharge can be removed and the dried discharge can be cleaned. Some wounds need to be cleaned once a day, some every few days. The most frequently used substance in the cleaning process is water with the same salt ratio as our blood, called saline. In cases where it is not available, normal water can also be used for cleaning. However, it is necessary to make sure that this water is clean and free of germs. For this reason, tap or drinking water that has been pre-boiled and cooled can also be used.
If we need to describe wound cleaning very simply, it can be said that it is washing the inside of the wound with sterile water or saline. Some substances used to kill germs, products such as alcohol, tincture iodine, and other iodinated compounds, etc. also delay wound healing. For this reason, these substances are not applied to the wound in simple dressing and wound cleaning. Such products are applied to the wound environment and the surrounding area is cleaned. Their use is in the form of circular erasing from the inside out. Even applying it to intact skin to clean around the wound sometimes causes problems and allergies.
The biggest effect of wound cleaning is to remove undesirable dead tissues, residues, excessive discharge, and tissues that are suitable for the establishment of microbes. This process is commonly called “debridement”. The simplest debridement procedure during dressing is to remove the gauze stuck to the wound while removing these tissues. When large amounts of debridement are needed, this is not what the patient can do on his own, but can be done surgically.
After cleaning the wound, it is necessary to cover it. In this way, protection against harmful substances from the outside world, such as microbes, is provided. Excess wound discharge is absorbed, wound drying is prevented, the temperature of the wound is maintained. The simplest of these materials that cover the wound is a cotton fabric called gauze. After the gauze is placed on the wound, it is wrapped with a bandage or stuck with tape. On the other hand, there are a wide variety of occlusive dressings. Some of these are high-tech production, but they come at a cost. An ideal dressing cover is expected to have the following properties:
- Protected from bacteria and foreign substances
- It should create a warm and humid environment
- It should absorb the discharge
- It should not be harmful and allergic
- Should prevent heat and fluid loss
- The environment should not harm healthy tissues
- Its structure should not deteriorate (lint etc.)
- Must be non-stick
- It should be aesthetic
It is almost impossible to find a dressing material with all these qualities. Even so, it is a fact that the wound will change from day to day and their needs will change. For example, a dressing material used for a low-flow wound should protect it from drying out. However, if the wound starts to increase the discharge, this time the dressing material should be changed and a product with high absorbency should be used. If there is any sign of microbe contamination in the wound, it should be replaced with a product produced for this purpose. These evaluations can only be made by a healthcare professional specialized in wound treatment.
It is known that patients sometimes apply a wide variety of substances to the wound. The use of some herbal products, ointments of unknown form, various chemical compounds, medicines used for other purposes, and even unreasonable use of products such as toothpaste does not heal the wound, on the contrary, it makes it unmanageable.
The most important danger that will worsen and aggravate the wound of diabetic patients and disrupt the healing process completely is that the wound is infected with microbes. Diabetes patients are already resistant to microbes. An open wound is also an excellent door for germs to enter the body. Unfortunately, germ transmission most often occurs during wound dressing. Sterile dressings may not be applied by the patient himself or his relatives. The wound environment is very suitable for microbes. Here they hold, settle and begin to multiply. If they can reach a sufficient number, they also spread to healthy tissues. This time around the wound and in the patient, symptoms such as fever, pain, swelling, redness, weakness begin to be seen. A simple wound that is not taken seriously suddenly puts the patient’s limb and even his life under threat. Whether the wound is contaminated with microbes, whether a special dressing material should be used for this, or whether the infection is at the level of using antibiotics can only be evaluated by a physician.
Special wound care products for diabetes patients
Sometimes, according to the needs of the wound, wound care products containing ingredients to meet this need are used. These may be in the form of liquid, sometimes ointment, and sometimes wound dressing. A wide variety of products are available in the market, such as pain relievers, antimicrobials, substances effective in various stages of wound healing, growth factors, cleansing products, disintegrating products, etc. Which product, which substance, which wound, and when to use is a matter of expertise. No wound care product can be used continuously for all kinds of wounds.
Patients sometimes tend to use products recommended by others. These products may indeed have worked for other patients. However, it should not be forgotten that every wound is different. Choosing a product with hearsay information can lead to aggravation of wounds.
Special treatments used for the wound
In addition to various wounds, there are some special devices and treatments used for the wounds of diabetic patients: Negative pressure wound therapy, hyperbaric oxygen therapy, larva therapy, stem cell, ozone therapy, laser, light, electrical treatments, etc… Some of these treatments either have no effect on the wounds of diabetic patients or are effective only in some types. Moreover, the costs of these treatments on the patient can be quite high. There is no such treatment or device that should be used in all kinds of diabetic wounds. Unless the decision of which wound and when these treatments are needed is made by physicians who specialize in wound treatment, patients should not turn to these treatments with hearsay recommendations.