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When debridement is necessary, wounds are left open so that serial debridements may be performed over the course of the wound's healing. [7] Antibiotic choice should be guided by deep tissue culture, severity of the infection, presence or absence of osteomyelitis, prior antibiotic treatment, and previous or current MRSA infection. [17]
Broken toes can usually be cared for at home, unless the break is in the big toe, there is an open wound, or the broken ends of the bone are displaced. [4] In high-force crushing and shearing injuries, especially those with open wounds, blood circulation (tested by capillary refill) can be impaired, which needs urgent professional treatment. [3]
Diabetic foot ulcer is a breakdown of the skin and sometimes deeper tissues of the foot that leads to sore formation. It is thought to occur due to abnormal pressure or mechanical stress chronically applied to the foot, usually with concomitant predisposing conditions such as peripheral sensory neuropathy, peripheral motor neuropathy, autonomic neuropathy or peripheral arterial disease. [1]
The wound must be of a type that can benefit from the application of maggot therapy. A moist, exudating wound with sufficient oxygen supply is a prerequisite. Not all wound-types are suitable: wounds which are dry, or open wounds of body cavities do not provide a good environment for maggots to feed.
Foot of an 80-year old individual with type 2 diabetes and heart failure. The second toe has a large ischaemic ulcer. The first toe has a small one. The prevalence of arterial insufficiency ulcers among people with Diabetes is high due to decreased blood flow caused by the thinning of arteries and the lack of sensation due to diabetic neuropathy.
An open wound after debridement. Debridement is an essential element of effective wound care. [7] Although this view is deeply rooted in practice it is nonetheless based on empirical observation. Bradley et al. have stated that it is "unclear whether wound debridement is a beneficial process that expedites healing". [8]
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Treatment is typically to avoid the ulcer getting infected, remove any excess discharge, maintain a moist wound environment, control the edema, and ease pain caused by nerve and tissue damage. Topical antibiotics are normally used to prevent the ulcer getting infected, and the wound or ulcer is usually kept clear of dead tissue through surgical ...