Topic One: Dressing Selection
Wound care for the diabetic foot requires a multi-factorial approach that takes the person and the wound into consideration. Following a comprehensive holistic assessment, an individual treatment plan can be implemented. Guidelines recommend selecting evidence-based dressings (Wounds UK, 2021; Nair et al., 2022; IWGDF, 2019).
There are also several factors to evaluate when choosing a dressing, including:
- The wound characteristics, wound bed, size, and depth
- Risk and signs of infection
- Exudate/moisture type, amount, and management
- Patient preference
- Protection, suitable for use with off-loading devices/footwear
- Cost-effectiveness of the medicine or medical device
- Clinical evidence
- Impact on quality of life
- Local clinical pathways
(Wounds UK, 2021; Nair et al., 2020; IWGDF, 2019)
Good wound hygiene, cleansing, debridement, and redressing should be undertaken related to the presentation of the ulceration.
Dressings with antimicrobial agents can be used with the infected diabetic foot, in line with antimicrobial stewardship principles for topical treatment, where appropriate. Frequently used antimicrobial agents include:
- Iodine
- Silver-impregnated dressings
- Polyhexamethylene Biguanide (PHMB)
- Octenidine. (Nair et al., 2022)
A diabetic foot wound can deteriorate quickly and require close monitoring. Infected wounds should be checked more frequently. (Nair et al., 2022).
Classification systems have been developed to grade the severity of diabetic foot ulcers, provide prognosis on healing and aid in the formulation of treatment plans. There is no one widely accepted system of classification for diabetic foot ulcers (Jeffcoate & Game, 2006, IWGDF 2019). The next topic looks at several systems currently in use.