Wound healing--a practical algorithm.

The decision-making process involved in the management of diabetic foot wounds is complex but hinges on certain simple principles. The first is to agree the actual aim of management with the patient or their representative - and healing of an open wound may be only a part of this. The agreed plan should be discussed and reviewed if the wound is unresponsive to intervention. Management depends otherwise on regular debridement and cleansing, treatment of any infection, consideration of revascularisation and protection of the wound by dressings and off-loading. The evidence to justify the use of advanced wound care therapies is not strong, and outcome depends more on the organisation of the wound care process than on the choice of a particular wound care product. The introduction of an expert multidisciplinary team has been shown to lead to a very significant reduction in the incidence of major amputation and it is likely that it is the availability or otherwise of prompt expert advice which is the principal explanation of the major variations that are known to exist in the incidence of amputation even within single countries.