An overview of chronic wound characteristics.
DIABETIC ULCERS
Predisposing Factors/Cause
Diabetic patient with peripheral neuropathy and/or peripheral vascular disease
Location and Depth
Any sites on the foot and lower limb subjected to repetitive pressure, friction, shear, or trauma; plantar aspect, metatarsal heads (especially first and fifth), great toe, heel; shallow to deep, may have tracking and/or undermining
Wound Bed and Wound Appearance
Granular tissue unless peripheral vascular disease is present; often has deep necrotic area; may be dry; cellulitis or osteomyelitis may be present; neuropathic ulcers almost always accompanied by eschar and often accompanied by exposed tendons
Exudate/Drainage
Low to moderate exudate; infected ulcer may have purulent drainage
Wound Shape and Margins
Smooth, even; may be small at the surface with large subcutaneous abscess, characterized by callus around the ulcer and undermined edges
Surrounding Skin
Dry, thin, frequently callused; periwound hyperkeratosis is common and indicates continued pressure
Pain
No sensation, or constant or intermittent numbness or burning; neuropathic ulcers are almost always accompanied by numbness and paresthesia
Healing
Patient must comply with diet, glucose regulation, exercise, and foot care/wear; aggressive revascularization and appropriate antibiotics may be needed for healing; custom or specialized shoes will reduce pressure and help prevent recurrence
FIGURE