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A 40-year-old member asked:

what is the best wound care for a necrotic diabetic foot ulcer?

8 doctor answers21 doctors weighed in
Dr. Vasu Brown
Integrative Medicine 34 years experience
Depends on Bloodflow: If the skin around necrotic area is still healthy only a small portion is necrotic then you can start locally the first week with antibiotic cream to reduce bioburden and keep using local debridement - removedead tissue off the wound site and try to heal the area. Diabetic ulcers respond to oral vitamin k2 - you can read http://vitamink2.Org. I use 10% Phenytoin cream locally http://drbrown.Us.
Dr. Scott Bolhack
Wound care 35 years experience
Diabetic foot: You need to seek care from wound center or podiatrist as soon as possible. The evaluation of a diabetic foot ulcer requires a careful history, investigation of your neurological status of your feet, an assessment of the blood flow, and a comprehensive treatment plan that may include debridement, cultures, offloading (which is the most important issue most of the time), and testing. Do not delay!
Dr. Kristin Wulff
Wound care 19 years experience
I agree - most important is the level of neuropathy you may have due to the diabetes. This can be easily checked in clinic while the other tests are being done so that a whole picture of what is going on in your wound can be seen and understood by the right people.
Feb 1, 2012
Dr. Adam Teichman
Orthopedic Foot and Ankle Surgery 19 years experience
Wound Care Center: If you suffer from any diabetic foot wound you need to see help with a certified wound care specialist and podiatric surgeon. Wound care centers specialize in treating all kinds of complicated diabertic and non diabetic wounds. If you are suffering with a necrotic wound seek medical attention, dont delay becuase a wound untreated can lead to limb loss.
Dr. Tharesh Udupa
Podiatry 22 years experience
Team approach: Depends on what is meant by necrotic. Is there blood flow to the extremity or wound? If not, a vascular or interventional cardiologist need to increase the blood flow to the extremity. A podiatrist is needed to get any bony prominence resected and to offlaod the wound. An endocrinologist is needed to get the diabetes under control if out of control.
Dr. Jeffrey Kass
Podiatry 28 years experience
Medical care: Best care would imply you are seeing the appropriate people to best deal with this condition. A team approach responsible for keeping your sugar under control, making sure your bloodflow is adequate, offloading the foot if the ulcer is on the bottom of the foot and taking care of all other comornidities. This is not something to do without proper medical attention.
Dr. Khurram Khan
Wound care 20 years experience
Multiple factors: It’s changing every day. Wound care requires multi-discipline input for proper wound healing. There are multiple modalities and multiple strategies to get a wound closed but it takes a knowledgeable well trained specialist to know when to implement the appropriate treatment during the course of wound healing using evidence based medicine.
Dr. Payam Rafat
Podiatry 22 years experience
See a professional: Successful treatment of diabetic foot ulcers consists of addressing these three basic issues: debridement, offloading, and infection control. Seek professional assistance.
Dr. Payam Rafat
Dr. Payam Rafat commented
Podiatry 22 years experience
Provided original answer
Treatment includes infection control, offloading, optimizing circulation and nutrition, and wound care. Optimal outcomes can be achieved when your primary physician work together with a podiatrist, neurologist, endocrinologist, vascular surgeon, orthopedist, nutritionist, infectious disease specialist, and pedorthist when indicated. Inappropriate treatment can lead to infection and amputation.
Mar 11, 2013
Dr. Robert Dorsey
Wound care 36 years experience
Maggot therapy: If the wound is necrotic this needs to be removed. Apply maggots to debride the wound. Must make sure the blood supply is adequate for healing. Need to off load the wound. See a wound care specialist.

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Last updated Feb 6, 2019

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