by Elliot Fialkoff and James McGuire DPM, PT, CPed, FAPWHc
There are numerous causes for ulcerations including pressure, venous insufficiency, arterial insufficiency, and neuropathic wounds. All have very different characteristics and require very different interventions. One thing that all chronic wounds have in common is the accumulation of necrotic material, biofilm or non-viable materials secondary to a prolonged inflammatory stimulus to the wound. In order for an ulcer to heal properly this "slough" must be regularly removed from the wound base so that healthy granular tissue can develop.