Microbiological investigations

We believe that it is important to make a microbiological diagnosis and ascertain the organisms that are responsible for the infection. This involves either taking a deep ulcer swab or curettings, or tissue scrapings after debridement. How to take a deep ulcer swab/curettings:

• The ulcer is debrided of surrounding callus and superficial slough

• The ulcer is washed out with sterile normal saline

• The base of the wound is then curetted (or scraped with a scalpel blade) and the curettings/scrapings sent for culture without delay. If curetting is not possible then a deep swab is taken from the base of the ulcer.

If the patient subsequently undergoes operative debridement then deep infected tissue rather than a swab should be sent to the laboratory.

Bone fragments removed by debridement should be sent for culture.

Blood cultures should also be taken if there is fever and systemic toxicity.

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