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Definition & Etilology
A diabetic ulcer is a
poorly healing ulcer usually on the feet, caused by a
combination of diabetes induced foot neuropathy, and
diabetes induced vascular disease. These
processes lead to ischemia in the soft tissues
compressed against bone prominences. The acute
wound healing process is slowed down. There is a
decrease in cell proliferation and protein synthesis.
Soft tissue perfusion
is impaired as a result of diabetes induced small
vessel disease. In addition, red cell rigidity
caused by high glucose impedes capillary blood flow.
The perfusion deficit is caused by blood vessel
changes which are progressive. However, blood
flow is often adequate for healing in the acute ulcer
if the healing process can be jump-started.
Perfusion is also locally impaired by excessive
compression of soft tissue onto the boney prominences,
especially the feet. A prominent cause is
diabetic neuropathy which impairs skin sensation
to pressure or pain resulting in local necrosis from
excess pressure. Boney prominences are also more
pronounced as a result of foot distortion caused by
the neuropathy. There is no evidence that
diabetic ulcers are caused mainly by infection
although secondary infection can lead to chronicity.
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Incidence:
Approximately 15 to 20 percent of the estimated 16
million diabetics in the United States will be
hospitalized for a foot complication, usually an
ulcer, during the course of their disease.
Progression of these ulcers are the leading cause of
foot amputations. |
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Characteristics: The
ulcer is usually full thickness, therefore
extracellular matrix components are initially
absent. The most common site is on the
foot, especially over bony prominences and on
the heel. The ulcers are typically full
thickness and difficult to heal, often
becoming chronic wounds. An adequate
description of ulcer characteristics is
necessary for selection of appropriate
treatment. Description includes size,
depth, appearance and location. In
addition, it must be determined whether the
ulcer is the result of neuropathy, ischemia or
typically both. Gentle probing with a
blunt sterile probe will detect the presence
of an undermining ulcer and the presence of
sinus tracts. |
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One classification system uses wound
color as a marker of wound status. Red
wounds are typically the healthiest and need wound
coverage for protection and to maintain moisture.
Yellow wounds
indicate the presences of non-viable but moist
tissue. Wounds need to be debrided to remove
necrotic tissue and reduce the bacterial load.
Frank infection does not need to be present to
retard healing, simply an increased bacterial burden
which overwhelms the wound defenses.
Black wounds indicate dead, dehydrated
tissue or eschar on the wound surface. The
eschar needs to be removed to be able to assess the
wound, prevent infection and promote healing. |
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