Advanced Wound Care & Skin Grafting

The principle: fix the cause, then close the wound

A wound that has not healed in weeks is not waiting for a better dressing — it is waiting for a diagnosis. Arterial disease starves a wound; venous disease drowns it; diabetes blunts the body's repair and defence. That is why wound care in my practice starts with the circulation: angioplasty or bypass for an ischaemic wound, vein treatment and compression for a venous ulcer. The techniques below close wounds; the vascular work is what lets them.

The reconstructive ladder

• Debridement — surgical removal of dead and infected tissue, the single most useful wound procedure; done in clinic for small wounds and in theatre for deeper ones
• Negative pressure wound therapy (NPWT) — a sealed vacuum dressing that removes fluid and encourages granulation, changed every few days, usable at home
• Dermal substitutes — collagen-based scaffolds (such as Integra® and Myriad™) laid into a clean wound to rebuild a dermal layer over exposed structures before grafting
• Adjuncts in selected wounds — electrical stimulation therapy and blood-derived clot matrices are used where the wound and the evidence justify them
• Split-thickness skin grafting — a thin shave of skin, usually from the thigh, resurfaces a healthy wound bed; the donor site heals like a graze over one to two weeks

What to expect

Chronic wound care is a campaign, not an event: serial reviews, staged procedures where needed, offloading or compression as the diagnosis dictates, and infection treated early. Diabetic patients are managed along the limb-preserving pathway described on the diabetic foot page, with sugar control coordinated alongside.

When to seek assessment

Any wound on the leg or foot that has not clearly improved in two weeks — or any wound with spreading redness, odour or blackened tissue — deserves vascular assessment, not another dressing change. The earlier the cause is treated, the smaller the reconstruction that follows.