Introduction: This video highlights the key steps of surgical debridement of the skin from a non-healing diabetic foot ulcer (DFU). Debridement past the level of callus in DFU's is a widely accepted surgical procedure. However, little has been reported about guiding the sharp surgical debridement to cellular markers. This video accomplishes the goal of establishing surgical techniques based on cellular markers.

Methods: The operative reports of 170 consecutive debridements on 147 patients in a 3 year period were reviewed.

Results: The keys steps for cutaneous debridement of diabetic foot ulcers are: 1) sharp excision of the callus extending past the hyperkeratotic tissue into the soft epidermis 2) removal of clinically infected or non-viable soft tissue 3) width of debridement defined by absence of hyperkeratotic tissue, 4) depth of debridement defined by absence of fibrosis and infection. Techniques of sharp debridement are highlighted in a single excision of the skin,callus, and the wound bed. Empasis on hemostasis using cautery, collagen and thrombin.

Conclusion: Surgical debridement is a rapid and safe procedure. No patients returned to the operating room for bleeding. Depth and width are not based on clinical impression, but rather pathological margins. The biological rationale of epidermal debridement is the removal of abnormal keratinocytes. Hyperkeratosis contains keratinocytes that abnormally differentiate and proliferate and should be removed.