Diabetic Wound Care Measures

Priority is given to stabilizing blood sugar to reduce healing obstacles at the source, targeted debridement and anti-infection according to the wound stage, and pressure management and circulation improvement throughout the process. As long as these three cores are grasped, more than 80% of mild to moderate diabetic wounds can heal smoothly within 4-8 weeks.

Don't underestimate the impact of blood sugar. When many people find a hole in their foot, their first reaction is to go to a surgeon for dressing change. They wish they could apply iodophor three times a day, but forget about taking hypoglycemic drugs and insulin. I took care of a 72-year-old man last year. His fasting blood sugar was always above 10mmol/L. The ulcer on his foot remained unchanged even after changing medicine for three weeks. The wound surface was always dusty and not even fresh granulations could be seen. Later, he consulted an endocrinologist and adjusted the insulin plan. Within a week, the blood sugar stabilized at around 6mmol/L. Within a week, new pink granulations appeared on the wound surface, which grew very fast. For diabetic patients, high blood sugar is a "corrosion agent" for wounds. If blood sugar is unstable, no matter how expensive the dressing is, it will be useless.

After blood sugar is stabilized, the next step is to deal with the local wound, which is also the most controversial part in the academic community. The traditional nursing school advocates dry healing. It is safe to keep the wound dry after disinfection with iodophor and alcohol and allow the scab to fall off on its own. This method is indeed suitable for small initial wounds that are superficial and have very little exudation, such as small blisters that have just been polished. After breaking, disinfect and let them dry for two days, and the scab will be fine. However, the wet healing school that has been popular in the past 20 years has the opposite view. They believe that scabs will compress the new granulation tissue and instead delay healing. They advocate covering the wound with a wet dressing to keep the wound in a constant temperature and humidity environment. Granulation can grow faster along the moist environment. This method is indeed more effective for moderate to severe wounds that already have ulcers and a lot of exudate. I met a retired teacher before. After his heel was worn out, he applied iodophor at home every day and left it to dry. A thick layer of black scab formed. He thought it was going to be cured. However, it turned out that the scab was full of pus, which had rotted into the fat layer. Later, the scab was removed, and a foam dressing was used to absorb the exudate and maintain a moist environment. It healed in less than a month. There is no final answer as to which solution is better. The key lies in the stage of the wound. There is never a universal method of "one trick".

Many people think that everything is fine after changing their medications. In fact, subsequent stress management is the most easily overlooked point. I met an aunt at a community free clinic last week. She had an ulcer on her toe. She said she hadn’t walked outside for a month. Why was the wound not healing? As soon as I saw her foot still hanging down under the stool, I understood instantly - wounds on the lower limbs are prone to poor blood supply. The foot was hanging down, and the blood was stagnant at the far end. Of course, the wound surface was purple and no new flesh could grow. Later, I asked her to raise the tripod higher than her heart when she was fine, and wear a pressure-reducing shoe worth tens of dollars to suspend the ulcerated toe. Within ten days, she came to me and said that the wound had begun to grow flesh. Many people have heard others say that soaking feet can promote circulation. As a result, most people with diabetes have neuropathy and are not sensitive to temperature. Ordinary people find 45-degree water hot, but they feel the temperature is just right when they touch it. Soaking for ten minutes will cause burns, and it will rot faster. I have seen too many examples of this.

If you are taking care of yourself at home, I would like to give you a practical suggestion: normal saline is enough for normal cleaning. There is no need to rub iodophor on the wound every day. When there is only redness, swelling and pus around the wound, just use iodine to wipe out a circle of normal skin around the wound. Applying it to the wound will burn out the new granulation. There is no need to buy hundreds of dollars worth of imported dressings. For exudate, ordinary foam dressings are used, and for less exudate, hydrocolloid dressings are used. The effect of domestic brands is not much different, and the price/performance ratio is much higher.

Finally, I would like to remind you that if the wound does not heal for more than a week, or even develops pus, redness, swelling, or fever, do not mess around with applying folk remedies at home. Do not apply any Panax notoginseng powder or toothpaste to the wound. Go to the diabetic foot specialist in the hospital to see a doctor immediately. By the time the bones are so rotten that they require amputation, it will be too late.