This video highlights the proper technique in the debridement of venous ulcers based on the molecular biology of the skin edge. Once a wound stops healing, as measured by decreased area, repeat debridement and cellular therapy is done.

Operative reports of 771 consecutive debridements of venous ulcers were reviewed in developing the surgical technique. A patient with a non-healing ulcer of 23 years in duration, history of osteomyelitis and previous treatment with cellular therapy is shown. Sixteen skin edge specimens from venous ulcers, including the patient shown in the video, were analyzed with immunohistochemical staining of beta-catenin.

Key steps shown in the video are:

1. Sharp debridement parallel to the wound bed.
2. Debridement of skin up to 1 cm past ulcer edge and specimen to pathology analysis.
3. Debride the wound bed until pathology reveals granulation tissue, no infection or fibrosis.
4. Application of human living cellular bilayer of fibroblasts & keratinocytes is shown after perfect hemostasis. H&E stain of skin showed hyperkeratosis. Phosphorylated beta-catenin was present throughout the cytoplasm and nucleus of keratinocytes in the full thickness of venous ulcer epidermis in 15/16 specimens, but only in cytoplasm of normal skin.

Hyperkeratosis in the venous ulcer skin edge indicates abnormal keratinocyte function. Routine histopathology can be used to define the margin of debridement at the skin edge and the depth of debridement in the wound bed. These details in surgical technique will ensure healing of venous ulcers.