September 19, 2019

Treating Extreme Diabetic Foot Wound PART 1 – FOOT HEALTH MONTH 2018 #21


Patient: It is for sure smaller, right? TB: It is. P: She has a small stick. TB: A small stick, yep. P: Like a plastic stick. and she put it in and she said it was less deep than before. I don’t know. But she everything she is putting in the computer. TB: Yeah, they, take the measurements. And she says they’re getting it’s getting smaller, right? P: Yes, that’s what she said. And I believe her, so. (music) TB: So, what I see is again, we have that yellow rim that’s closing in. We just need to make sure the depth comes up. We don’t want the hole to close from the top, but it’s still empty underneath. That’s the issue. So i’m happy that you got that bioabsorb. It’s good. So let’s scrape this down. So now it’s been a month and a half since you’ve been coming in or a month. P: Okay. TB: So not too bad. So again, anything that the dead has to come off. That white tissue will turn into a nice healthy pink tissue with time. P: Is someone… TB: Just the tv’s on. No ,it’s just you and me every night. So we see nice new tissue that’s forming on the sides. So I’m getting the hard callus off the top and then, we do the cleaning. This is the important part. What else have they said to you at that place? Not much? They just dress it? P: Not too much. TB: But they know you’re seeing me or not? P: Oh, yeah yeah. Yesterday, because every time is different girl right? TB: Yes. P: Yesterday was i saw her a long long time before. TB: So, we need, to make sure the wound edge is in line with the skin on top so everything closes in together. This, top part here, the wound, and the edge of the skin is together. On the bottom part, the skins growing faster and covering the wound. So we just have to clean up this bottom part a little bit more this top part is P: So the bottom TB: The skin on top it’s still deep still deep it’s not filling in and that’s why this hard skin on top is coming inside. It’s covering a hole, but the bottom is empty so it’s almost like a ledge. We don’t want to have a ledge. We want everything to be a nice circle closing in at the same time so this one’s going to need a little bit more cleaning on that bottom part. The top part is in line. So this one’s gonna need a little bit more cleaning today. But the top part is really not that shallow. I mean not that deep like before. This part is good it’s the bottom part that’s a little deep. So making sure that the wound edge and the skin are in line so, we don’t have like a ledge. We call that P: You mean the ledge on the bottom or the ledge on the side? TB: Ledge on the sides yeah. We call this undermining. We don’t want to have all this growth over and underneath there’s no real tissue. That’s what allows infection and things to grow. But the top one is okay. There’s not really any ledge. They’re tight together. Did you end up going for your appointment? P: For what? TB: With the specialist? I changed for the 3rd of May but I’m not sure I’m going there because that guy is TB: But you, did tell them that you weren’t coming in, right? P; No, I just change appointment for 29 of march to may 3rd. It wasn’t a problem. That’s the next available time when TB: They can accommodate you, yeah. P: Make an appointment. This specialist is doing the same as you, nothing else. TB: Well at the top part, it’s really connected which is good. It’s all the same level. Think of it like a slope, like a mountain slope. We want it to all be one nice smooth slope. P: So that’s why you are cutting the sides? TB: Yes, to make it connected with this P: To connect with the other tissue? TB: Exactly, exactly. So the top part is looking really good, we have a nice slope. The bottom I have to take a little bit more of the rim because it was kind of growing a ledge. We don’t want to have a ledge Because then what happens underneath the ledge, that’s where we can have bacteria grow. That’s how we get infection. That’s how we have more problems. Now the top is really nice and sloped nice.
It’s just bottom one, it has a little bit of this what we call a ledge or undermining. So I got to find where the wound edge connects to the to the wall. So next time, I want to see the work boot just to make sure that we make a nice that the padding is helping, okay, because your work, boots are one of the most important things that have to have a good cushion. P: So if i if i put the (?) So i have to put something under there this or just TB: The hole. The hole, would be a good start. P: The hole is the most important. TB: Yeah, just right over the spot so that way there’s not direct pressure on the wound, like a crater. So, what I can see happening is we’re gonna have the top part of the wound close in nice. It’s the bottom part that’s gonna take maybe a little bit longer but we have a nice slope. It’s gonna come in nice. But nothing, is digging into the into the joint. There’s no the the wound isn’t digging deeper. We can see the bottom of the wound. We just got to make sure that the right P: But you know it’s still leaking. That’s normal? TB: It’s an open sore. P: It’s not like blood. TB: Clear liquidish and that’s the P: A little, maybe a little but not too much. TB: What that is, P: Clear liquid is coming. TB: That’s the body sending fresh, new liquid for the cells to stay moist for the cells to move across the wound surface to reheal itself. Much healthier. The side are good. Okay, so i’m just gonna apply a little bit of pressure. So that’s the goal every time, we clean off whatever is dead, make sure that edges are sloped so nothing has a ledge and goes down. The top looks good. But you know looking at it I can see that the bottom is filling up because now I made it flat again. It was really bumpy and then I scraped it flat. So this is looking pretty good. The other two wounds have healed P: It is important to have it flat? TB: Yes, a flat yes yeah, we want the wound to just rise up like the sea. Nice and level and that’s why we want the sides also to be level with the wound so we don’t have to let P: You told me last time it wasn’t even. TB: It wasn’t, no. P: It was growing less than the other side. TB: Yeah, and we’re having problem with the with the bottom side, the part that’s this part of the wound. P: Yeah but you told, me that bottom sides not growing either. TB: No, no. P: Like scabs. TB: Exactly and that’s why the skin was almost growing over that area faster. So, now i’ve scraped it. It’s not perfectly flat but it’s more level. It’s not like, this anymore; it’s more level. P: Okay. TB: So what we’re gonna do P: If it’s growing, growing but not the same level TB: It’s okay, no, no it’s still okay, it’s still okay, yeah it’s still okay. But, we don’t, want it like this. P: Oh, okay. TB: We want to just even like, level, like that’s okay. It will just move up together. P: Okay. Yeah yeah.

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