A key requirement for the successful treatment of chronic wounds is close collaboration within specialized wound care teams. A proven coordinating center is the wound clinic or wound care center. Here, diagnostics and the initiation of treatment are carried out in accordance with professional guidelines and current scientific knowledge, tailored to the specific stage of the wound.

Well treated in a wound care center
At the wound care center, additional diagnostic or therapeutic measures are arranged or coordinated as needed. For example, if there are signs of a serious circulatory disorder in the feet, prompt referral to a vascular surgeon is ضروری. The approach is based on recommendations from professional societies and the latest scientific evidence.

Checklist for the treatment of diabetic foot syndrome

• Detect early: Check your feet daily
• Seek treatment early: Show every wound to your doctor immediately—better once too often than too late
• Identify the cause: Are you wearing insoles or protective footwear? Do they still fit properly? Ask your doctor about circulatory disorders and nerve damage
• Completely offload wounds: This can be achieved with special footwear, a wheelchair, or, if necessary, bed rest
• Regular wound care: Removal of excess callus and application of dressings by medically trained professionals
• Fight infection: Take antibiotics if necessary
• If circulatory problems exist: Improve blood flow (e.g., balloon dilation, vascular surgery)
• In difficult cases: Seek care at a diabetic wound clinic or wound center
• Amputation only as a last resort!

The right specialist team is crucial!
It has proven effective for an experienced primary physician—who knows the patient and their wound condition well—to coordinate further necessary measures or discuss them within the treatment team. This also determines whether a patient should be admitted to the hospital for inpatient treatment and when they can return to outpatient care. Cooperation with general practitioners is organized accordingly; depending on their expertise and practice focus, they may refer patients to a wound clinic earlier or later, or continue treatment themselves once the condition improves.

What happens during wound therapy
Wound therapy begins with cleaning the wound. Typically, yellowish wound coatings are removed to allow new, healthy tissue to form. Antibiotic treatment with tablets or infusions is not necessary for every chronic wound; it is used when, for example, there is a risk of the infection spreading or clear signs of infection persist despite cleaning. Early pressure relief is essential in treating diabetic foot wounds.

Before applying a dressing, the wound is disinfected, for example with polyhexanide, octenidine, or PVP iodine. The wound should be kept neither too moist nor too dry. Special dressings, such as thin foam dressings, are used for this purpose. If the wound tends to be dry or has stubborn coatings, a wound gel is applied. Exception: wounds on the tips of the toes may sometimes be treated dry if there are circulatory disorders.

Local wound care follows a defined plan outlining the type and frequency of treatment. If care is not provided exclusively at the wound center, each patient should receive a treatment plan for co-treating providers, including the wound center’s contact number. Family members can often be involved in wound care, which can be beneficial since continuous observation allows early detection of small or rapidly developing changes and enables prompt adjustments in treatment.

For heavily exuding wounds, vacuum therapy may be used. This involves a negative pressure system to remove wound secretions and promote healing. In certain cases, when removing wound coatings is difficult, “bio-surgery” can be used as an alternative to surgical methods. This involves placing larvae (maggots), enclosed in small tea bag–like pouches, into the wound. The larvae absorb wound secretions and help clean the wound.

Categorized under: Diabetes and foot disorders (diabetic foot syndrome)
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