Assessment begins with a complete wound evaluation — size, depth, wound bed quality, surrounding tissue, and infection status. Vascular assessment (Doppler, ABI) determines whether blood supply is adequate for healing. If it isn't, a vascular surgery referral runs concurrently with wound care.
Surgical wound debridement is the foundation of chronic wound care. Removing necrotic tissue, slough, and bacterial biofilm converts a stalled wound into one that can progress through normal healing stages. We perform sharp debridement in-office and, when needed, in the operating room — then select advanced wound dressings calibrated to the wound bed's specific biology to maintain the optimal healing environment between visits.
Correcting the anatomy that caused the wound is equally critical. Many chronic wounds are sustained by an underlying structural problem that no dressing can overcome. We surgically correct deformities — such as Charcot foot collapse, hammertoe deformities, or equinus contracture — that concentrate destructive pressure on vulnerable tissue. When a bony prominence is the direct cause of recurrent ulceration, surgical exostectomy removes the offending bone and eliminates the mechanical driver of the wound permanently.
For diabetic and neuropathic patients, limb preservation is the guiding principle behind every decision. Neuropathy masks pain, allowing wounds to progress silently; peripheral vascular disease impairs the healing response. Our limb salvage approach combines aggressive infection management, structural surgical correction, and close coordination with vascular surgery and infectious disease specialists — exhausting every available option to keep the foot functional and avoid amputation.
