Diabetic ulcers: evaluation and management

Four factors are necessary for healing any diabetic ulceration. First, the vascular supply must be adequate. Second, any infection must be controlled. Third, pressure that is contributing to the formation of the ulceration must be eliminated. Lastly, adequate nutritional status must be maintained. With the variety of ulcer treatments that appear on a regular basis, it is frequently difficult to evaluate one method versus another. Any treatment regimen that is advised must ultimately depend on these basic building blocks for success. It is frequently difficult and sometimes impossible to control each of these factors, but an understanding of their mechanisms and contribution to ulcer healing allows the clinician to plan therapy and develop an ultimate prognosis for each case he encounters. Tables 1 and 2 contain guidelines for evaluation and treatment based on these principles.