Neuropathic ulcers

Our approach to neuropathic ulcers is as follows.

At the first visit, if there is no cellulitis, discharge or probing to bone, the foot is deemed to be at stage 3. Debridement, cleansing with saline, application of dressings and daily inspection will suffice. The patient is reviewed at, preferably, 1 week or less, together with the result of the deep ulcer swab or tissue culture. If the neuropathic ulcer shows no sign of infection and the swab is negative, treatment is continued without antibiotics. If the ulcer has a positive swab, the patient is treated with the appropriate antibiotic, according to antibiotic sensitivities until the repeat swab, taken at weekly intervals, is negative. It is accepted that some organisms isolated from the swab may be commensals; however, if there are Grampositive organisms or anaerobes or a pure growth of Gram-negative organisms we regard this as a significant result and microbiological evidence of infection. It was shown in a study of the bacterial population of chronic crural ulcers that a swab should be obtained routinely from patients with diabetic ulcers as 70% of diabetic ulcers with a positive swab developed clinical infection.

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