Wound care management

Monique Marais and Marionette Roselt outline the importance of wound care management in the diabetes community.

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People living with diabetes are more prone to wounds and/or chronic wounds due to several factors that affect the body’s ability to heal.

Neuropathy (nerve damage) can cause a loss of sensation, especially in the feet and lower legs, making it difficult to detect injuries like cuts or blisters, which can worsen over time without treatment.

Poor circulation (peripheral artery disease (PAD)) caused by narrowed blood vessels, reduces blood flow to the extremities, slowing the delivery of oxygen and nutrients needed for healing.

High blood glucose levels (hyperglycaemia) can damage blood vessels, weaken the immune system, and interfere with collagen production, making it easier for infections to develop and harder for wounds to heal.

Additionally, a weakened immune response further increases the risk of infections, such as cellulitis or gangrene, as the body’s ability to fight bacteria is compromised.

People who have diabetes also have thicker, less elastic skin, which is more prone to cracking and injury, and they produce less collagen, which is crucial for tissue repair.

Furthermore, increased pressure and poor foot care habits, often due to neuropathy and improper footwear, can lead to pressure sores and ulcers. All these factors combined make wound prevention and proper skin care essential for people with diabetes.

As a result of people living with diabetes being more prone to wounds, it’s important to know the various types of wounds that can develop to prevent them from developing.

The most common types of wounds

1. Diabetic foot ulcers (DFUs)

• Most common type of wound for people living with diabetes.
• Occurs due to neuropathy, which leads to a lack of sensation in the feet, and peripheral artery disease (PAD), which reduces blood flow, slowing healing.
• Common triggers: pressure from shoes, minor cuts, blisters, or unnoticed injuries.
• Can lead to infection and in severe cases amputation.

2. Pressure ulcers (bedsores)

• People living with diabetes who have limited mobility are at risk of pressure injuries, especially on bony areas like heels, ankles, hips, and the sacrum.
• Caused by prolonged pressure, friction, moisture, or shear forces.

3. Venous stasis ulcers

• Occurs when poor circulation leads to blood pooling in the legs, resulting in swelling and ulcer formation.
• Typically found on the lower legs and ankles.

4. Arterial ulcers

• Result from peripheral artery disease (PAD).
• Appears as deep, painful wounds, often with a punched-out appearance, typically on the feet, toes, or lower legs.

5. Surgical wounds and poor healing

• People with diabetes have delayed wound healing due to impaired blood flow and immune response.
• Surgical incisions take longer to heal and are at higher risk of infection or non-union (not healing at all).

6. Traumatic wounds (cuts, burns, scrapes)

• Minor injuries can escalate quickly due to poor healing capacity and susceptibility to infection.
• Common causes: household accidents, shoe-related friction, or stepping on sharp objects.

7. Infections (abscesses, cellulitis, gangrene)

• Even small wounds can become infected quickly, leading to serious conditions, such as cellulitis (skin infection) or gangrene (tissue death).

Prevention action tips

People living with diabetes can take several preventative actions to avoid wounds and manage them effectively if they occur.

• Regular foot care is crucial — checking feet daily for cuts, blisters, redness, or swelling, and moisturising to prevent dry, cracked skin. Ensure you dry between your toes after washing or swimming.
• Wearing proper footwear that fits well and provides support can help reduce pressure points and prevent injuries. Inspect shoes on the inside to ensure no foreign objects are in the shoe that can contribute to pressure injuries or lacerations.
• Keeping blood glucose levels under control is essential to promote better circulation and faster healing.
• Practising good hygiene by keeping the feet clean and dry helps prevent infections.
• Regular medical check-ups with a healthcare provider or podiatrist can catch potential issues early.
• Engaging in gentle exercise improves circulation, while avoiding smoking and excessive alcohol consumption can further support vascular health.

If a wound does occur, it should be treated promptly by cleaning it, applying appropriate dressings, and seeking medical attention if it doesn’t heal or shows signs of infection.

Basic wound care at home

It’s always best to consult with a GP or wound care practitioner that has professional opinions and guidelines before attempting to do the wound care yourself.

Basic principles to follow on minor cuts or wounds at home:

• Wash your hands thoroughly before touching the wound.
• Clean the wound immediately with warm water and a disinfectant.
• If the wound is large or deep, consider using a sterile saline solution or clean water to flush out any debris or foreign objects. This helps create a clean environment for healing. Consult with a professional if there is excessive bleeding or pain.
• Avoid ointments that can cause irritation or allergic reactions.
• Cover the wound to keep it clean and dry.
• Monitor for signs of infection (see below) and seek professional care if it becomes infected or the wound healing process is prolonged.
• Manage your blood glucose levels to promote wound healing.
• Maintain good circulation to promote wound healing

Recognising the signs of infection

• Warmth around the wound: If the skin around the wound feels hot to the touch, it could mean the body’s immune system is fighting the infection.
• Increased redness and swelling: If the area around the wound become more red, swollen, or warm, it could indicate an infection is developing.
• Increased pain: Some pain is normal, but persistent or worsening pain around the wound could be a sign of infection.
• Pus or drainage: The presence of thick, yellow, green, or foul-smelling discharge is a clear sign of infection. Clear fluid is usually normal, but anything cloudy or discoloured is concerning, as well as if there is an increase in exudate levels.
• Bad odour from the wound: An unusual or foul smell coming from the wound is often a sign of bacterial infection.
• Increased drainage or bleeding: A sudden increase in fluid coming from the wound, especially if it’s thick or bloody, can be a warning sign.
• Fever or chills: A fever (over 38°C) or feeling generally unwell with chills can indicate the infection is spreading beyond the wound. Seek urgent medical attention if these symptoms appear.
• Delayed healing: If the wound isn’t improving or appears to be getting worse after a few days, it may be infected and require medical attention.
• Skin discolouration: If the skin around the wound turns dark, bluish, or black, it could indicate serious tissue damage or a spreading infection.
• Swollen lymph nodes: Tender lumps under the arms, neck, or groin may signal that the body is fighting an infection.

Wound dressing and treatment options

It’s important to educate yourself on the types of wound dressing and treatment options available so that you can discuss it with your GP or wound care practitioner and decide on an appropriate treatment plan.

The below guidelines serve as options for wound care treatment. Keep in mind that this is a field of expertise that is constantly evolving and improving, and what works now might not be the best treatment plan in the future.

Wound care dressing types

When choosing the right dressings for diabetic wound care, several factors should be taken into consideration:

Considerations for choosing the right wound care treatment
Wound type	The type and severity of the wound will dictate the appropriate dressing. Different dressings are designed to manage specific wound types, such as diabetic foot ulcers or pressure ulcers.
Exudate level	Assessing the amount of wound exudate (drainage) is crucial in determining the appropriate dressing. Dressings that are highly absorbent are suitable for wounds with heavy exudate, while low exudate wounds may require dressings that provide a moist environment for healing.
Wound size and depth	Consider the size and depth of the wound when selecting dressings. Some dressings can conform to irregular wound shapes or are available in various sizes to cover larger wounds.
Frequency of dressing changes	The frequency of dressing changes should be considered, as some dressings require more frequent changes than others. This can impact the overall management of the wound and the patient’s comfort.
Patient comfort and allergies	Consider any patient-specific factors such as allergies or sensitivities to certain dressing materials. It’s important to choose dressings that are comfortable for the patient and minimise the risk of adverse reactions.

Taking ownership of your health is crucial for anyone living with diabetes to achieve better outcomes and lead healthier lives. By actively managing your condition through regular monitoring, healthy lifestyle choices, and adherence to medical advice, you can prevent complications and improve your quality of life.

Equally important is the role of healthcare professionals in providing education, support, and personalised care to empower you in this journey. A collaborative effort between you and healthcare providers is essential to ensure effective diabetes management, early intervention, and overall well-being. Together, through awareness, commitment, and proactive care, better health outcomes this can be achieved for those living with diabetes.

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References

1. How wounds heal: MedlinePlus Medical Encyclopaedia
2. Evaluation and Treatment of Diabetic Foot Ulcers | Clinical Diabetes | American Diabetes Association
3. Diabetic Foot Ulcers: Causes and Treatments
4. Diabetic Wound Care: Why These Wounds Take Longer to Heal and What You Should Know About Treatment – R3 Wound Care & Hyperbarics
5. South Africa – International Diabetes Federation
6. UP EXPERT OPINION: South Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment | University of Pretoria
7. 2023-11 – Diabetes – SA’s second biggest killer – Wits University
8. Assessment of prevalence and risk factors of diabetes and pre-diabetes in South Africa | Journal of Health, Population and Nutrition | Full Text
9. South Africa diabetes report 2000 — 2045
10. A Complete Guide for Wound Care for Diabetics?
11. Diabetes and Wound Care, Steps to Find Healing | Banner Health
12. The Dos and Don’ts of Diabetic Wound Care: Midwest Institute for Non-Surgical Therapy: Vascular and Interventional Radiologists

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