ABC of wound healing: Diabetic foot ulcers

Local signs of wound infection Granulation tissue becomes increasingly friable Base of the ulcer becomes moist and changes from healthy pink granulations to yellowish or grey tissue Discharge changes from clear to purulent Unpleasant odour is present Management Wound control In the neuropathic foot, all callus surrounding the ulcer is removed with a scalpel, together with slough and non-viable tissue. The ABC of wound healing is edited by Joseph E Grey ( joseph.grey@cardiffandvale.wales.nhs.uk ), consultant physician, University Hospital of Wales, Cardiff and Vale NHS Trust, Cardiff, and honorary consultant in wound healing at the Wound Healing Research Unit, Cardiff University, and by Keith G Harding, director of the Wound Healing Research Unit, Cardiff University, and professor of rehabilitation medicine (wound healing) at Cardiff and Vale NHS Trust. Indications for urgent surgical intervention Large area of infected sloughy tissue Localised fluctuance and expression of pus Crepitus with gas in the soft tissues on x ray examination Purplish discoloration of the skin, indicating subcutaneous necrosis The ulcer should be cleansed and dressed with an appropriate dressing A foot ulcer is a sign of systemic disease and should never be regarded as trivial Members of the multidisciplinary team Physician, podiatrist, specialist nurse, orthotist, dietician, radiologist, vascular surgeon, and orthopaedic surgeon Further reading Edmonds M, Foster AVM, Sanders L. A practical manual of diabetic foot care.