An
ulcer refusing to heal may be due to various diseases. Among all,
diabetes, leprosy and cancer are most important. Those due to
diabetes and leprosy are called Trophic Ulcers; Trophe=Nutrition.
There is impaired nutrition to the place due to lack or less blood
supply; neuropathy i.e. damage to the nerve fibre.
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| Deutsch: Geschwür am diabetischen Fuß (Photo credit: Wikipedia) |
Lack
of pain sensation, mostly in the foot, makes it vulnerable to
repeated trauma; pain makes the person cautious, to use foot
carefully and draws attention.
Apart
from the specific disease oriented treatment, offloading of foot
after debridement plays a major role in healing the ulcer.
Offloading
can be achieved in various ways, among the available methods,
non-removable ones are more helpful; Total Contact Cast (TCC) or plaster
boot.
After
through debridement of the infected and dead tissue, excision of the
callous and hypertrophied skin, either TCC or plaster boot is to be
applied for 21 days. After this period, the ulcer can be inspected
for healing and if required, can be kept offloaded for a further period of 21
days.
Debridement
of the wound helps healing by migration of platelets and thereby the
growth factor; Offloading helps by saving from repetitive trauma and
pressure to the part.
