The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
1. Diabetic ulcers of the feet are both troublesome and dangerous. Potentially they can result in foot and/or lower leg amputation, especially in Thailand.
2. Ken had an ulcer to his right hallux, big toe, for 15 months. It was painless. He brought it to my attention in March this year. I asked his wife to debride the dead skin, which she did with a scalpel blade after cleaning the toe with betadine.
3. I reviewed his toe in May. Despite his wife’s attention, the ulcer remained the same. The discolouration was caused by daily cleaning with Betadine. Despite daily dressings, the wound did not heal.
4. There are 3 types of wound healing: Primary intention, Secondary intention and Tertiary intention.
Primary intention; the wound is sutured.
Secondary intention; due to the amount of tissue lost, the wound cannot be sutured. It is dressed and left to heal by granulation. Granulation tissue is composed of connective tissue and tiny, nascent blood vessels that develop in the wound bed. The connective tissue forms a scaffold for new tissue and blood vessels which heal the wound.
Tertiary intention; the wound is cleaned, dressed and left open for a period of time prior to closure by suture. This type of healing is used in amputations when the remaining tissue after amputation is left for 5-7 days to ensure the stump is viable before it is closed.
5. Ken’s wound was left to heal by secondary intention. The wound failed to heal because his wife was using Betadine to clean the wound. Betadine, like Chlorhexidine, Alcohol and Peroxide, is a strong antiseptic designed to kill infection. Unfortunately, it also kills/destroys granulation tissue.
6. The correct way to manage an open wound is:
Clean the open wound with an antiseptic. Once the wound is clean, irrigate with Normal Saline, available from your local pharmacy.
Pack the wound with Bactigras, see video.
Dress with gauze.
Remove dressing in 24 hours.
Repeat dressing as above.
7. Within 3 weeks Ken’s ulcer was healed, see photo 4.
8. In the West, if Ken’s ulcer had become infected, he may have lost his toe. In Thailand he may have lost his foot! Such is the folly of diabetes in Thailand.
Addendum: Over the past 6 years, as a retired medic living in Buriram I offered second opinions on any medical issue. I recently moved to Pattaya. As in this case, if you reside outside of Pattaya, telephone consultations are provided. For assistance; please contact me, Doc Martyn, on Facebook or call Dao on 095 414 8145.
