Weekly Wound Treatment Leads To Better Results

Tissue death that necessitates amputation is perhaps the most gruesome consequence of poorly controlled diabetes. After 10 to 15 years of high blood sugar levels, many diabetics begin to lose sensation in their feet, beginning at the tips of the toes and deteriorating backwards, up the leg.

What Is Debridement?

Debridement is a process of cleaning a wound so thick, callused, dead skin does not interfere with circulation in healthy tissue below it. Most of the time doctors clean wounds with a process called surgical debridement.

If the wound on the foot is small, the doctor or podiatrist may simply use a disposable scalpel to cut off dead skin right down to healthy skin. It may not even be necessary to use an anesthetic. Debridement of small wounds can be completely painless, especially when diabetics suffer neuropathy, and only a few droplets of blood may be lost in the procedure.

For larger wounds, it may be necessary to administer an anesthetic or even to put the patient under general anesthesia, as the doctor cuts away dead tissue until the wound just starts bleeding, without cutting into healthy tissue. Since many diabetics are treated with blood thinners, such as Plavix, Coumadin, or (when they have had heart attacks) Brilinta, the doctor may put a tourniquet on the leg during the operation to stop bleeding.

After all the dead tissue is removed, bleeding is stopped, and the tourniquet is removed, the doctor covers the wound with a moist, non-adhesive dressing. Typically this is a layer of moist gauze held in place with tape. The dressing has to be changed every day to prevent infection, and the wound has to be inspected regularly for accumulation of pus and new scar tissue, which also have to be removed.

The thought of debridement is upsetting, but usually it doesn't hurt. And debridement doesn't always have to be performed by a surgical method.

Alternatives to Surgical Debridement

Diabetes doctors also perform chemical, biological, autolytic, mechanical, and ultrasound debridement when surgery is contraindicated. Of these methods, the one that diabetics can emulate is autolytic debridement, in which an area of tough skin is kept moist so that it softens and peels away on its own. This procedure can't be done on an open wound, but it is possible to soften and shrink a callus by frequent use of moisturizer under clean socks.

How Often Do Diabetic Wounds Need Debridement?

Most insurance plans in the USA pay for monthly debridement of diabetic wounds, typically billed at about $300 per visit. It typically takes 2 or 3 debridement sessions with the doctor of the podiatrist to treat a wound, but recent research has found that debridements are even more effective if they are scheduled once a week rather than once a month.

Recently, Dr. Robert Kirsner and his colleagues at Healogics, a company that runs a chain of wound treatment centers, examined the records of 155,000 diabetics who received treatment for 330,000 wounds at one of the company's 525 medical centers. They looked at the records of treatment for wounds caused by diabetes, by friction or pressure on the skin, and by accidents and other trauma.

The average wound was treated twice, 30 days apart, and took 76 days to heal. However, when wounds were treated weekly, they took an average of 21 days to heal. Wounds caused by accidents and trauma typically took about 1/3 less time to heal than wounds caused by friction, pressure, or diabetes complicaitons.

Since the same number of treatments is required whether the wound is debrided once a week or once a month, it seems to make sense to encourage weekly trips to the doctor so the wound heals right away, rather than monthly trips to the doctor that create greater risk of infection and complications.

Patients Also Get Credit for Wound Treatment Success

The doctors at Healogics believe that patients are more likely to follow their home care routine when they are treated once a week rather than once a month, so it is possible that it isn't just the additional treatment that is responsible for the faster healing time. The researchers note that shorter healing times mean less need for antibiotics, and lower risk of encouraging the development of antibiotic-resistant infections.

Don't Try to Treat Hard-to-Heal Foot Wounds On Your Own

If you have a diabetic wound, it's important to see a doctor rather than trying to treat it on your own. Because diabetics can break bones without feeling pain, the foot has to be x-rayed, at least initially, to make sure there are no infected bone fragments that have to be removed by the doctor. 

Always Take All Prescribed Antibiotics

It's also imperative to take all of the antibiotics you are prescribed, even if your wound looks uninfected. Antibiotics kill up to 99.99% of bacteria very quickly, but there may be just a few bacteria that have a natural resistance to the medication and that take longer to kill. Stopping antibiotic treatment early can leave hard-to-treat bacteria behind and cause serious complications a few weeks to a few years later.

Let Your Doctor Fend Off Complications

It's also necessary to see a doctor to make sure wounds are not developing complications such as the red and painful condition on inflammation known as cellulitis and healing of the wound is not impeded by ill-fitting shoes or socks. It is always best to work with your doctor rather than against your doctor, and to get foot wounds of all kinds treated as soon as possible.