Clinical management of diabetic ulcers.

The presence of neuropathy is the most important factor in the development of a diabetic ulcer, whereas inadequate vascular supply is the most important factor in healing. Diabetic foot ulcers are complex wounds that require a long time to heal. A key element in treating diabetic wounds is to off-load, or remove, pressure from an insensate foot. Topical wound dressings are aimed at providing a moist wound environment. No single dressing has been shown to be superior to another. Clinical infections are common but probably overdiagnosed. The question of how much and how often a diabetic foot wound needs to be debrided is controversial.