Biological basis of diabetic foot wounds.

The steps to achieving a healthy healing wound include a correct diagnosis, ensuring a good local blood supply, debriding the wound to reveal a clean base, correcting the biomechanical abnormality, and nurturing the wound until it shows signs of healing. Debridement should be performed as often as necessary until the wound is deemed clean and ready for reconstruction. The repair is then dictated by how much of the foot remains post-debridement and how the foot can be closed in the most biomechanically stable construct possible. The subsequent reconstruction can then usually be accomplished by simple techniques most of the time, and with complex flap reconstruction in about 10% of cases. Wound healing adjuncts such as growth factor, cultured skin, and hyperbaric oxygen can be helpful adjuncts.