Join Emily Greenstein APRN, CNP, FACCWS, CWON as she provides an overview on diabetic foot ulcers, basic management tactics and learn her strategies for protecting the peri-wound skin.
My name is Emily Greenstein, and I'm a certified wound in Ostuni, nurse practitioner at Sanford Health in Fargo, North Dakota. Today, I'm going to talk to you a little bit about some great products that are available for diabetic foot ulcers and protecting that Perry one's skin. So, first of all, some important information. Just so you know that nothing I talked about today is going to be off label, and this is all of the legal jumble disclosures. I am a part of the Speakers bureau for Casey, which is now part of three M. So I look at health care costs. Nearly 80,000 lower extremity amputations are performed in diabetics each year. Are two year costs are extra? Nah, Mikel, especially those associated with initial hospitalizations. And then, if we look at the impact on life, the projected lifetime health care costs for patients who have undergone an amputation is over $500,000 a year. When we look at the diabetic foot ulcer pathology, there are multiple things that play into this. There is a loss of Achilles tendon flexibility. There's a loss off rolling motion of the ankle. There's increased forces on the mid foot and 4 ft. And then there's sensory neuropathy. So if you put all of these things together and think about it as a whole, you have a patient who already it cannot feel their feet. And then there gate is altered because of the loss of mobility in the tendency, which results in more pressure on the 4 ft, which creates this constant friction and pressure, which then results in a alteration. So looking at a few of the statistics, diabetes affects 26 million people every year, or about 8% of the US population. Pro democracy effects about 10 to 15 million, or 40 to 60% of these diabetic patients peripheral disease. So diabetics generally have some type of peripheral arterial disease, also, which affects 15 million people and then foot ulcers occur in 1.5 million people, or about 6% of a diabetic population. Critical limb ischemia effects about 1.5 million people, or 0.5% of the US population each year. So just looking at these statistics, you can see what a big impact diabetes has on the population and why we need thio treat these patients so diabetic foot ulcer. When we look at the basic management of it, it begins with a comprehensive history and physical. This includes a thorough assessment of the wound and treatment, including management. Fulfill arterial disease, infection control and management. These patients are at high risk for the development of infection, which can lead to a limb. Woz. And then that debridement adequate and thorough debridement offloading, which is the gold standard for diabetic foot ulcer management and then, of course, maintaining a moist wound. Healing environment. Timely wound healing is less likely without comprehensive management, including offloading. When we look at these patients, there are often times very complicated cases. They have to control their blood sugars. We have to look at the whole patient. Look at what they're doing. What's their footwear? Um, everything. A complete and thorough history. So when we talk about diabetic foot ulcers in the peri wound skin thes air, a few of my patients that I have seen in the past, as you can see there, are very macerated around These wounds are the principal portal of entry for infection for patients with diabetes. And like I said before, these patients are at higher risk for the development of infections and at higher risk for amputations with the development of these infections frequently these ulcers air covered by a callous or a fiber fiber nick tissue. Oftentimes, these patients will actually present to the clinic or present to their provider with a callous on their foot. They say this callous has been there forever. That's why we need to do trimming off the hyper charismatic tissue, which is very important. You need to see the wound bed in order to evaluate it. A necessity properly, the maceration or that white tissue around the wound occurs a secondary to drainage. When you look a diabetic foot ulcers, the exit date is often more on the alkaline range from about 6.2 to 8.5. When you look at the normal pH of skin, that's about 4.7 to 5.75 So these patients are already at higher risk for Perry won't break down just due to that alkaline environment that they're constantly sitting in. So how do we protect this? Perry wound skin. There are several different options available to protect this Perry wound skin. Our goal when we look at prevent is preventing prairie wound skin breakdown. Improving the Perry wound skin quality. So two options that I use the most most of the time are the three m Catalan no sting barrier film and then the new three m Catalan advanced skin protectant. So prevention obviously is easier than treatment when we're looking at preventing Perry wound skin breakdown. Ah, great option if there is really not a lot of breakdown to the skin if the skin is intact, but you just want to prevent it from breaking down. Ah, great option is the no sting barrier film because it forms a waterproof coating on the skin and protected from the extra date friction and then adhesive or the types of dressings that you're putting on it. Great things about this is it's non stinging. It will not interfere with any of the healing. It's super easy to apply. You can get it in a stick. You could get it in a spray on. It's not sticky. It helps their allows adhesion of tape and dressings. I have a lot of elderly patients who have a hard time seeing um, and they really like the spray option because it's easy for them to apply themselves. So when we look at is this evidence based, It is, It is is effective as conventional moisture barriers but easier year as defined by the blow studies for patients and staff. He's just a couple of examples of studies that people have put out showing the ease of use and the effectiveness off the no sting barrier film. So this is just an example of a patient of mine that we use the nosing barrier film on. He was a 36 year old male. He had a history of uncontrolled diabetes. He had been in and out of the hospital in diabetic ketoacidosis. At this time, he was admitted with necrotizing fasciitis or a necrotizing soft tissue infection. Initially, he was treated with negative negative pressure wound therapy. Unfortunately, he did develops a maceration secondary to the dressings, not having a good seal. And if any of you guys use the negative pressure on feet, you will know that it's hard to protect that Perry wound skin because of the sweating, the moisture from the wound, the patients if they're very non compliant and walking on it. So we decided for this patient that we would start him on the nose. Think barrier film with each of the negative pressure dressing changes as you can see the skin that's subsequently improved day of time after time with each dressing change and then did to stay, um, closed the whole time. So Day zero he was pretty macerated. And then when we change it on the day four and Day seven, it was improved significantly. Now I want to talk to you about the Catalan advanced in protectant. So this is a protectant that could be used on intact and damaged skin If it's mass rating or weeping, Ah, lot of you might notice this product or might be familiar with this product from incontinence associated dermatitis or incontinence management. However, this is a great option for diabetic foot ulcer protection around. Carry one skin. Also, because it is breathable, it's hypoallergenic. It's easy to apply. You don't need to remove it. It's breathable, and then it's clear so you can see through it. So this is an example of using the Cavil on Advanced. When I look at using the Catalan advanced, I look at using it on patients who are having more highly extra dated wounds or if they're going to be on there for a longer time. This does hold up for a longer time underneath certain things. So if I have a patient, for example, like this patient who was put into a total contact cast, that cast stayed on for seven days. So we needed something that was going to protect the skin for that amount of time. So he was a 59 year old male. He had a history of diabetes. He had re occurring diabetic foot ulcers, He went on, underwent surgical debridement of the area, and we originally treated him with a negative pressure wound therapy. Also, he was started on the total contact casts. Like I said, we started the cab on Advanced to the Perry wound skin, and you can notice what the cast was removed seven days later. How the Perry wound skin has improved and then, with the weekly interval changes, the skin did continue to improve and we did not see further breakdown. So how do I know when to use the product so you can see all of these are diabetic foot ulcers. All of them have a different levels of maceration to the Perry wound skin different things that need to be different needs for protection. So looking at this one of the hands also, that I use if you're not, if you're going to do an extended dressing that's going to stand for a week, I would use the advance. Or, if you have open and weeping skin, the advanced is to you is better to use. So in this one, we would use the no staying barrier film because the Perry one's skin is pretty dry. It's not broken down in the toe. One. We'd use the no sting barriers spray also because for now, the Perry one skin is intact. But we want to protect that from further breakdown and the bottom one. We would use the advanced skin protectant because of that maceration and Perry wound skin breakdown that is already there. So we look at the area needing protection, the amount of drainage, the frequency of the dressing change and then, if there is severe perry, one skin breakdown versus if it's still intact. So that concludes our presentation. Thank you for attending, and please contact us if you have any questions