THE ROLE OF DEBRIDEMENT IN WOUND HEALING OF PATIENTS WITH DIABETES FOOT ULCERS (REFLECTIVE ANALYSIS)
As a registered nurse with over 10 years of clinical practice experience in various field of nursing including caring for patients with diabetic foot ulcers (DFUs), I was concerned with rise in the numbers of DFUs cases resulting into higher rates of amputation, disabilities and mortality . DFU are caused by a combination of peripheral neuropathy and vascular diseases resulting from diabetes mellitus (Army and Tanja, 2012). Statistics provided indicate that a limb is lost to improper management of DFUs every 30 seconds somewhere in the world (International Diabetes Federation, 2005). In addition, over 85% of lower extremity amputations in patients with diabetes occur in people with antecedent foot ulcer (Apelquist and Larson, 2000). Besides, DFUs have negative impact on quality of life of diabetic patients. In fact, diabetic patients with a history of DFUs had a 47% increase risk of mortality compared to those without a history of DFUs (Iversen et al, 2009). Delayed healing of DFU leads to reduced patients mobility, diminished quality of life and increased risk of lower extremity amputation (Army and Tanja, 2012). Approximately, 15% of individuals with diabetes have had an ulcer on the feet or ankle while five years recurrence ulcer in diabetic patients is about 70% (International Working Group on Diabetic Foot, 2003). Amputation is found to be higher cost to healthcare system because of multiple and prolonged hospitalization than the lower cost of wound management of DFUs (Krapfl and Gondes, 1999). The economic burden of DFUs and complications arising are enormous. The cost to treat a DFU over a period of 2 years was $27,987 in 1995 and based on medical component of U.S consumer price index rose to $46,841 in 2009 (Ramsey et al, 1999) and more than 50,000 amputations were performed on patients with DFUs yearly in United States (Chadwick et al, 2007). In Nigeria where I practice, a prospective study documented diabetic foot gangrene as a leading indication accounting for 58% of major limb amputations over a 5 years period (Udosen, Ikpeme, Etiuma, and Egors, 2004) and DFUs ranges from 0.9% to 8.3% among diabetic patients every year. The incidence of open wounds in patients with diabetes is very high and affects 1 of every 6 patients. Consequently most of my patients with DFUs over the years have asked me “if there wound will ever heal on time”. The management of foot ulcers in patients with diabetes is a complex and increasingly a common problem (Calhoun et al, 2002).
Debridement is one of the principles of DFUs management and the most effective means of achieving positive results in wound healing of DFUs (International Diabetic Federation, 2005). Moreover, it has been a common practice within the field of podiatry for many years (Haycocks and Chadwick, 2012). Although there are many methods of debridement, Bradley et al, (1999) concluded that there is little or no evidence to suggest that one debridement method is more effective than others. Although radical debridement of DFUs is fairly a recent development (Haycock and Chadwick, 2012), there is currently little persistency in the education provided to people with DFUs regarding the role and significance of debridement in facilitating their wound healing process and ultimately reducing their period of hospitalization and personal costs (Berardis et al, 2005); hence my decision to clinically teach three male DFUs patients on the significance, benefits and roles of debridement to the healing of DFUs within the clinical environment of Lagos state university teaching hospital in Nigeria; to enable these patients:
• Define the term debridement.
• Explain why debridement is necessary for this particular diabetic foot ulcer
• Explain how to care for both feet
In DFUs management, debridement is at present the gold standard...