Dry necrosis

When dry necrosis develops secondary to severe ischaemia, antibiotics should be prescribed if discharge develops, or the deep wound swab or tissue culture is positive, and continued until there is no evidence of clinical or microbiological infection.

When toes have gone from wet to dry necrosis and are allowed to autoamputate, antibiotics should only be stopped if the necrosis is dry and mummified, the foot is entirely pain free, there is no discharge exuding from the demarcation line, and swabs are negative.

In severely ischaemic feet (pressure index < 0.5) antibiotics may sometimes be continued until healing.

Daily inspection is essential. Regular deep swabs and tissue should be sent for culture and antibiotics should be restarted if the demarcation line becomes moist, the foot becomes painful, or swabs or tissue cultures grow bacteria.

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