Wounds in Patients with Diabetes Mellitus

Since retiring, my father diligently exercising. For two years now every morning he went around the park near the house. My father with diabetes mellitus, the disease was diagnosed five years ago. However, because of busy work, less than optimal diabetes control. Dad had lunch at the office and sometimes also eat breakfast there. Eating is not the advice of a nutritionist so uncontrolled diabetes. Examination of his blood sugar is still up and down.

Dad also had coronary heart disease since the age of 48 years. On consultation with an ophthalmologist, the results are good, and kidney function tests are still good. A month ago, when a sharp object punctured father a morning walk. Wound is not treated properly, just washed and given a wash liquid pests.

Several days later, his body heat and festering wound. I immediately took him to a regular hospital treating his diabetes. The wound was cleaned and given a strong antibiotic. However, it turns out the wound after cleaning to be rather wide. Said the doctor likely will be a long recovery. Father also asked to control blood sugar well, keep clean, and avoid trauma.

I often read that the wounds in diabetics are difficult to cure. In fact, people with diabetes who have foot ulcers often need surgery. How to prevent injuries in people with diabetes, especially injuries to the leg? Is it true that diabetic foot ulcers are difficult to cure? When the injured leg require surgery? Thank you.

M in J

Diabetic foot does need attention so that maintenance can be done right. Diabetic foot often impaired circulatory (vascular) and neurological disorders (neuropathy). In addition, infection can also occur. The third condition causing wound healing in patients with leg becomes more difficult and requires management involving various areas of expertise. Therefore, understanding and practice is very important to prevent the occurrence of diabetic foot ulcers.

Trauma to the foot can occur due to cutting the nails too short, the use of ill-fitting shoes, and cuts from sharp objects. Most people assume, would walk barefoot can stimulate blood circulation, even those walking on sharp gravel. This action actually risk injuring your feet, and the wound may also be infected. If there is an infection, infection control often is not easy.

At uncontrolled diabetes mellitus, decreased immune to this situation also complicates the healing of infections. Uncontrolled infection can be widened, and even the muscles and bones. If bone infection, antibiotics are specifically required for the antibiotics need to be able to penetrate the bone. If the wound is too wide, sometimes required plastic surgery. Leather wide-open closed by taking skin from other parts of the body, such as from the skin of the thigh.


In the event of the death of tissue called gangrene, the skin becomes black because it had no blood supply. In the state of severe, sometimes gangrenous leg that had the necessary surgery. Cutting the legs below the knee can be done, but sometimes above the knee. This situation is certainly very difficult for the patient.

Experience in Cipto Mangunkusumo Hospital (RSCM), most of which had diabetes foot care in the hospital in a state of patients come too late. When there is trauma or injury, patients treat their own wounds in many ways. The cost factor is usually slow patients looking for a doctor. It was only an attempt to self-medicate if this fails, the patient will usually go to the doctor. At that time, the wound is usually bad and require hospital treatment. If admitted to the hospital, treatment is usually quite long, about 25 percent more than a month maintenance.

Approximately 50 percent of injuries caused by mechanical factors, such as shoes, nails, and falling. Only about one-third of the injuries suffered spontaneous. Thus, in fact most injuries can be prevented if patients understand how to maintain healthy feet.

The results of treatment, according to research at the RSCM, is still less than satisfactory. Mortality rate of about 4 percent. Amputation, although most avoided, had to be done with a large percentage of amputation minor amputation 2.1 percent and about 6.4 percent. Fortunately, about 30 percent of patients who are not amputees can heal well and 34 percent were cured with the help of a skin graft.

Factors of infection is a major factor in the worsening state of the wound, while the interruption of blood flow accounted for 10 percent, both in the form of peripheral vascular disorders mild to moderate. After the patient's discharge, the patient still needed rehabilitation in order to be active again. RSCM available in the diabetic foot clinic is an integrated service diabetic foot problems under one roof. This service involves a variety of experts, including specialists in internal medicine, surgery, and medical rehabilitation.

Wound healing also requires control of vascular, metabolic, injury, infection, and others. Looking at the data from the RSCM, we need to keep the diabetic foot can be well maintained. Counseling of the patient is essential. If there is a change in the feet, people with diabetes should consult a doctor immediately to avoid injury occurs that is difficult to overcome.

We should certainly try to reduce the number of amputations due to diabetic wounds as low as possible. Thus, the expected quality of life can be maintained. Therefore, the approach in the management of diabetes mellitus is counseling, diet control, exercise, and blood sugar controlling drugs and other necessary medications.

If diabetes can be caught early and the patient able to practice a healthy lifestyle in accordance with the management of diabetes, complications of diabetes is expected to be prevented, including diabetic foot problems.