Every 30 seconds worldwide, a person with diabetes loses a leg to amputation. Dr. John “Jack” Byrnes wants to make sure you won't be one of them.

Byrnes is a specialist in wound care and hyperbaric medicine who treats about 4,000 patients a year at Novant Health Rowan Medical Center in Salisbury, North Carolina. About 20 percent of his patients have diabetes, which makes their lifetime risk of amputation is 10 times that of the general population.

People with diabetes have limitations on their early warning systems – they may not develop pain or redness until (a wound) has gone beyond where you want to intervene,” Byrnes said. “Early intervention is best.”

Byrnes explains here why diabetes can be so problematic for wound care and what patients need to know.

WHAT DIABETES CAN DO: Diabetes can impede blood flow, which slows healing, and cause skin changes such as thick calluses that can develop into painful ulcers, or open sores.

It can also lead to nerve damage, especially in the legs and feet. The resulting numbness is why a diabetic can get a cut or blister on his foot and remain unaware of it until he notices blood on a sock, checks it out and spots a significant wound.

“So there's often a significant delay in care,” Byrnes said. “That's how the specialty of wound care came about.”

WHAT DIABETIC PATIENTS CAN DO: For all these reasons, diabetics need to check their feet and legs every day for broken skin, ulcers or redness, Byrnes said. Putting a mirror on the floor can make it easier to see the soles of your feet. Or, he suggests, ask a family member to check for you.

The Centers for Disease Control and Prevention has a step-by-step guide to diabetic foot care.

While the lower limbs are most vulnerable, diabetics shouldn't overlook other wounds. If an injury breaks the skin, causes bleeding and isn't healing in 48 to 72 hours, see your primary care doctor, Byrnes advised. If needed, he or she can send you to the wound center.

“If a wound doesn't heal the way it should, it can go on to become a life-threatening problem,” he said.

WHAT THE WOUND CARE CENTER CAN DO:  Your wound-care treatment is likely to begin with antibiotics.

But if dead tissue has built up around the wound, it may need to be surgically removed – a process called debridement. “Fresh, new skin is soft and supple and finds it very difficult to go through that hard material,” Byrnes said. Sometimes excising it is the kick-start a patient needs.


For other nonhealing wounds, Byrnes calls upon a pair of state-of-the-art infection-fighters – bio-engineered skin substitutes and the hyperbaric chamber.  

Similar to a traditional graft of your own tissue, a skin substitute is tissue cultured from cells supplied by an animal, cadaver or living donor. Applied over the wound, it provides a road map for the patient's own skin to grow in, Byrnes said. The skin substitutes are applied once a week for up to 10 weeks.

“If everything fills in before that, you don't have to go 10 weeks,” Byrnes sad. “If it hasn't done much good in 10 weeks, it's probably not going to.”

If a wound isn't responding to conventional treatments – or infection has spread into deeper tissue – some time in the hyperbaric chamber may be just what the doctor orders.

Novant Health’s Rowan wound center has two chambers that can treat a total of eight patients a day, Monday through Friday.

“Hyperbaric is useful because it gets a higher quantity of oxygen into the blood, and many bacteria don't like high concentrations of oxygen,” Byrnes explains.

Though the chamber is highly pressurized, patients don't feel it. Most spend their time inside watching DVDs or napping. Still, it’s a demanding prescription: Treatments last 90 to 120 minutes, and 20 to 30 sessions are usually required. Insurers must be persuaded that other treatment hasn't helped, Byrnes said.

The assorted treatments can also be used together. Byrnes said his aim is a regimen that will mesh with what other doctors are doing for a patient – and then keeping everyone in the loop.

For people with diabetes, Byrnes offers a stark takeaway: Letting a wound fester can cost you a limb – or your life. So don't procrastinate.

“If an infection is caught while it's still limited to the skin, we can usually get people healed fairly quickly,” he said.


Novant Health diabetes experts are here to help you understand your options and provide the care you need. Our team of wound care experts provides specialized treatment, including hyperbaric oxygen therapy, for chronic or nonhealing wounds to help you get back to your normal routine.