45
10.3.1. Pressure Offloading for CLTI
COR LOE
Recommendations
1 A
1. Patients with CLTI and diabetic foot ulcers should receive
pressure offloading, when possible, to promote tissue growth
and wound healing.
1 B-R
2. Patients with PAD and previous diabetic foot ulcers should
be referred for customized footwear that accommodates,
protects, and fits the shape of their feet.
2b C-EO
3. Patients with CLTI and foot ulcers who do not have diabetes
may be considered for pressure offloading to promote tissue
growth and wound healing.
10.3.2. Wound Care and Management of Infection for CLTI
COR LOE
Recommendations
1 B-NR
1. In patients with CLTI, prompt management of foot
infection with antibiotics, debridement, and other surgical
management is recommended.
1 C-LD
2. In patients with CLTI with nonhealing wounds, wound
care should be provided to optimize the wound-healing
environment after revascularization with the goal of complete
wound healing.
2b B-NR
3. In patients with CLTI with nonhealing diabetic foot ulcers,
hyperbaric oxygen therapy may be considered to assist in
wound healing after revascularization.
10.3. Minimizing Tissue Loss for CLTI
Table 17. Components of Wound Care for Patients With CLTI
• Revascularization for adequate perfusion (see Section 10.2, "Revascularization for
CLTI")
• Debridement of nonviable tissue
• Management of infection, inflammation, or both
• Pressure offloading, when appropriate (see Section 10.3.1, "Pressure Offloading for
CLTI")
• Maintaining conducive wound-healing environment (ie, local wound care, dressings)
(see Section 10.3.2, "Wound Care and Management of Infection for CLTI")
• Pain control
• Medical optimization of host factors (eg, smoking cessation, glycemic control) (see
Section 5, "Medical Therapy and Preventive Footcare for Patients with PAD")
• Optimization of tissue growth
• Control of edema
Modified with permission from Gerhard-Herman MD, et al. Copyright © 2017 American
Heart Association, Inc., and American College of Cardiolog y Foundation.
