MANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING DR NORLIZAH PAIDI FAMILY MEDICINE SPECIALIST KLINIK KESIHATAN BANDAR MAS KOTA TINGGI JOHOR

Transcription

1 MANAGEMENT OF DIABETIC WOUNDS : HEALTH CLINIC SETTING DR NORLIZAH PAIDI FAMILY MEDICINE SPECIALIST KLINIK KESIHATAN BANDAR MAS KOTA TINGGI JOHOR

2 OUTLINE DEFINITION FACTORS CONTRIBUTING TO WOUND DEVELOPMENT WOUND HEALING PROCESS TYPES OF WOUND IN PRIMARY CARE SHARING EXPERIENCE

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4 FACTORS CONTRIBUTING TO WOUND Impaired circulation: Ischemia or stasis. Ischemia : Reduced blood supply due to the narrowing or blockage of blood vessels Stasis : immobilization for long periods or failure of the regulating valves in the veins Neuropathy: This is seen mostly in cases of prolonged uncontrolled diabetes mellitus Medical illness: such as hypertension, hyperlipidemia, arthrosclerosis, diabetes mellitus, AIDS, malignancy, morbid obesity, hepatitis C virus, etc.) medical illnesses can lead to impairment of the immune system functions, diminishing the circulation and damaging other organs and systems.

5 DIABETIC WOUNDS External Skin Cuts Burns Bumps Bruises Internal Ulcers Ingrowing toenails calluses

6 DIABETIC FOOT ULCER Approximately 15-20% of the estimated 16 million persons in the US with Diabetes Mellitus will be hospitalized with a foot complication at some time during the course of their disease It has been estimated that every 20 seconds a lower limb is amputated due to complications of diabetes

7 WHERE ARE WE? NHMS 2015 Prevalence of diabetes in Malaysia had increase a relative 15% 15.2% in 2011, 17.5% in 2015 every one DIANGNOSED DM, there is one UNDIAGNOSED

8 WHERE ARE WE? Major limb amputations in Seremban Hospital: a review of 204 cases from Medical Journal Of Malaysia;2001 Non traumatic amputations constitute 85.8% of the cases mainly due to diabetic ulcers or gangrene (91%) followed by peripheral vascular disease (7%) and malignancy (2%).

9 PHYSIOLOGY OF WOUND HEALING

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11 the primary goal of wound care is not the technical repair of the wound; it is providing optimal conditions for the natural reparative processes of the wound to proceed Richard L. Lammers (Roberts and Hedges)

12 FACTORS AFFECTING WOUND HEALING Extrinsic Factors Mechanical stress Debris Temperature Desiccation and maceration Infection Chemical stress Medications Other factors such as alcohol abuse, smoking, and radiation therapy

13 FACTORS AFFECTING WOUND HEALING Intrinsic Factors Health status Age factors Body build Nutritional status

14 TYPES OF WOUND IN PRIMARY CARE PKD KOTA TINGGI 2016

15 HOW DIABETIC WOUND IS MANAGED?

16 CARTA ALIR

17 CLERKING SHEET

18 CONT.

19 WOUND ASSESSMENT

20 IDEAL WOUND DRESSING GENERAL Easy to apply and maintain Aesthetically pleasing Cost permissive Easily stored Non allergenic Facilitate healing Maintain moist environment Minimize trauma/maceration Retention of heat Facilitate gas exchange Minimize risk of infection Debride necrotic tissue Absorb exudate Minimize external contamination Remove excess exudate Waterproof Maintain moist wound healing environment Trauma protection Allows gaseous exchange if appropriate Non adherent Provide barrier to pathogens Safe and easy to use Provide thermal insulation Am J Clin Dermatol (2013) 14: MOH Wound Care Manual Firt Edition (2014)

21 DR. WOUND SILVER ANTISEPTIC SPRAY Antiseptic/cleaning DR. WOUND DEBRID GEL Autolytic debridement No pain, no bleeding DR. WOUND POWDER Granulation DR. WOUND CHITOHEAL GEL Faster wound healing Moisture balance DR. WOUND ABSORBENT PAD Absorbs exudates 3000% absorption power

22 SILVER ANTISEPTIC Spray Kills bacteria, fungus & viruses + CHITOHEAL Gel Fasten wound healing process

23 USAGE METHOD For clean to medium infection wound (low mild level of exudate) : 1. Spray Silver Antiseptic Spray thoroughly on the wound bed 2. Leave it for 45 secs 1 min 3. Apply ChitoHeal gel 4. Cover wound with any secondary dressing (if necessary) (example : Normal gauze / Paraffin gauze)

24 USAGE METHOD For challenging wound : (presence of slough or necrotic tissues) 1. Spray Silver Antiseptic Spray thoroughly on the wound bed 2. Leave it for 45 secs 1 min 3. Apply Dr Wound Debrid gel 4. Cover the wound with any secondary dressing (example : Normal gauze / Paraffin gauze)

25 USAGE METHOD For challenging wound : (wound with cavity / tunnel / pocket) 1. Spray Silver Antiseptic Spray thoroughly on the wound bed 2. Leave it for 45 secs 1 min 3. Apply Dr Wound powder 4. Apply ChitoHeal gel 5. Cover the wound with secondary dressing (example : Normal gauze/ Paraffin gauze)

26 USAGE METHOD For highly exudative wound : 1. Spray Silver Antiseptic Spray thoroughly on the wound bed 2. Leave it for 45 secs 1 min 3. Cover the wound with Dr Wound Absorbent Pad

27 ADVANTAGES OF CHITOSAN DRESSINGS

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29 CASE SHARING

30 MZM/45/MALAY/MALE/DM NAIL PRICK OVER RT FOOT DA Y 1 DA Y 15 DA Y 50 DA Y 53

31 RM/64/MALAY/FEMALE/DM DFU OF RIGHT FOOT 2/6/2016-DAY 1 15/9/2016-DAY 73 4/10/2016-DAY 89

32 7/10/2016-DAY92 20/10/2016-DAY 123

33 5/12/2016 8/1/2017 LAST REVIEW

34 AA/MALAY/MALE/DM DFU OF RIGHT LEG 22/9/2016- DAY 1

35 2/10/2016- DAY 10 14/10/2016- DAY 24 7/11/2016- DAY 48

36 23/11/2016 DAY 65

37 MSK/78/MALAY/MALE/DM ALLEGED MVA (MB EXZOS) RT LEG DAY 1 DAY 3

38 PRACTICAL TIME!