IWGF wound prevention Flashcards
IWGDF preventive recommendation for diabetes at risk of foot ulceration
prevention category:
A. Identifying the at-risk foot;
B. Regularly inspecting and examining the at-risk foot;
C. Instructions on foot self-care;
D. Providing structured education about foot self-care;
E. Instructions about foot self-management;
F. Ensuring routine wearing of appropriate footwear;
G. Treatment of risk factors or pre-ulcerative signs on the foot;
H. Surgical interventions;
I. Foot-related exercises and weight-bearing activity;
J. Integrated foot care
Australian preventative guideline of wound development
1- Annual neurovscular including per ulcerative lesion such as callus as well as limited joint mobility
2- Not walking barefoot
3- Inspect foot daily, inspect inside the shoe, wash feet daily particularly between toes, use emollients to lubricant dry skin , cut toeanils straight across, avoid using chemical agent or plaster to remove callus
4- Appropriate education
5- A person at moderate to high risk of foot ulceration self monitor for foot temperature to identify early sign of inflammation . If there is a temperature difference in two feet or in vicinty region of the same foot reduce movement and see HRFC
6- A person at moderate risk of foot ulceration or healed from none plantar foot ulcer to wear medical grade fits the foot shape properly and reduce plantar pressure. Consider custom made foot orthosis or toe pressure if there is a sign of PR ulcerative lesion
7- Again, custom foot orthosis such as toe silicone. Specifically in a person with abundant callus
8- Treat any preulcerative lesion such as callus and ingrown toenail in a diabetes persson who is at risk of foot ulceration
9- If there is abundant callus on the apex of the toe or there is an ulcer on none rigid hammer toe consider digital flexor tenotomy to prevent foot ulcer and recurrence
10- In a person with diabetes and a plantar forefoot ulcer that has failed to heal with evidence-based non-surgical treatment, consider Achilles tendon lengthening, single or pan metatarsal head resection, metatarsophalangeal joint arthroplasty or osteotomy, to help prevent future ulcer recurrence
11- Suggested not to use nerve decompression procedure in a diabetes person who is at moderate to high risk of foot ulceration
12- Educate a diabetes patient increase in activity should be gradual, wearing appropriate footwear, and offloading devices are worn and the skin is monitored frequently
Explain the application of each wound classification system
1- SINBAD: In a person with diabetes and a foot ulcer, as a minimum, use the SINBAD wound classification system for
communication among health professionals about the characteristics of the ulcer
2-WIFI use WIfI scoring to aid decision making in the
assessment of perfusion and likelihood of benefit from revascularisation
3-IDSA
In a person with diabetes and an infected foot ulcer, use the IDSA/IWGDF infection classification
Wound classification recommendations?
1- Recommendation 1
In a person with diabetes and a foot ulcer, as a minimum, use the SINBAD wound classification system for
communication among health professionals about the characteristics of the ulcer (strength of recommendation:
strong; quality of evidence: moderate)
2-Be cautious in the application of any of the currently available classification/scoring systems to offer an
individual prognosis for a person with diabetes and a foot ulcer (weak; low
3-In a person with diabetes and an infected foot ulcer ( IDSA is the infection component of WIFI)
4- In a person with diabetes and a foot ulcer who is being managed in a setting where appropriate expertise in
vascular intervention is available, use WIfI scoring to aid decision making in the assessment of perfusion and
likelihood of benefit from revascularisation (weak; moderate
SINBAD scoring startification
WIFI scoring stratification
Wound dressing management
Wound dressing 13 reccomendation
Wound dressing recommendation AI version
he recommendations are grouped into three categories: wound management, adjunctive therapies, and interventions not recommended.
Wound management:
Recommendation 1: Remove dead tissue and surrounding callus with sharp debridement, but consider pain and severe ischemia when making this decision.
Recommendation 2: Choose dressings based on their ability to absorb fluid, comfort, and cost.
Recommendation 3: Avoid dressings containing antimicrobial agents solely to speed up healing.
Adjunctive therapies:
Recommendation 4: Consider using a sucrose-octasulfate impregnated dressing, in addition to standard care, for non-infected ulcers that are slow to heal.
Recommendation 5: Consider using hyperbaric oxygen therapy, in addition to standard care, for non-healing ulcers caused by poor circulation.
Recommendation 7: Consider using negative pressure wound therapy to reduce wound size, in addition to standard care, for wounds following foot surgery.
Recommendation 9: Consider using placental derived products, in addition to standard care, if standard care alone has not reduced the wound size.
Recommendation 11: Consider using autologous combined leucocyte, platelet and fibrin, in addition to standard care, for non-infected ulcers that are difficult to heal, but only if this treatment becomes approved in Australia.
Interventions not recommended:
Recommendations 2, 3, 6, 8, 10, and 12: Avoid using various types of dressings, therapies, and devices aimed at speeding up healing, as they are not supported by strong evidence.
Recommendation 13: Nutritional interventions are not recommended to specifically improve healing, but maintaining good nutrition is still important.
Prevention guideline?
PAD guideline
