In the lower extremities, surgical procedures are available to assist wounds to heal or as reconstructive procedures to prevent ulceration. Open wounds with non-viable tissue often require surgical debridement, including debridement of infected bone in osteomyelitis. Once a wound is devoid of all non-viable tissue, skin grafts or flaps may aid in wound healing. Rigid bony deformities with high-pressure areas may be corrected by either arthrodesis or osteotomy. Correction of toe deformities, such as claw-toe, may prevent ulceration in high-pressure areas. Tendon transfers are available to rebalance a paralytic foot, such as posterior tibialis transfer for foot drop. Tendon release procedures, such as a tendo Achilles lengthening, will help reduce high-pressure areas. Amputation may be required for uncontrollable sepsis, an avascular extremity or when function will be increased by prosthetic usage.
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