Wound care and diabetes
Tuesday, 22 December 2020
Living with diabetes means you live with a higher risk of infection and ulceration. Because you can’t wrap yourself in cotton wool at all times, you will get wounds occasionally.
Your pharmacist and GP are the best people to help you with wound management; however, below is a practical guide for you. This is not a comprehensive list, so if you are in any doubt ask your pharmacist or GP.
You should go straight to your doctor when:
- Bleeding cannot be controlled
- You can’t remember when you last had a tetanus injection
- Wounds fail to heal or if ulceration occurs
- You have callouses on your feet or severely cracked heels (see a podiatrist)
- Wounds break open or are more than skin deep
- A wound is weeping or develops an odour
- Other things happen such as bleeding from your mouth, nose, eyes, ears or genital area
- You also have a bad headache or loss of consciousness, slurred speech or blurred vision
- The redness around the wound increases in size or becomes more painful, or you develop a fever
- For any animal bites
- Burns that are larger than a 20-cent coin or deeper than your first layer of skin, or on your face or genital area.
‘Airing’ a wound is a myth
Airing a wound or applying powder will slow healing. Applying a dressing provides protection from further damage and bacteria. Dressings should keep a wound warm and moist but still allow the wound to breathe.
Antiseptics and wound cleansing will reduce the risk of infection. A gentle wash with saline or tap water can be used to remove dirt, sand or gravel from a wound such as a graze, skin tear or shallow cut. Usually you don’t need an antiseptic as they slow healing or restart bleeding. You could reserve them for situations where your skin is broken in the presence of a highly infective agents such as: another’s bodily fluids, faeces or rotting matter. Always use the antiseptic as directed. Dilute a strong solution of antiseptic to avoid burning your skin. If you use a disinfectant wash leave it on for three to four minutes and rinse it off with tap water or saline. Self-cleaning of wounds is for the first time only. If you feel a wound requires recleaning, go to your GP. If you need to dry a wound after cleaning, use a product that is clean and will not stick or leave lint. Cotton wool can be used during gentle wet cleaning of the area but not for drying.
Burns and blisters
Creams, ointments or gels are generally not necessary for healing. The exceptions are burns and skin tears which benefit from hydrogels such as Solosite, Solugel or wound aid gels. Always run a burn under cool water (no ice or ice water) for 20 minutes before doing anything else. For a small burn apply a liberal amount of gel before applying a dressing. Do not burst blisters. Blisters protect underlying skin and reduce infection.
If your wound is clean and not infected leave it alone. If you feel the need to add an ointment before applying a dressing you could use povidone iodine such as Betadine, medical grade manuka honey or use a silver dressing to reduce the risk of infection. There is no need to reapply ointments with dressing changes. Infected wounds require medical attention.
Plastic/fabric strips are fine for a shallow cut especially on your fingers, as long you clean and dry the cut first. If cuts are deep or getting infected see your GP.
Film island dressings are for shallow cuts or grazes. The island part of the dressing is a non-stick dressing that is surrounded and covered by an adhesive film. The adhesive film may be waterproof. This allows you to bathe without wetting the wound. Examples are Cutifilm Plus or Opsite Post Op. The film may be a stretchy fabric type which will conform and stretch with body parts such as knees and elbows. Examples are Primapore or Cutiplast. These dressings will absorb a small amount of weeping. If your wound is weeping larger amounts of fluid see your GP. The non-stick part of the dressing must be bigger than the wound. Dressings can be left on for seven days undisturbed. Each time you redress a wound, healing is disturbed.
If you have fragile skin the adhesives in island dressings may cause your skin damage upon removal. Instead try a non-stick dressing such as Melonin or Cutifilm. Always place the plastic side down on the wound. These dressings are kept in place by a light crepe bandage or a self-adhering wrap such as Easyfix Cohesive or a Tubifast. Wraps and bandages must never be tight enough to restrict blood flow. Allevyn gentle border is also suitable for fragile skin.
For skin tears replace the flap with sterile tweezers and control the bleeding with gentle pressure from a sterile dressing, rinse with tap water or saline, dab dry with a lint free dressing, attach a wound closure strip across the tear, apply a small amount of hydrogel and then apply an island dressing as above and leave this on undisturbed for seven days.
Silicone coated dressings are gentle and minimize pain without sticking to the wound. They are suitable for fragile skin. Example are Allevyn and Mepilex. They are designed to kept on the wound for a week and may be cost effective compared to multiple dressing changes.
When to seek medical attention
If you are not sure about a wound, seek medical attention. Procrastination with wounds and burns leads to ulcers that are much harder to heal.
By Donna Itzstein, Pharmacist and Credentialled Diabetes Educator