LIMBWatch Series | Dr. Paula DeJesus DPM, FACFAS, : The Future of Limb Salvage Through Minimally Invasive Surgery

Dr. G examines how diabetic toes and ulcers are rarely just wounds but visible warnings of neuropathy, poor circulation, infection, and gaps in care. She asks who is responsible for protecting the foot — the patient, primary care, podiatry, vascular, infectious disease, surgery, or nursing — and how fragmented referrals and delayed access can lead to a cascade ending in amputation.

The episode also explains hospital handling of amputated tissue, patients’ rights to their removed parts, and the future of limb preservation through surveillance technologies and coordinated responsibility to prevent avoidable loss.

This episode introduces edge trenching, a novel debridement technique developed by Dr. Igor Melnichuk that targets dysfunctional wound edges (epibolies, hyperkeratosis, rolled or fibrotic margins) to create a biologically active transition zone and promote epithelial migration.

It explains the procedure, proposed mechanisms, clinical use—especially in diabetic plantar ulcers—how trenches are created and repeated, and emphasizes that edge trenching must be part of comprehensive care addressing perfusion, infection control, offloading, and underlying causes.

Dr. Giulia Baldazzi, a vascular surgeon, fellow and phd candidate researcher, shares her journey from UCSF to Italy and explores advances in perfusion assessment, revascularization, and limb preservation for diabetic foot care.

She discusses diagnostic innovations (PAT, MaxCORE, NIRS), the importance of early vascular referral and multidisciplinary teams, and practical strategies to prevent amputations and improve healing.

Actinomycosis is a rare, slow-growing filamentous gram-positive bacterial infection that can mimic cancer, tuberculosis, or chronic diabetic foot infections by producing woody fibrosis, interconnected sinus tracts, and characteristic yellow "sulfur" granules.

Diagnosis requires deep tissue biopsy and careful anaerobic culture or histology; treatment is prolonged high‑dose penicillin (or alternatives if allergic) often combined with surgical drainage and debridement.

In this episode of Diabetics with Files, Dr. G explains liquid biopsies — blood tests that detect cell-free DNA and other molecular signals — and how they work.

We explore how this technology could help detect infection early, identify harmful inflammation, predict a wound’s healing potential, and personalize treatment for diabetic foot ulcers.

The episode also covers current limitations — cost, access, standardization, and need for clinical validation — and explains that liquid biopsies would complement, not replace, clinical exams and imaging.

Ultimately, liquid biopsies could shift wound care from reactive to predictive and improve limb salvage in the future.

This episode explains how chronic wounds—especially heavily exudative and diabetic ulcers—act like metabolic drains, leaking proteins, growth factors, immune cells, electrolytes, and calories and impairing the body’ s ability to heal.

Listen for signs of protein loss (low albumin, persistent drainage, weight/muscle loss, delayed healing) and practical strategies to fight back: infection control, offloading, appropriate compression, nutrition optimization, and closing the wound to stop the ongoing resource loss.

LIMBWatch | Dr. David B. Alper – The Policy Behind Preventing Amputations

Why are so many lower extremity amputations still happening when the majority could be prevented?

In this powerful episode of LIMBWatch, Dr. Gabrielle Hutcheson sits down with nationally recognized limb preservation advocate Dr. David B. Alper, DPM, to explore the critical intersection of healthcare policy, reimbursement, advocacy, and limb salvage. Drawing on decades of clinical experience and legislative leadership, Dr. Alper explains why preventing amputations requires more than excellent medicine—it requires changing the healthcare system itself.

Together, they discuss the barriers clinicians face in obtaining early diagnostic testing, advanced wound care therapies, diabetic footwear, vascular imaging, and emerging technologies that could dramatically reduce limb loss. Dr. Alper also shares ongoing legislative efforts to improve access to care, simplify insurance requirements, expand diabetic foot protection programs, and strengthen multidisciplinary collaboration.

The conversation highlights the importance of early detection of peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI), the role of advocacy organizations, and why clinicians, patients, and policymakers must work together to shift healthcare from reacting to amputations toward preventing them.

In this episode, you'll learn:

Why an estimated 85% of diabetic-related amputations may be preventable

The policy barriers limiting early PAD and CLTI diagnosis

How insurance reimbursement influences limb salvage decisions

Why diabetic footwear, vascular imaging, and preventative screening remain underutilized

The importance of multidisciplinary limb preservation teams

How clinicians and patients can become advocates for legislative change

Practical clinical pearls for identifying high-risk patients before limb loss occurs

Whether you're a podiatrist, vascular specialist, wound care clinician, primary care provider, healthcare administrator, policymaker, or patient advocate, this episode offers valuable insight into how policy decisions directly impact patient outcomes—and what can be done to change the future of limb preservation.

Because saving limbs starts long before the operating room—it starts with education, early intervention, and advocacy.

In this episode , one of the world’s most influential pioneers in limb preservation, Dr.David Armstrong DPM, MD, PhD Distinguished Professor of Surgery and Neurological Surgery and a Global Leader in limb preservation whose research has fundamentally changed how clinicians approach diabetic foot disease.

Dr. Armstrong shares the personal story that inspired his lifelong mission to prevent amputations, describing two unforgettable patients whose experiences taught him one of medicine’s greatest lessons—that the absence of pain can be more dangerous than pain itself.

Throughout the conversation, he explains why diabetic foot ulcers remain one of the most underestimated complications of diabetes, introduces the revolutionary concept of diabetic foot remission, and discusses why healing an ulcer is only the beginning of lifelong prevention.

Listeners will discover:

Dr. Armstrong also reflects on the evolution of limb preservation over the past three decades, discusses the rapid advances in digital health and remote monitoring, and shares his vision of a future where preventable diabetic amputations become increasingly rare.

Whether you’re a podiatrist, vascular surgeon, wound care specialist, endocrinologist, nurse, therapist, researcher, student, or someone living with diabetes, this conversation offers invaluable insights from one of the architects of modern diabetic limb salvage.

Key Takeaway:

“Find a friend.” According to Dr. Armstrong, preventing amputations isn’t the work of one specialty—it takes interdisciplinary teams united by one mission: keeping patients walking and living healthier lives.

This episode explains the crucial difference between hypoxia (low oxygen that can trigger repair) and ischemia (lack of blood flow that deprives tissue of oxygen, nutrients, and immune cells), and how diabetes worsens both.

Clinical takeaways: check vascular status with toe pressures and TcPO2 before escalating to advanced wound therapies, and prioritize revascularization when needed to give wounds a real chance to heal.