Treatment OF Foot Ulcer in Dallas, Plano & Prosper


Successful treatment of diabetic foot ulcers in Dallas, Plano & Prosper consists of addressing these three basic issues: debridement, offloading, and infection control.

Debridement

Debridement consists of removal of all necrotic tissue, peri-wound callus, and foreign bodies down to viable tissue. Proper debridement is necessary to decrease the risk of infection and reduce peri-wound pressure, which can impede normal wound contraction and healing. After debridement, the wound should be irrigated with saline or cleanser, and a dressing should be applied.
In case of an abscess, incision and drainage are essential, with debridement of all abscessed tissue. Many limbs have been saved by timely incision and drainage procedures; conversely, many limbs have been lost by failure to perform these procedures. Treating a deep abscess with antibiotics alone leads to delayed appropriate therapy and further morbidity and mortality.

Offloading

Having patients use a wheelchair or crutches to completely halt weight bearing on the affected foot is the most effective method of offloading to heal a foot ulceration. Total contact casts (TCCs) are difficult and time consuming to apply but significantly reduce pressure on wounds and have been shown to heal between 73 and 100% of all wounds treated with them.

Inappropriate application of TCCs may result in new ulcers, and TCCs are contraindicated in deep or draining wounds or for use with noncompliant, blind, morbidly obese, or severely vascularly compromised patients.

Clinicians often prefer removable cast walkers because they do not have some of the disadvantages of TCCs.
Postoperative shoes or wedge shoes are also used and must be large enough to accommodate bulky dressings. Proper offloading remains the biggest challenge for clinicians dealing with diabetic foot ulcers.

Infection control

Antibiotics selected to treat severe or limb-threatening infections should include coverage of gram-positive and gram-negative organisms and provide both aerobic and anaerobic coverage. Patients with such wounds should be hospitalized and treated with intravenous antibiotics.

Mild to moderate infections with localized cellulitis can be treated on an outpatient basis with oral antibiotics such as cephalexin, amoxicillin with clavulanate potassium, moxifloxacin, or clindamycin. The antibiotics should be started after initial cultures are taken and changed as necessary.


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