The VIPs of Healing a Wound
When it's too late to prevent, here's the next step.
I recently attended an excellent talk given by Dr. Lee C. Rogers, DPM, Associate Medical Director, Amputation Prevention Center at Valley Presbyterian Hospital, Van Nuys, CA.
He and I both agree — when it comes to diabetes foot problems, prevention is of utmost importance. But, what about when it's too late, and you have developed a wound on your foot? Then what?
Dr. Rogers told us that wounds heal in steps. The first three steps are making sure the VIPs are managed.
What are the VIPs of Wound Healing?
They are the same principles I've written to you about in my articles about healing a wound. You need to have good circulation, no infection, and relief from pressure on the wound.
The VIPs of Wound Healing are:
- V=Vascular (a medical term for circulation) — Assure there is good circulation. If there is impairment, manage it. You must have good blood flow to the wound for it to heal.
- I=Infection — Identify and manage any wound infection. A wound will not heal if there is infection.
- P=Pressure — A wound needs to be free of pressure to heal.
Dr. Rogers told me he learned this acronym from Dr. Larry Harkless, DPM, Dean, Western University of Health Sciences School of Podiatric Medicine, Pomona, CA.
Dr. Rogers also said the VIPs are more important that the dressing you use on a wound. No dressing will work unless you take care of the VIPs.
If you or your loved one has a non-healing foot wound, don't be surprised to find that it will take a team, it will take tests, possibly surgery, and it will take time.
Tests: With a foot wound, besides checking your blood sugar, A1C, blood pressure, and health care levels, your health care team will (or should) be checking to make sure you have the blood flow needed to get to the wound. This may be a simple test in the office such as one Dr. Rogers uses call the SensilLase System, which is non-invasive and takes only 5-7 minutes, or you may be referred to a vascular surgeon for evaluation for an invasive evaluation such as an angiogram.
Procedures: The procedure you will have depends on your particular wound. Your wound care team will evaluate the cause and check for infection.
There are two procedures for most all non-healing wounds.
- Debridement — the removal of foreign material and dead tissue in order to prevent infection and promote healing of a wound. This is usually done surgically in your doctor's office, but it may also need to be done in the operating room. Some dressings debride certain types of wounds. Debridement is not always recommended for heel wounds.
- Wound culture — this tests the wound bed itself to see if there is infection. A wound should be debrided prior to obtaining a culture. Once debrided, the culture should be obtained deep within the wound, not just on the surface of the wound.
Beyond this, your treatment will depend on your wound. For example, if it is infected, you will need antibiotics as part of your treatment. The antibiotic must be the one that can fight your particular infection. You may even need more than one kind of antibiotic.
Pressure Relief: All wounds require pressure relief to heal. Again, the type of pressure relief you will need depends on where your wound is. If you have a wound on the sole of your foot, you may be advised to keep any weight off of it until it heals, or you may need to wear a protective cast that ensures you keep your weight off of it, or you may be fitted for shoes or inserts that will help you keep the weight off of it.
The good news is, with the right treatment, most wounds heal. Understand the VIPs of healing a wound. Make sure the VIPs are part of your care.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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