Wound Care

Wound Care



by Donna Medina, RN, BSN

Diabetes mellitus is a major health problem that

affects as many as 16 million Americans. One of its major

complications is non-healing foot wounds and infections.

Twenty percent of current diabetics either have a foot wound

or have had one within past years. Diabetics account for

60% of the non-traumatic amputations in the world.

Several factors influence the diabetic toward the

development of infected, non-healing wounds. Diabetics can

develop neuropathy, decreased level of sensation, in their

feet and legs, making wounds difficult to detect before they

become infected or septic. Also, diabetics can have

ischemia, poor circulation, in their feet. If a wound or

ulcer develops in the foot, healing is difficult, as the

impaired circulation delivers decreased levels of oxygen to

the wound. Diabetics can develop such poor lower extremity

circulation that spontaneous tissue breakdown can occur.

Because of these two factors, indetectability and poor

circulation, diabetic foot wounds are prone to infection.

Allowed to progress, such infection, with its increased

demands upon an already weakened circulatory system, and the

tissue damage from the resultant swelling, can lead to

further complications, such as osteomyelitis, bone

inflammation. Once such a major uncontrolled infection

occurs in a diabetic's foot wound, amputation of the limb

may be necessary.

Hyperbaric medicine is the therapeutic delivery of 100%

oxygen under atmospheric pressure greater than that found

at sea level. It is well known that hypoxia (oxygen

insufficiency) and infection are primary causes of problem

wounds, and hyperbaric medicine specifically addresses both

these factors. This has been verified by extensive research

and clinical experience.

Hyperbaric delivery of oxygen provides a major increase

in tissue oxygenation in an infected wound. It promotes

wound healing by assisting with the replication of

fibroblasts, formation of collagen, and creating new

capillary beds at the wound site, thus increasing endogenous

oxygen level. It also has a bactericidal effect by

increasing oxygen radicals.

Diabetics need to be aware that hyperbaric medicine may

be able to help heal their problem wound, and may help

prevent an amputation. Hyperbaric treatment for diabetic

wounds is approved by Medicare, Medicaid and most insurance

companies for payment.

Hyperbaric units have multiplied in the past few years,

but there are still only a limited number available. To

locate such a facility, please contact: The Undersea and

Hyperbaric Medical Society, 10531 Metropolitan Ave.,

Kensington, MD 20895; telephone: (301) 942-2980. They

offer a directory of hyperbaric facilities: "The Chamber

Directory; U.S. and Canada", which they will furnish for $25

(plus $5 shipping).

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