8.5.3 Treatment by a specialist practitioner

• Regular removal of necrosis at least once a week by a trained practitioner. In cases with arteriosclerosis, dry necrosis should not be removed until skin circulation is restored or auto amputation has occurred
• Autolytic necrosisechtomy is widely used to loosen necrosis
• Redress the wound every day
• Never use local antibiotics when the wound is infected. Use instead simple non-adherent dressings
• The dressing should be able to be removed without causing wound pain or damage to the wound bed
• Compression may be required if there is oedema and adequate arterial circulation
• Use dressings that manage to remove excessive exudates and provide a moist wound environment

Additional treatment

• Relief of pressure from the wound area
• Patient education for patients and relatives concerning risk factors and glucose control
• Vascular surgery in severe arterial failure to restore skin circulation
• Treatment of oedema and malnutrition
• Mobilise if possible, never put any pressure on the wound

Never use

• Local antibiotics in the wound bed
• Local disinfectants in the wound bed
• Soaps to wash the foot
• Occlusive dressings such as films, hydrocolloids or foam adhesives
• Footbaths