Dia iabetic Foot Dis isease; what stops healing? Prof Fran Game - - PowerPoint PPT Presentation

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Dia iabetic Foot Dis isease; what stops healing? Prof Fran Game - - PowerPoint PPT Presentation

Nov 13, 2023 198 likes •456 views

Dia iabetic Foot Dis isease; what stops healing? Prof Fran Game Derby Teaching Hospitals NHS FT frances.game@nhs.net Amputation Ulceration Neuropathy/PAD/Deformity Stairway to amputation Diabetes Marion Kerr 2017 What causes ulcers in

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Dia iabetic Foot Dis isease; what stops healing?

Prof Fran Game Derby Teaching Hospitals NHS FT frances.game@nhs.net

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Stairway to amputation

Diabetes Neuropathy/PAD/Deformity Ulceration Amputation

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Marion Kerr 2017

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What causes ulcers in patients with diabetes?

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1. . Neuropathy

95% small fibres 5% large fibres

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Sensory

dozing in front

  • f the fire

1. . Neuropathy

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Sensory

shoes rubbing

1. . Neuropathy

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Motor neuropathy

  • deformity
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Deformity

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Autonomic

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2. . Is Ischaemia

Macrovascular

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Arteriography - collaterals

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What stops healing?

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Is Ischaemia

  • Assessment
  • Palpation pulses
  • Doppler Ultrasound Wave forms
  • Ankle or toe systolic pressure
  • Direct/MR or CT angiography
  • TcPO2 – affected by neuropathy
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Neuropathy

  • Pressure relief
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Diabetic Foot lesion Repeated trauma Increased macrophage activation TNFα, IL6 Proteases - MMPs Degradation of matrix and growth factors Infection

Chronic in infl flammation and wound healing

Fibroblasts and inflammatory cells

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Infection

  • Diagnosis?
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ID IDSA 2012 infection grading

Infection present -at least 2 of the following items:

  • Local swelling or induration
  • Erythema
  • Local tenderness or pain
  • Local warmth
  • Purulent discharge

Mild : >0.5 cm to ≤2 cm around the ulcer Moderate : erythema > 2 cm, or involving structures deeper than skin and subcutaneous tissues Severe : systemic symptoms

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Specimen Type : Aspirate left Foot Microscopy Gram stain Leucocytes Nil Epithelial cells Nil No organisms seen Aspirate/Tissue Culture 1 Moderate growth of Diphtheroid organisms 2 Moderate growth of Enterobacter cloacae complex Candida species NOT isolated 1 2 1 2 Ampicillin/Amoxicillin R Ciprofloxacin R Gentamicin S Vancomycin S Trimethoprim S Penicillin S Extended Anaerobic Culture Anaerobes NOT isolated Enrichment Broth Culture No further isolates

Microbiology?

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Other markers?

  • Lactate?
  • pH?
  • Temperature?
  • NO
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Dia iabetic Foot Dis isease; what stops healing?

Prof Fran Game Derby Teaching Hospitals NHS FT frances.game@nhs.net