Step it Up! Using an Integrated Step-wise Approach to Achieve Outcomes in the Patient with Diabetic Lower Extremity Wounds

Purpose: Many clinicians use an algorithmic approach to the wound management of the patient with diabetes.¹ After addressing vascular issues, wound bed preparation is key to outcomes. Often overlooked is a biofilm-based wound management, need for exogenous extra-cellular matrix deposition², use of adequate offloading and reduction of edema.³

Objective: Use of an algorithm incorporating evidence-based practice can assist in achieving wound improvement in patients with lower extremity diabetic neuropathic wounds.

Methods: A standardized step-wise algorithmic approach in an outpatient setting was developed directed at meeting intermediate outcomes that address biofilm management with a bacterial binding agent* as an initial intervention followed by exogenous matrix application**. Serial sharp debridement was performed as needed on a weekly basis. Total contact casting***, if a diabetic plantar ulcer was involved or edema management with compression strengths as dictated by skin perfusion pressures, addressed the local and peripheral wound environment. Repeated implementation with this standardized approach with providers from novice to expert experience in wound management occurred over several months.

Results: Providers across the continuum embraced the algorithm as intermediate outcomes were positive in the majority of patients. Novice providers appreciated guidance in the management of difficult wounds. Staff nurses were able to articulate rationale for treatment to providers and patients alike. Increasing compliance with treatment regimens were observed when patients saw visible improvement in their wounds.

Conclusion: Using an algorithm to address specific physiological alterations in the wound bed of the patient with a lower extremity wound in a step-wise fashion to address local wound bed dysfunction improves patient adherence and provider consistency in wound management.

*Cutimed^® Sorbact^®, BSN Medical, Inc., Charlotte, NC

**Cutimed® Epiona®, BSN Medical, Inc., Charlotte, NC

***Cutimed® Total Contact Cast, BSN Medical, Inc., Charlotte, NC