Diabetic Foot Wounds

Our Approach in Managing Diabetic Foot Wounds

Heal the wound. Save the limb. Restore the life.

Diabetic foot wounds are complex ; driven by neuropathy, ischaemia, infection, and impaired healing all at once. Effective management requires a team approach: plastic surgery, vascular surgery, endocrinology, orthopaedics, and podiatry working together with a single goal.

1. Comprehensive Foot & Wound Assessment

Our evaluation covers every factor driving non-healing:

• Wagner grading of wound depth —;superficial ulcer through to bone/joint involvement
• Neurological assessment : monofilament testing and vibration sense for peripheral neuropathy
• Vascular assessment ; ankle-brachial index (ABI), Doppler studies, or CT angiography
• Wound culture and sensitivity to identify causative organisms and guide antibiotic therapy

2. Glycaemic Optimisation

Wound healing is impossible without blood sugar control:

• Immediate referral to endocrinology for intensive glucose management
• HbA1c target set in collaboration with the diabetologist ; ideally below 7.5% during wound healing
• Daily glucose monitoring protocol and insulin adjustment during inpatient wound management
• Nutritional assessment — protein and micronutrient supplementation to support wound repair

   

3. Surgical Debridement

    

The cornerstone of diabetic ulcer debridement and wound bed preparation:

• Sharp debridement of all necrotic, fibrinous, and infected tissue under appropriate anaesthesia
• Removal of surrounding callus and hyperkeratotic tissue that masks wound extent
• Bone biopsy when osteomyelitis is suspected ; microbiological confirmation guides antibiotic duration
• Repeat debridement sessions as required until a clean, granulating wound bed is achieved

4. Vascular Intervention & Revascularisation

A wound cannot heal without adequate blood supply:

• Limb salvage surgery in collaboration with our vascular surgery team
• Percutaneous transluminal angioplasty (PTA) for stenosed tibial or peroneal vessels
• Bypass surgery for proximal disease not amenable to angioplasty
• Post-revascularisation wound reassessment within 48–72 hours to confirm improved perfusion

5. Advanced Wound Dressings & Negative Pressure Wound Therapy

Chronic wound management requires more than a standard dressing:

• Silver-containing antimicrobial dressings for infected or heavily colonised wounds
• Foam, hydrofibre, and hydrocolloid dressings matched to wound exudate level
• Negative Pressure Wound Therapy (NPWT / VAC) for deep cavity wounds  accelerates granulation
• Dermal substitutes (Integra, acellular dermal matrix) for wounds with exposed tendon or bone

6. Wound Closure & Reconstruction

Once the wound is clean, granulating, and well-vascularised, definitive closure is planned:

• Split-thickness skin grafting for superficial wounds with healthy granulation tissue
• Diabetic foot wound treatment in Mumbai using local perforator flaps for heel and plantar defects
• Sural artery flap or reverse sural flap for distal lower limb and heel coverage
• Free flap microsurgery (anterolateral thigh, gracilis) for large or complex defects where local options are unavailable

7. Offloading, Footwear & Recurrence Prevention

Healing without offloading is not possible  and healed wounds re-ulcerate without prevention:

• Total Contact Cast (TCC) or removable cast walker during active ulcer healing
• Custom therapeutic footwear prescribed at wound healing to redistribute plantar pressure
• Regular podiatry review  nail care, callus management, and footwear monitoring
• Patient education on daily foot inspection, footwear selection, and early warning signs