Which dressing will you apply

The dressing that is considered to be the 'dressing of choice' at present is the sterile gauze impregnated in NaCl 0.9 percent or even better 15 percent solution. Ulcers heal better when their surface is humid and for this reason dressings that dry out the ulcer surface should not be used. An exception to this rule is the existence of dry gangrene, when it is desirable to maintain the affected area dry, to avoid wet gangrene. There are various different dressings available with varied characteristics and certain small studies support their effectiveness. These dressings, their characteristics and their indications are presented in Table 17.7. The cost of the dressings is quite large and no comparative studies exist that suggest the supremacy of one against the other. This is also the reason that the impregnated with NaCl 0.9 or 15 percent solution gauze constitutes at present the 'method of choice'. Special dressings can be used in resistant ulcers.

In ulcers that are not infected or necrotic, the use of povidone solution is not advisable, because it is toxic for the fibroblasts. Dressings should be changed by the patient in his or her environment on a daily basis (or even more often, if the quantity of exudate is large). The frequency of outpatient visits in the diabetic foot clinic should be once a week provided the ulcer does not manifest any complications. The patient should be informed that the appearance of signs of infection should indicate the search for urgent medical help and no postponement until the next programmed visit in the diabetic foot clinic.

0 0

Post a comment