1. Wound Bed Preparation

Ongoing evaluations of wound bed preparation are necessary.

• Initiate wound bed preparation to convert the molecular and cellular environment of a chronic wound to that of an acute healing wound.
   

2. Early Intervention

If the diabetic ulcer is not healing at the expected rate, interventions for wound bed preparation need to be reassessed. The longer the duration of the ulcer, the more difficult it is to heal. If an ulcer is recurrent, patient education or issues of prevention and long-term maintenance need to be reassessed.
 

3. Predictors of Effectiveness

Diabetic foot ulcers are a significant health care problem. Complications of foot ulcers are a leading cause of hospitalization and amputation in patients with diabetes mellitus.

• Patients who fail to show a reduction in ulcer size by 40% or more after four weeks of therapy should be reevaluated and other treatments should be considered.
   
• Percent change in wound area of diabetic foot ulcers over four weeks of treatment is a good predictor of effectiveness of therapy and likelihood of healing.