It is common for a multidisciplinary team of specialty wound care providers to oversee the management of acute and chronic wounds. Each specialist offers a particular knowledge base about the wound and its treatment, which strengthens the entire team and fills any knowledge gaps that may exist.¹ Each member of the wound care team must be aware of the surgical concepts, procedures, and treatment outcomes the surgical specialist brings to the team so that referrals are appropriate and timely.² Operative intervention as part of a patient’s wound care plan may include incision and drainage of an abscess or wound, operative debridement, repair of a wound that is not healing appropriately, biopsy of wounds or lesions that are not healing, removal of foreign bodies including infected prosthetics and vascular grafts, skin replacement (eg, skin grafts and flaps), reconstruction of a limb deformed by disease or trauma, and when all else fails, limb amputation. The surgical specialists may be asked to intervene in any number of ways to aid in the treatment of patients with wounds. This issue of WOUNDS focuses on the surgical perspective of wound care. The surgical approach to selected nonhealing wounds will be discussed.
       Dr. Wei and Dr. Granick have addressed the surgical approach to wound bed preparation and surgical debridement. Both point out many important factors to be considered in surgical debridement. The information about the importance of foreign body removal first encouraged by Galen in the first century A.D. as a result of his work with the gladiators in Rome is especially helpful.³ The concept of removing all dead and infected tissue without being concerned for wound closure is stressed. However, remember to remove only what is needed, but no more than necessary. In 1315, Frenchman Guy de Chauliac presented the concept that questionably viable tissue should be left in place since “tissue can always be removed later but can never be replaced.”⁴ Serial debridements are permissible and preferred if there is question about the viability of some tissue.
       Dr. Thomas and Dr. Huffman present an excellent overview of one of the most difficult treatment challenges in the patient with peripheral neuropathy—the Charcot foot deformity. The Charcot foot was first described in patients with peripheral neuropathy due to syphilis,⁵ but can be seen in patients with neuropathy from any cause. Until the time wound care pioneers Dr. Grace Warren and Dr. Paul Brand developed advances in the treatment of neuropathic foot problems, the treatment for the insensitive, deformed and usually ulcerated foot, was amputation. Thanks to their work these patients can be treated, often avoiding amputation.^6,7 Dr. Thomas and Dr. Huffman discuss treatment and surgical options and the timing for referral to a surgical specialist.
       Dr. Caputo provides an overview of the operative procedures that can be used to treat the patient with a diabetic foot ulcer or deformity. The patient with the deformed foot and recurrent ulcer is a difficult management problem. Dr. Caputo outlines operative options to minimize the risk of ulcer recurrence that are not generally considered.
       Surgical specialists become involved in the care of patients with wounds in many ways. The articles in this Surgical Perspective on Wounds section introduce the concept of operative care for wound patients and affirm that surgical consultation and operative care often may be the best approach.