What is the proper way to clean a 2-week old skin ulcer on the foot?

Proper Cleaning of a 2-Week Foot Ulcer

Clean the ulcer regularly with clean water or normal saline—these simple, inexpensive solutions are all you need for routine wound cleansing. 1

Core Cleaning Approach

The most recent International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines emphasize a straightforward cleaning protocol:

• Use clean water or normal saline for regular ulcer cleansing 1
• Clean the wound regularly at each dressing change 1
• Avoid using antiseptic or antimicrobial solutions for routine cleaning, as they do not improve wound healing 1

The evidence consistently shows that simple irrigation with water or saline is sufficient and cost-effective. More elaborate cleansing solutions offer no proven benefit for healing outcomes. 1

Essential Steps Beyond Basic Cleaning

After cleaning, proper wound bed preparation is critical:

• Perform sharp debridement to remove necrotic tissue, slough, and surrounding callus 1
• Sharp debridement is strongly preferred over other methods (enzymatic, autolytic, biosurgical) 1
• Repeat debridement as clinically needed based on wound assessment 1
• Apply a sterile, inert dressing after cleaning to control exudate and maintain a moist wound environment 1

What NOT to Use

The 2024 IWGDF guidelines provide strong recommendations against several common practices:

• Do not use topical antiseptic or antimicrobial dressings for wound healing purposes (strong recommendation, moderate evidence) 1
• Do not use silver-containing dressings or other antiseptic products routinely 1
• Do not use honey, collagen, or alginate dressings for healing 1
• Avoid footbaths where feet are soaked, as they cause skin maceration 1

Important Clinical Caveats

Infection changes everything. If the ulcer shows signs of infection (erythema, warmth, purulence, fever), then antimicrobial therapy becomes necessary:

• For mild superficial infections: cleanse, debride, and start oral antibiotics targeting S. aureus and streptococci 1
• For moderate-to-severe infections: consider parenteral broad-spectrum antibiotics and surgical consultation 1
• Even with infection, the basic cleaning principle remains water or saline, but systemic antibiotics (not topical antiseptics) are the appropriate treatment 1

Practical Implementation

The cleaning process should follow this sequence:

1. Irrigate with clean water or normal saline to remove surface debris 1
2. Sharp debridement of nonviable tissue and callus (if trained and no contraindications like severe ischemia) 1
3. Apply appropriate dressing selected based on exudate control, comfort, and cost 1
4. Ensure proper offloading and address underlying causes (ischemia, pressure) 1

One small study suggested 5% hypertonic saline may accelerate healing compared to normal saline 2, but this requires further validation and is not yet incorporated into major guidelines. Standard normal saline remains the evidence-based choice. 1

The key insight is that wound healing depends far more on adequate debridement, offloading, and addressing underlying pathology than on the specific cleansing solution used. 1 Simple is better, cheaper, and equally effective. 1