removal of all slough and necrosis from wound as it hinders the growth of underlying granulation tissue; satisfactory debridement is indicated by fresh capillary bleeding
wound should be repeatedly re-examined and further slough removed
assessment for the presence of abscess communicating with ulcer base:
it should be entered, its walls broken down, and the cavity packed
antibiotic cover is required, as is the case if cellulitis is seen around the ulcer margin
resistant ulcers may benefit from reconstructive surgery:
rotational skin flaps for buttocks
split skin grafts for heals
dressings; alternatives include:
gauze roll replaced regularly
silicone foam elastomer, washed and replaced regularly
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