8.5.3 Treatment by a specialist practitioner Listen
  • 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