Lower extremity wounds or ulcerations of any kind can be extremely painful and debilitating. Patients with these common ulcerations can experience significant disability and are at much greater risk for amputation if not treated properly. It is also important to understand that every wound has its own personality, & can require an individualized treatment plan. Part of that treatment plan involves addressing the current health status, such as the presence of diabetes or vascular disease.

View Our Wound Care Services

WHAT IS IT?

Debridement refers to the removal of necrotic or infected tissue from open wounds, allowing for new vascular tissue to grow and ultimately heal the wound. This is commonly performed to promote healing for diabetic foot ulcers, venous stasis ulcers, arterial ulcers, pressure ulcers, burns, and infections. Debridement is a key element to a successful and faster healing rate.

Wound Debridement specifically aims to:

  • Promote successful wound healing
  • Remove necrotic, infected, or dead tissue material
  • Stimulate the healing process
  • Remove any scar tissue
  • Facilitate drainage of fluid buildup
  • Permit more thorough inspection of wound base
  • Reduce pressure on ulcer base
  • Remove keratosis

Types of Wound Debridement

After careful inspection, we will determine the best type of debridement specific to the wound’s condition.

Surgical debridement is one of the most effective methods and leads to minimal damage to the surrounding tissue. The minor bleeding involved encourages the release of cytokines, which assists in the healing process.

Enzymatic debridement, or chemical debridement, is a less invasive approach that applies proteolytic enzymes and selectively removes necrotic tissue without harming granulation tissue.

Mechanical debridement physically removes debris from the wound using a combination wound irrigation with a high-pressure stream of water, whirlpool therapy, and wet-to-dry dressings. This method is especially effective for inflammatory wounds.

Often used for pressure sores, autolytic debridement assists your body’s natural ability to clean the wound by using dressings that retain wound fluids. This method is not good for large or infected wounds, but it works well if your body cannot tolerate the other methods.

WHAT IS IT?

Flap surgery is a surgical procedure that requires removing tissue from an area of the patient’s own body, and applying it on a wound that has not been able to heal. The goal is to reconstruct the area of tissue to help restore its form and function. In this method, the affected area that is receiving the tissue has its own blood supply source.

Common types of flap surgeries include local, pedicled, and muscle flaps.

Candidates for Skin Flap Surgery

You may be a candidate for flap surgery if you suffer from tissue loss or wounds on your foot and ankle. If the wound cannot be stitched together or sutured, flap surgery may be performed to save the area from amputation.

RISK FACTORS/COMPLICATIONS

As with all surgical procedures, there is a risk for potential complications, such as bleeding, infection, loss of sensation in the skin, severe scarring, and tissue death due to poor circulation.

If complications occur, we will address the issues and utilize alternative wound care modalities to help heal the wound.

WE TREAT

Based on the condition of the wound, our reconstructive foot & ankle surgeon will decide if and which type of surgery is appropriate for the patient. While both flap surgery and skin graft surgery include the transfer of healthy skin from one site to the other, surgeons will not perform a skin flap or skin graft using skin that is not healthy. We will maintain continuity of care by providing specific instructions on how to care for the wound at home and scheduling appointments as needed.

WHAT IS IT?

Skin graft surgery is a surgical procedure that requires taking tissue from one site, and applying it to a wound area that is not healing. The goal is to reconstruct the area of tissue to help restore its form and function. Unlike flap surgery, the tissue used in skin graft surgery does not have its own blood supply source. The tissue can either come from the patient’s own body, or from a skin graft substitute.

Candidates for Skin Graft Surgery

You may be a candidate for skin graft surgery if you suffer from tissue loss or wounds on your foot and ankle. If the wound cannot be stitched together or sutured, skin graft surgery may be performed to save the area from amputation.

RISK FACTORS/COMPLICATIONS

As with all surgical procedures, there is a risk for potential complications, such as bleeding, infection, loss of sensation in the skin, severe scarring, and tissue death due to poor circulation.

If complications occur and compromise the skin graft, we will address the issues in a short window of time and utilize alternative wound care modalities to help heal the wound.

WE TREAT

Based on the condition of the wound, our reconstructive foot & ankle surgeon will decide if and which type of surgery is appropriate for the patient. While both skin graft surgery and flap surgery include the transfer of healthy skin from one site to the other, surgeons will not perform a skin flap or skin graft using skin that is not healthy. We will maintain continuity of care by providing specific instructions on how to care for the wound at home and scheduling appointments as needed.

SKIN GRAFT SUBSTITUTES

WHAT IS IT?

Skin graft substitutes are biologic or synthetic skin substitutes used to cover wounds that will not heal. They might also be used for extreme cases such as severe burn wounds, skin loss due to infection, severe trauma, skin cancer, or diabetic ulcers that are not responding to treatment.

Candidates for skin graft substitutes

Patients who are undergoing skin graft surgery may require the use of skin graft substitutes if they have had a failed skin graft surgery, their skin cannot be harvested, or they are unable to undergo anesthesia.

Types of Skin Graft Substitutes include bioengineered tissue, allograft (human donated), and xenograft (animal donated).

WHAT IS IT?

Negative pressure wound therapy is a technology used to promote wound healing through rapid granulation tissue formation. It typically involves applying a topical sub-atmospheric pressure across the wound surface and helps heal wounds by removing excess edema, decreasing bacterial colonization and increasing vascularity.

COMPLICATIONS

Some complications may arise due to a loss of vacuum suction, irritation or breakdown of skin, macerated wound edges, bleeding, and sensitivity to the dressings.

WE TREAT

We utilize this vacuum assisted closure in foot and ankle conditions such as acute and chronic wounds, traumatic wounds, infected wounds, pressure sores, diabetic foot ulcers, leg ulcers, exposed tendon, capsule and bone, exposed orthopedic hardware, skin graft recipient site fixation, skin graft donor site, flap salvage, fasciotomy wounds, degloving injuries, and burns.


When evaluating a wound to determine the treatment modality, we assess:

  • Condition of the wound
  • Area and volume
  • Tissue involved
  • Neuropathy (loss of feeling)
  • Infection
  • Inflammation
  • Deformity
  • Vascular circulation
  • Chronic conditions or comorbidities of the patient
  • Nutritional health status
  • Psychosocial status