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Amputation Prevention in Black Populations: Tackling Infectious Wounds

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Wound infection is a common complication in diabetic patients and is associated with high morbidity and risk of lower extremity amputation. Blacks, in particular, have a 77% higher risk of diabetes than the rest of the U.S population, which translates to an increased rate of infectious wounds in the community. Therefore, tackling infectious wounds is a significant intervention necessary for amputation prevention in Black populations.

What Causes Infectious Wounds?

It’s estimated that 25% of people with diabetes will suffer from an infectious wound at a point in their life. People with diabetes have impaired wound healing associated with underlying conditions such as neuropathy, vascular disease, and foot deformities. It’s also a significant factor in half of all cases of lower-extremity amputations.

Peripheral neuropathy plays a significant role in developing diabetic infectious wounds and occurs in about 30 to 50% of diabetes patients. Neuropathy causes the patients to lose pain sensations impairing awareness of trauma such as a cut or foreign objects penetrating the body. Once the skin is broken, the underlying tissues are exposed to pathogens, and a resulting wound infection begins at that spot. If left untreated, the infection spreads to even deeper tissues.

People with diabetes have impaired leukocyte function leading to inadequate fighter cells migrating to the wound. The result is an increased risk of wound infection. Infectious wounds can escalate to sepsis and are associated with high morbidity and mortality. However, little is known about infectious wounds in diabetics, and more research is in the offing.

Diagnosis of Infections Wounds

Infectious wound diagnoses are often based on clinical signs and symptoms of local inflammation. The doctor may use debridement strategies to remove necrotic tissue and examine the wound’s depth and severity. The severity of a wound determines the antibiotics to be used, how they will be administered, and whether hospitalization is necessary.

Infectious wounds are classified as either mild, moderate, or severe. Staphylococcus aureus (S. aureus), a gram-positive bacterium, and beta-hemolytic streptococci are the most common causes of previously untreated mild and moderate skin and invasive infections. Treating S. aureus infections is challenging, and the associated mortality rate remains high. Early diagnosis facilitates appropriate management and prevents further infection.

Management of Diabetic Wound Infections

Infectious wounds are associated with increased frequency and length of hospitalization and lower limb loss. Prevention and prompt management are necessary to reduce morbidity, especially amputation. Optimal management of infectious wounds involves antibiotic therapy, surgery, and regular foot inspections.

Antibiotic Therapy

Antibiotics such as cephalexin and dicloxacillin can be used to treat mild infectious wounds effectively. Intravenous administration of ciprofloxacin and clindamycin is done for severe tissue sores. Topical antibiotics are effective for mildly infected wounds, though routine use is discouraged. Antibiotic treatment for mild and moderate wounds lasts 1 to 4 weeks, whereas severe sores get better after 6 to 12 weeks. Antibiotics are not required for noninfected sores since they don’t promote wound healing or prevent infection.

Surgical Treatment

Surgery is recommended for deeply infected wounds. The procedure ranges from a simple incision and drainage to surgical sharp debridement of a gangrenous or ischemic wound. Early revascularization is recommended to successfully treat an infected wound with critical ischemia and is the best shot at limb salvage. Also, vascular surgeons can treat the infectious sore with a flap or graft.

Safeguard Your Feet

The first step in managing infectious wounds is regular foot inspections by a qualified healthcare provider, followed by at-home self-care strategies. Here are some things to include in your daily routine:

  • Inspect your feet daily: Check for bumps, blisters, redness, bruises, cracked skin, and sores. Even the most minor crack is susceptible to infections, and early discovery ensures you prevent further infections.
  • Feet Hygiene: Wash your feet in lukewarm water and dry them thoroughly to prevent fungal growth, especially between the toes.
  • Keep the toenails short: Long toenails can be a breeding ground for bacteria.

Avoid being barefoot, even in your home, since bare feet are more prone to injury. Call your doctor if you discover anything wrong with your feet that doesn’t disappear even after in-home treatment.

Control The Infectious Wound

People with diabetes and other at-risk patients should monitor their blood glucose levels closely. High glucose levels prevent the white blood cells from fighting pathogens and reduce blood flow around the wound site. The infected wound should remain covered with a bandage and a wound dressing to maintain an optimum environment that’s neither too dry nor too wet. Doing so helps the wound heal properly.

Avoid walking directly on the injury site on your foot until the wound heals. Excess pressure on the infectious sore can delay healing and increase your risk of further infections. Leg edema slows the healing of infected wounds and should be controlled by leg massage and elevation, reducing salt intake, and wearing compression stockings.

Bottom Line

Prevention of infectious wounds starts with identifying at-risk patients. People with diabetes should have regular foot examinations for nail disorders, skin breaks, loss of sensation, and constricted blood supply. Proper education of patients, healthcare providers, and caregivers is an effective strategy in tackling infectious wounds among Blacks.

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