Diabetic Foot

Question 1

haemostasis

Answer 1

vasoconstriction: stops the bleeding
platelet response: forms blood clot and preliminary extra cellular matrix

Question 2

stages of wound healing

Answer 2

• inflammatory phase
• reconstruction/proliferation phase
• maturation phase

Question 3

inflammatory phase

Answer 3

0-3 days
arrival of neutrophils: protect would against bacterial invasion
arrival of macrophages: clear wound of debris

Question 4

reconstruction/proliferation phase

Answer 4

2-24 days
macrophages begin to stimulate fibroblasts to produce collagen
new capillary development is seen in granulation tissue called angiogenesis
epithelial cells migrate over the granulated wound bed

Question 5

maturation phase

Answer 5

24 days - 1 year
remodelling - increase the tensile strength
collagen is replaced in a more organised manner
the epithelial layer thickens
decrease in vascularity and scar size

Question 6

chronic wounds are defined by

Answer 6

four straight weeks of non healing
failure to proceed through an orderly and timely process to produce anatomic and functional integrity

Question 7

intrinsic factors limiting would healing

Answer 7

• age
• disease eg. peripheral arterial disease, diabetes mellitus
• stress

Question 8

extrinsic factors limiting wound healing

Answer 8

malnutrition
obesity
smoking
drugs
chemotherapy

Question 9

some drugs that may limit wound healing

Answer 9

anti-inflammatory
anti-coagulants
corticosteroids
immunosuppressive

Question 10

local factors affecting healing

Answer 10

wound management practices
hydration of the wound
pressure, shear and friction
foreign bodies
wound infection

Question 11

necrotic tissue will usually require

Answer 11

debridement

Question 12

sloughy tissue

Answer 12

Question 13

granulating tissue

Answer 13

Question 14

hypergrnaulating tissue

Answer 14

Question 15

epitheliating tissue

Answer 15

Question 16

acute symptoms in wound infection

Answer 16

pain
heat
swelling
erythema
exudate
offensive would exudate

Question 17

chronic wound infection symptoms

Answer 17

delayed healing
increased exudate
discolouration of granulation tissue
friable tissue
new areas of slough
undermining
malodour and wound breakdown

Question 18

TIME acronym for wounds

Answer 18

tissue
infection
moisture
edge of wound

Question 19

M: moisture

Answer 19

dessication (dryness) slows epithelial cell migration
excessive fluid causes maceration of wound margins
goals is to remove excess exudate and hydrate the wound

Question 20

E: edge of wound

Answer 20

cells at the edge may fail to proliferate and migrate
undermining
hypergranulation

Question 21

what is macrovascular disease

Answer 21

coronary heart disease
stroke
peripheral vascular disease

Question 22

what is microvascular disease

Answer 22

retinopathy
neuropathy
nephropathy

Question 23

pathophysiology of peripheral neuropathy

Answer 23

microneurovascular dysfunction with loss and inflammatory response
vasomotor dysfunction with arteriovenous shunting
capillary basement membrane thickening with altered capillary exchange
glycation of matrix proteins
loss of apocrine/eccrine gland function

Question 24

appearance of foot in peripheral neuropathy

Answer 24

toes curled in claw position
cavus deformity with increased pressure under metatarsal heads

Question 25

diabetic foot ulcers are typically located at

Answer 25

pressure points

Question 26

pain in diabetic foot ulcers

Answer 26

usually painless

Question 27

general appearance of diabetic foot ulcers

Answer 27

pinched out with surrounding callous warm foot foot deformity (clawed toes, yes cavus)

Question 28

pressure offloading

Answer 28

appropriate offloading reduces time to heal, risk of infection and amputation complete non-weight bearing is ideal and non practical

Question 29

some types of offloading apparatus

Answer 29

total contact cast (gold standard) CROW (Charcot restraint orthotic walker) Aircast CAM walker/moon boot wound care shoe/Darco footwear and insoles

Question 30

some contraindications for use of the gold standard total contact case

Answer 30

infection fever deep sinus tract extreme exudate dermatitis or leg wounds fluctuating/excessive oedema cast claustrophobia history of non-compliance PAD falls risk

Question 31

foot sepsis assessment

Answer 31

- resuscitate as appropriate with immediate antibiotics - asses vascular supply and peripheral neuropathy - collection present - plain x-ray, specialised imaging (MRI, WC scan) - consider need for urgent surgery

Question 32

once sepsis is absent or controlled

Answer 32

dressings relieve pressure revascularisation if necessary