DM Heel Ulcer - Wound Care Help!

[LadyBug52]

I need some help with a dm heel ulcer... I'm a homecare nurse, and we use Convatec protocol for our wound care (unless we come up with something else on our own of course). This DM patient has a heel ulcer which is about 2cmx2cmx0.3 and a few weeks ago it was hyperkeratotic/callused/dry so I went by the protocol for dry dm ulcer and did Aquacel Ag with Duoderm Signal. The patient hated the Aquacel, said it burned. So, I switched to Duoderm Hydrogel with Duoderm Signal as wound was still dry and this is another option in our protocol. Well, the wound went from dry/callused/hyperkeratotic to wet, macerated and is now deeper in one week. I haven't dealt with these extremes before, and am not sure what to do next, I don't want to change to a dry dressing and have it just go back to being callused but I don't want it to be macerated either?! Any advice is appreciated!

[sorlando]

You could try using the Duoderm signal by itself. I don't know if you have Mepilex. I would use Mepilex AG on this type of wound.

[finchfamily4]

Is the pt walking on this ulcer? It needs to be properly off loaded or the build up cycle will continue. Regranx might be an option if the base is clean. Is it being occassionally sharp debrided?

[isitfridayyet?]

Does this patient have lower extremity edema? This needs to be addressed foremost.

Does the wound have slough? If so, Santyl to wound bed, calcium alginate, dsd.

[NursSherri]

if a pt has a large periwound callous, it needs to be debrided so proper healing can occur. strict offloading is a must, and so orthotics should be looked at. sometimes diabetic foot ulcers (plantar) need to "look" worse before they get better.