International Wound Journal ISSN 1742-4801
LETTER TO THE EDITOR
To debride or not, that is the question Dear Editors, A 65-year-old male patient with 24 years’ duration of diabetes mellitus presented with thermal injury affecting his left foot (Figure 1). On examination, his peripheral pulses were palpable but foot sensation, as assessed by the 10-g monofilament, was poor. Glycaemic control was poor [glycated haemoglobin level: 8.2% (normal 3.3–6.4%)]. There was no clinical sign of infection. A plastic surgeon was consulted who recommended either conventional care or debridement of the lesions. In an attempt to compare the results of debridement and conventional care, the wound over the ankle was debrided while the one above the ankle was not. Local moisturising ointments were applied to both the wounds prior to closing with foam dressings. Debridement was undertaken once every week and the patient was told to apply the moisturisers to both wounds every 2 days. Three weeks later, the difference between wound healing was significant (Figure 2), and at 6 weeks follow-up the wound over the ankle showed near-total epithelialisation while the comparative wound displayed significant remnant eschar (Figure 3). Thermal injuries of the foot are common among diabetic patients (1). The injury usually causes necrosis with resultant dry eschar over the wound. Debridement is a well-established and widely recognised practice in wound care (2). The decision of debriding dry eschar depends on several factors, that is,
Figure 2 Wound healing at three-week follow up.
Figure 3 Significant difference in the degree of healing between the wounds at six-week follow up.
perfusion and oxygenation of the wound, pain and patient adherence. Although both approaches, eventually, provided complete epithelialisation, faster healing should be preferred as it lowers the risk of infection and wound chronicity.
Figure 1 Thermal injury wounds located over and above the ankle.
Mesut Mutluoglu1 , Gunalp Uzun2 , Huseyin Karagoz3 , Ali Memis1 , Omer Ersen4 & Hakan Ay1 1 Department of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Uskudar, Turkey [email protected]
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd doi: 10.1111/iwj.12355
1
A. Memis et al.
Letter to the Editor 2 Department
of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Ankara, Turkey 3 Department of Plastic and Reconstructive Surgery Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Uskudar, Turkey 4 Department of Orthopedics and Traumatology Erzurum Military Hospital Erzurum, Turkey
2
References 1. Mutluoglu M, Uzun G, Karagöz H, Ay H. Unexpected thermal injury caused by noncontact heat exposure in a diabetic patient. J Burn Care Res 2013;34:e309–10. 2. 2 Armstrong DG, Lavery LA, Nixon BP, Boulton AJ. It’s not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis 2004;39(2 Suppl):S92–9.
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd
LETTER TO THE EDITOR
To debride or not, that is the question Dear Editors, A 65-year-old male patient with 24 years’ duration of diabetes mellitus presented with thermal injury affecting his left foot (Figure 1). On examination, his peripheral pulses were palpable but foot sensation, as assessed by the 10-g monofilament, was poor. Glycaemic control was poor [glycated haemoglobin level: 8.2% (normal 3.3–6.4%)]. There was no clinical sign of infection. A plastic surgeon was consulted who recommended either conventional care or debridement of the lesions. In an attempt to compare the results of debridement and conventional care, the wound over the ankle was debrided while the one above the ankle was not. Local moisturising ointments were applied to both the wounds prior to closing with foam dressings. Debridement was undertaken once every week and the patient was told to apply the moisturisers to both wounds every 2 days. Three weeks later, the difference between wound healing was significant (Figure 2), and at 6 weeks follow-up the wound over the ankle showed near-total epithelialisation while the comparative wound displayed significant remnant eschar (Figure 3). Thermal injuries of the foot are common among diabetic patients (1). The injury usually causes necrosis with resultant dry eschar over the wound. Debridement is a well-established and widely recognised practice in wound care (2). The decision of debriding dry eschar depends on several factors, that is,
Figure 2 Wound healing at three-week follow up.
Figure 3 Significant difference in the degree of healing between the wounds at six-week follow up.
perfusion and oxygenation of the wound, pain and patient adherence. Although both approaches, eventually, provided complete epithelialisation, faster healing should be preferred as it lowers the risk of infection and wound chronicity.
Figure 1 Thermal injury wounds located over and above the ankle.
Mesut Mutluoglu1 , Gunalp Uzun2 , Huseyin Karagoz3 , Ali Memis1 , Omer Ersen4 & Hakan Ay1 1 Department of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Uskudar, Turkey [email protected]
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd doi: 10.1111/iwj.12355
1
A. Memis et al.
Letter to the Editor 2 Department
of Underwater and Hyperbaric Medicine Gulhane Military Medical Academy Ankara, Turkey 3 Department of Plastic and Reconstructive Surgery Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Uskudar, Turkey 4 Department of Orthopedics and Traumatology Erzurum Military Hospital Erzurum, Turkey
2
References 1. Mutluoglu M, Uzun G, Karagöz H, Ay H. Unexpected thermal injury caused by noncontact heat exposure in a diabetic patient. J Burn Care Res 2013;34:e309–10. 2. 2 Armstrong DG, Lavery LA, Nixon BP, Boulton AJ. It’s not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis 2004;39(2 Suppl):S92–9.
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd
