Treatment:

The primary goal of treatment is to obtain wound closure.  Treatment is multifaceted due to the complex nature of the wound.  Relief of pressure on the ulcer is critical to the wound healing process.  This endpoint often requires pressure relieving factors.  Total contact casting reapplied weekly is the optimum management of pressure off-loading.  Treatment of any underlying ischemia is required.  Distal vascular reconstruction may be required to restore pulsatile flow to the foot.  When infection is present, appropriate aerobic and anaerobic antibiotic therapy is necessary.  Adequate insulin availability to the wound is needed to stimulate healing.  Also, blood sugar control is important for healing.

Debridement of all necrotic tissue and callous is also required.  Debridement should be performed to bleeding tissue.  Moist wound healing should then be initiated along with protection from external contamination.  A number of agents are used including films, foams, alginates, and hydrocolloids.  The OASIS® wound matrix would not only provide an optimum healing environment, but also provides matrix components, known to improve the wound healing process.

The addition of growth factors in the form of platelet derived growth factor becaplermin have been shown to stimulate wound healing in the diabetic ulcer.  In addition, the use of dermal components have been shown to also improve healing.  A wound matrix such as OASIS^® wound matrix dressing will provide important biologically active matrix components to the diabetic ulcer including growth factors.