As we approach the last few hours for 2010, we all like and want to put together our list of resolutions to accomplish in the New Year. Our very own Lee Rogers suggested we do the same for the diabetic foot he even got things started with a few of his own. We need your help, though. Please post some of your suggestions and we’ll try to put together a list of resolutions that we’ll post on our toeandflow.com blog, on my facebook page or on my twitter feed. We will periodically use these in our DFCon.com email blasts (and at DFCon itself in March) to highlight and raise awareness about the oft neglected area of care. I believe Paul Brand taught us that “if you ignore your feet, they’ll go away.” Let’s do our best to counter that. Send us your diabetic foot/amputation prevention resolutions.
Most importantly, Happy New Year to you and yours. Let’s make it even happier and healthier than 2010.
Note: Shortly after we proposed this list, my SALSA partner, Joe Mills, went on a creative tear, identifying that “RESOLUTIONS” is actually 11 letters. He then worked to add one in per letter. Please note the final letter “S” refers to our recent manuscript in JVS/JAPMA (rescuing Sisyphus).
11 Diabetic Foot RESOLUTIONS for 2011:
Resolve: to practice what we preach: always identify and stratify risk; practice prevention; offer offloading
Evaluate: TOE (deformity, sensation, pressure, shear, shoe gear) and FLOW (ankle and toe pressures, Doppler waveforms, O2 tension)
Sample at Surgery: culture bacteria from the wound at the time of debridement (don’t perform surface cultures!)
Offload: I shall not forget to emphasize offloading, a simple solution, based on sound science.
LOPS (loss of protective sensation): Loss of the gift of pain is the underlying cause of DFU. To ameliorate this Loss, providers must Offer Preventive Services. Remember, prevention will always trump technology.
Under the Ulcer: Ulcers are like icebergs. Don’t focus on the surface. Investigate what is under the ulcer (bony prominence, soft tissue infection, abscess?) and consider the underlying causes (neuropathy, bony prominence, infection, trauma and ischemia)
Team: Team care improves DFU outcomes and prevents amputations.
If I am part of a Team, I will strive to improve it. If I am not, I will create one in my community or region.
Investigate: Investigate, classify and treat Infection and Ischemia
Ongoing Care: Treating DFU’s is never simple. Provide ongoing treatment until healing and practice prevention with an integrated team approach.
NPWT: Negative Pressure Wound Therapy, bioengineered tissues and other advanced modalities are important adjuncts. I will consider advanced therapies if wound area reduction is less than 50% at 4 weeks or if specific reconstructive circumstances call for them immediately.
S: Sisyphus. Teams of professionals, working together, can prevent amputation and reduce DFU recidivism. The task is made less daunting by teamwork rather than toiling heroically in isolation.