When Does a Diabetic Foot Wound Need a Plastic Surgeon?

Why are diabetic foot wounds serious?

Diabetes can reduce feeling in the feet (neuropathy) and narrow the arteries that supply them. A small blister or crack can therefore go unnoticed, fail to heal and become infected. Infection can spread quickly into deeper tissue and bone. Early treatment is the most effective way to protect the foot.

What are the warning signs?

Sign	What it may mean	Action
A new blister, cut or crack	Early wound	See a doctor or podiatrist within a day or two
Redness, warmth, swelling or pus	Infection	Same-day medical care
Spreading redness, fever, feeling unwell	Serious infection	Emergency care
Black, blue or grey skin	Loss of blood supply or gangrene	Emergency care
A hot, swollen foot without a wound	Possible Charcot foot	Urgent assessment
A wound not improving after 2 weeks	Healing has stalled	Specialist review

Why do some wounds stop healing?

• Pressure: walking on a wound on the sole keeps damaging it.
• Poor blood flow: narrowed arteries starve the wound of oxygen.
• Infection, sometimes deep in the bone.
• Dead tissue and callus covering the wound.
• High blood sugar and smoking.

Who does what in diabetic foot care?

Team member	Role
Diabetes doctor	Blood sugar control and overall health
Podiatrist	Callus care, offloading, footwear and prevention
Vascular surgeon	Checking and restoring blood flow with angioplasty or bypass
Wound-care nurse	Dressings and wound monitoring
Plastic surgeon	Surgical debridement, wound closure with grafts or flaps, and planning of minor amputations and stumps
Infectious disease or microbiology	Choosing antibiotics for complex infections

The exact team varies by hospital, but the principle is the same: different specialists working together give a wound a better chance to heal.

When does a plastic surgeon help?

A plastic surgeon is usually involved when:

1. Dead or infected tissue needs removing in theatre, and abscesses need draining.
2. A clean wound is too large to close by itself in a reasonable time.
3. Bone, tendon or a joint is exposed, needing a flap to cover it.
4. A pressure area, such as the heel, needs durable, padded tissue.
5. A toe or part of the foot must be removed, and the remaining foot needs a stable shape.

Wound closure is only attempted once infection is controlled, blood flow is adequate and pressure can be kept off the area. Grafts are explained under skin grafting surgery.

What happens at a wound assessment?

Expect the doctor to look at and measure the wound, gently probe it to see whether bone can be felt, test the feeling in your feet, check the pulses, and ask about your blood sugar control. An X-ray, blood tests or a swab may follow. Bring your medicines list, recent sugar readings and the shoes you usually wear.

Myths about diabetic foot wounds

• “If it does not hurt, it is not serious.” Nerve damage can hide severe infection.
• “Air helps wounds heal.” Wounds heal better under the right dressing.
• “Walking helps circulation, so walk on the ulcer.” Pressure on the ulcer stops healing; offloading is needed.
• “Amputation is inevitable.” Early, coordinated care saves many feet.

How can diabetic foot wounds be prevented?

• Check both feet every day, using a mirror or a family member’s help.
• Wash and dry the feet daily, especially between the toes.
• Moisturise dry skin, but not between the toes.
• Wear well-fitting shoes and socks indoors and out.
• Never use blades or corn plasters on calluses.
• Keep blood sugar, blood pressure and cholesterol under control, and stop smoking.
• Have your feet checked at least once a year, more often if you have had an ulcer.

What should you ask your doctor?

• Is my wound infected, and is the bone involved?
• Is my blood flow good enough for the wound to heal?
• How should I offload the foot?
• Will the wound need surgery to close?

For a full description of treatment, recovery and cost factors, see diabetic foot treatment. Slow-healing wounds from other causes are covered under chronic wound treatment.