Management of Diabetic Foot Ulcers - Essay Example

Management of Diabetic Foot Ulcers Introduction The management of wounds is a clinical practice that has been with the nursing and healthcare profession since time immemorial. Scott (2013) however noted that the approaches to wound management have not remained same over the years. With advancement of time, Forbes and Fetterolf (2012) made mention of improvement in the approaches, strategies and interventions used in wound management. Blumberg et al. (2012) also mentioned the fact that the overall depend on healthcare managers in the management of wound have lessened due to advancement in knowledge which is backed by improved technology and medicinal discoveries. In effect, the history or evolution of wound management is one that can be said to have been on a smooth path of improvement. This assertion is what the current paper seeks to critique by putting a specific clinical issue relating to wound management in context. The paper discusses the evolution of the management of diabetic foot ulcers to ascertain how this clinical area of foot management has also benefited from the purported improvement and advancement in professional practice as seen earlier. The paper’s aim is therefore to understand the outstanding achievements with the management of diabetic foot ulcers, whilst identifying areas for further improvement in this area of clinical practice. The paper’s conclusion will therefore take a stand on whether the management of diabetic foot ulcers have experienced desired growth while making recommendations based on any identified shortfalls in professional clinical practice. Clinical questions In order to ensure that the entire research writing is well focused within a scope that does not deviate from its objectives, some specific clinical questions are set to be answered in the course of the writing. These questions are presented below and further analysed with the use of evidence from previous literature. 1. What is the history associated with the management of diabetic foot ulcers? 2. What are the major changes in the approaches to the management of diabetic foot ulcers? 3. How has the evolution of diabetic foot ulcer management been met with improved clinical practices? Key terms and explanation of the clinical issue There are some key terms that will be of major importance in the review of previous literature and in helping to achieve the aim of the paper by answering the clinical questions that have been set. These key terms are focused on the clinical issue of diabetic foot ulcer management and include diabetic foot ulcers, best practices, glycamic control, promotion of healing, amputation, wound care, and multidisciplinary care. The clinical issue of management of diabetic foot ulcers is an area of multidisciplinary care. This means that there is no single all-conclusive approach or principle that can be followed or used to attain desired outcomes (Sohn (2010). Most previous researchers have therefore followed the use of different interventions, all of which have been done with the aim of finding the most workable and applicable ways to achieve desirable outcomes with the management of diabetic foot ulcers. The importance of the clinical issue of diabetic foot ulcer management can be related to the complicity of diabetic foot ulcer. For example, The Diabetes Health Centre (2015) noted that diabetic foot ulcer occurs in 15% of all patients while leading to lower-leg amputations in up to 84% of patients who develop the ulcers. This is certainly an alarming situation that requires pragmatic solution tied around not just one area of outcome but through multidisciplinary care. As part of the use of multidisciplinary care, Forbes and Fetterolf (2012) argued that the best way to guarantee success by reducing number of lower-leg amputations emanating from diabetic foot ulcers is through the use of best practices in wound management as a whole. Review of relevant scientific evidence in previous literature There are a number of studies that have been taken to focus on the chronology of treatment and care of diabetic foot ulcer. In one such study by Vyas and Vasconez (2014), the history of diabetic foot ulcer was related to the overall history of wound care where it was found that management of wound can be traced as far back to prehistory era before modern medicine. Before modern medicine, Scott (2013) indicated that most of the approach to wound care was through natural healing. This means that no special medications or specialised professional management approaches were rendered. This was largely due to the scarcity of knowledge in the area of wound healing processes. There was also scarcity of equipment and technology that could be used to facilitate the management of wounds, including diabetic foot ulcers. The inefficiency of natural healing has clearly been acknowledged by Jørgensen (2011) who mentioned that in most cases of diabetic foot ulcer, natural healing is impossibility. With time, Vyas and Vasconez (2014) observed that there was a shift in wound care to focus on the use of herbal remedies. The use of herbal remedies was common in ancient history where the necessity of hygiene and approaches aimed at the halting of bleeding became a major focus. Ignaz Philipp Semmelweis is associated with the first advancement in wound care in 19th century as he focused on the use of hand washing and cleanliness for the prevention of maternal deaths. Into the 20th century, knowledge on diabetic foot ulcer management increased with the discovery of several wound dressing techniques and approaches. Some of the techniques and approaches used in the 20th century that remain useful today are absorptive fillers, hydrogel dressings, and hydrocolloids (Lebrun, Tomic-Canic & Kirsner, 2010). Sohn (2010) lamented that a major limitation associated with 20th century wound dressing techniques was lack of proper studies and research on dressings and creams containing silver. The place of alginate dressing has also been confirmed not to have been properly researched in the 20th century as part of techniques for wound dressing (Blumberg et al., 2012). Once research was intensified, very useful discoveries were made with the treatment of diabetic foot ulcers towards the latter end of the 20th century and up to date. Some of these discoveries include the use of platelet-rich fibrin therapy which utilises techniques that isolates a fibrin rich in platelets from the main stream of blood so as to promote natural healing through enhanced growth factors (Jørgensen, 2011). The use of hyperbaric oxygen was also confirmed in 2004 as an effective means of reducing amputation and improves healing when used during the first year of wound development (Lebrun, Tomic-Canic & Kirsner, 2010). From prehistory era till date, one thing that most researchers agree to is that prevention of diabetic foot ulcer is almost impossibility (Diabetes Health Centre, 2015). However once the ulcers have been developed, complications and mutilation can be avoided through effective care. It is for this need that research on best practices in managing diabetic foot ulcers have not seized till date. Into the 21st century, a major discovery that has been made with wound management in diabetic patients is the use of multidisciplinary care. In a study by Chiu (2011), it was found that “factors that delay wound healing are multiple and relate both to diabetes and to the effect of its complications” (p. iii). This led to the use of multidisciplinary care principles by the researchers involving glycaemic control, promotion of healing, and wound care. As part of the principle of glycaemic control, the researchers used impairment of the structure and function of connective tissue and cells to improve the function of peripheral vascular disease and neuropathy. As part of the principle of promotion of healing, surgical revascularization and specific attempts to correct defined biological abnormalities thought to be hindering the healing process were used. Finally, wound care involved “regular inspection, cleansing and removal of surface debris, elimination of pathogenic bacteria and creation of an appropriate environment to facilitate endogenous tissue regeneration”. The outcome of this multidisciplinary care showed improved healing rate with reduced amputations (Chiu, 2011). Conclusion and recommendation for better practice From the review so far, it is possible to conclude that it is not always possible to prevent an ulcer. The good news however is that it is always possible to prevent an amputation. These conclusions come with a lot of implications to professionals in the field of wound management. First, there is an implication that nurses and other healthcare practitioners must always be on the lookout to expert more cases of diabetic foot ulcers. This is as a result of the high rate of probability of the onset of ulcers recorded in literature. Second, as these cases of diabetic foot ulcers are received, the real hopes of the patients in maintaining their legs rest with the professionals and the level of best practices attached to the management of the wounds. In sum, the conclusion of the paper reveals that the management of diabetic foot ulcers need to be taken extra serious. Meanwhile the review also helps in identifying some ways in which this goal can be achieved. First, for best practice to be attained, it is recommended that the option of multidisciplinary care be continued. This is because that is the only way of dealing with different diversities with patient wound demands. Second, it is recommended that follow-up will be given a very important place in the management of diabetic foot ulcers. This is because it is through such follow-ups that complications associated with the ulcers can be identified early enough to offset the application of every needed form of intervention to avoid amputation. References Blumberg, S.N. et al. (2012). The role of stem cells in the treatment of diabetic foot ulcers. Diabetes research and clinical practice 96 (1), 1–9. Chiu, C.C. (2011). A multidisciplinary diabetic foot ulcer treatment programme significantly improved the outcome in patients with infected diabetic foot ulcers. J Plast Reconstr Aesthet Surg. 64(7), 67-72. Diabetes Health Centre (2015). Diabetes and Wounds: Caring for Sores. Retrieved June 27, 2015 from http://www.webmd.com/diabetes/features/diabetes-wounds-caring-sores Forbes J. & Fetterolf, D.E. (2012). Dehydrated amniotic membrane allografts for the treatment of chronic wounds; a case series. Journal of Wound Care. 21(6), 290–296. Jørgensen, B. et al. (2011). A Pilot Study of Leucopatch, an Autologous, Additive-Free, Platelet-Rich Fibrin for the Treatment of Recalcitrant Chronic Wounds to Determine Safety. The International Journal of Lower Extremity Wounds. 45(3), 343-377 Lebrun E., Tomic-Canic M. & Kirsner R.S. (2010). The role of surgical debridement in healing of diabetic foot ulcers. Wound Repair Regen. 18(5), 433-8. Scott, G. (2013). The diabetic foot examination: A positive step in the prevention of diabetic foot ulcers and amputation. Osteopathic Family Physician 5(2): 73–78. Sohn, M. W. et al. (2010). Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets. Journal of Foot and Ankle Research 3, 27. Vyas K.S. & Vasconez H.C. (2014). Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare. 2(3), 356-400. Read More