Wound Healing Southern Africa - Volume 5, Issue 2, 2012
Volume 5, Issue 2, 2012
Source: Wound Healing Southern Africa 5 (2012)More Less
Diabetes is poised to become the healthcare issue of the future. Dietary habits, lifestyle and genetics have combined to produce a pandemic that will dwarf most other health problems. This impacts medical costs and quality of life and will, by extension, affect employment and the work force. Concurrently, a wave of new advances in molecular biology and cell signalling mechanisms are evolving, which should contribute to combatting the coming onslaught of this disease.
Author A.D. WidgerowSource: Wound Healing Southern Africa 5, pp 64 –67 (2012)More Less
Diabetic disease is increasing exponentially on a global scale. Diabetic foot ulcers (DFUs) are the leading cause of non-traumatic lower limb amputations. The pathophysiological events need to be considered when designing new interventions. Bioengineered skin substitutes (BSS) are accepted in the therapeutic armamentarium for DFU treatment. However, newer designs are likely to offer more targeted approaches to the disease process. This relates to the stimulation of vasculogenesis in particular. This can be achieved by using interactive scaffolds that stimulate endothelial progenitor cells to increase vascular endothelial growth factor production and reverse some of the damage that is caused by glycation end-products that are characteristic of diabetes.
Source: Wound Healing Southern Africa 5, pp 72 –82 (2012)More Less
People with diabetes mellitus will develop lower-limb complications, such as neuropathy, peripheral vascular disease, foot ulcers, and lower-leg amputations. Resources to control elevated haemoglobin A1c and blood pressure, along with the standardised approach using the 60-second tool (2012)©, can detect the high-risk diabetic foot and help prevent complications.
The outcome of using the 60-second diabetic foot screen to identify the diabetic foot at risk in Tanzania : original researchAuthor M.B. MwandriSource: Wound Healing Southern Africa 5, pp 86 –89 (2012)More Less
Objective : To determine the pattern of risk for the development of diabetic foot complications in Tanzania.
Setting : Diabetic care is offered in all public hospitals in Tanzania. Over 100 000 documented patients receive free or subsidised services. This is a small portion of the estimated one million patients with diabetes countrywide. Often, the clinics are congested and lack structured protocols for the focused screening of conditions and for risks that have the potential to cause diabetic foot.
Subjects : Fifty patients were recruited from the diabetic clinic of Temeke Municipal Hospital. The 60-second diabetic foot screen was used for the diabetic foot risk assessment.
Outcome measures : Risks factors that can cause diabetic foot and other foot complications were assessed.
Results : It was determined that 10% of the studied population had a significant neuropathy. Other identified risk factors in this group of investigated diabetic feet were fissures (37%), calluses (27%), active ulcers (8%), fungi in toe-web spaces (27%), a previous history of foot ulcers (8%), ingrown toe nails (6%), blisters (4%), Charcot foot deformities (4%) and hammer toe lesions (2%). In this study, approximately 46% of the patients with diabetes wore inappropriate footwear upon presentation to the clinic.
Conclusion : Patients with diabetes in Tanzania had risk factors that are associated with the development of diabetic foot complications. A screening tool, such as the adapted 60-second diabetic foot screen, may be used to facilitate a structured protocol for assessing the feet of patients with diabetes in busy Tanzanian clinics.
The outcome of 60-second foot screening tool education for healthcare workers at University College Hospital, Nigeria : original researchSource: Wound Healing Southern Africa 5, pp 91 –95 (2012)More Less
People living with diabetes are at risk of acquiring foot ulcers, which may eventually result in lower extremity amputation. Literature confirms that in patients with diabetes, foot screening is critical and yields positive outcomes. It was not certain whether a cross-section of healthcare providers from Nigeria were familiar with the use of the the 60-second foot screening tool, hence the need for this study. This was a descriptive cross-sectional survey. It included a pre-training test, a training education session and a post-training test. The study was conducted to evaluate baseline knowledge and the impact of foot screening education on the early detection of the risk of acquiring a diabetic foot ulcer in a group of healthcare workers, including doctors, nurses and physiotherapists, at the University College Hospital, Ibadan, Nigeria. The majority of the respondents (80%) scored above 50 in the pre-training test. All of the participants scored above 50 in the post-training test. The overall mean knowledge score of respondents in the pre-training test was 56.8 ± 10.8 (15.2-75.8), while it was 77.0 ± 7.9 (51.5-92.4) in the post-training test. At baseline, most of the healthcare providers had good knowledge of foot screening. Doctors' knowledge was slightly better than that of the nurses. The overall knowledge of participants on diabetic foot screening improved significantly after a training session on foot screening. Foot screening education had a significant impact on the foot screening knowledge of the healthcare workers.
Podiatric intervention in the management of a diabetic foot ulceration : a case study using total contact casting : podiatryAuthor F.J. HowardSource: Wound Healing Southern Africa 5, pp 96 –101 (2012)More Less
An understanding of the key elements of the cause of diabetic foot ulcerations is critical to enable comprehensive care for such patients. Identification of associated challenges is also essential in order to implement effective care. The management of diabetic foot ulcerations can be very challenging for both the health professional and the patient. Lack of resources and appropriate wound care skills may impact on the ability to achieve wound healing successfully. It is also crucial that management encompasses an interdisciplinary team to provide holistic care for the patient. This article shows that only a few members of different healthcare disciplines needed to work together to provide effective care. The reduction and redistribution of peak plantar pressures, in combination with ulcer debridement, is key to the management of diabetic foot ulcerations. Unfortunately, decisions that are taken in clinical practice vary widely as to which device to use when offering wound pressure offloading. This is despite the fact that total contact casting (TCC) is regarded as the gold standard in the offloading of noninfected neuropathic ulcerations. The consensus is that TCC is underused in the South African wound community. Other offloading devices, such as felt paddings or shoe inserts, are used primarily. This article seeks to demonstrate that in South Africa, TCC should be considered as a primary offloading device if there are no contraindications, such as impaired circulation or infections in the wound.
Author B. GreenSource: Wound Healing Southern Africa 5, pp 102 –107 (2012)More Less
The goal when managing any wound, whether it is acute or chronic, is to achieve wound closure as soon as possible.
The process by which wounds heal is complicated and delicate. In order for wound healing to occur, the body needs to allow all the four phases of wound healing (haemostasis, inflammation, proliferation, and regeneration) to run their course, uninterrupted. One of the major contributing factors to delayed healing in major or minor, acute and chronic wounds, is the presence of bacteria. This article will consider the classification of wound infection, as well as what role bacteria play in the management, and subsequent treatment decisions, of wounds.