Dr. G explains how lidocaine works, why its chemistry matters, and how too much—especially on open, inflamed, or diabetic wounds—can cause serious central nervous system and cardiac toxicity.

The episode covers safe dosing calculations, differences between wound types, safer alternatives for anesthesia, and first-aid steps if toxicity occurs, emphasizing caution and medical supervision.

Dr. G breaks down the Unna boot: its origin, ingredients (zinc oxide, glycerin, gelatin), and how its semi‑rigid, inelastic compression helps venous stasis ulcers. He compares Unna boots to modern multi‑layer systems, explains the pressure mechanics and therapeutic targets, and highlights practical application tips.

Key cautions are emphasized: always assess vascular status/ABI before compressing, avoid use with critical arterial disease, heavy drainage, active infection, non‑ambulatory patients, or purely neuropathic plantar ulcers. Compression must be individualized and combined with correct diagnosis and overall wound care.

Dr. Tom Hardiman DPM draws on decades of experience in podiatry and limb salvage to reveal how systemic inequities and barriers to care drive preventable amputations in people with diabetes. He explains the social determinants of health—housing instability, food insecurity, lack of transportation—and how unequal access to vascular care, nutrition, and timely treatment leads to worse outcomes for underserved communities.

Hardiman shares personal patient stories, emphasizes the importance of patient advocacy and education, and calls for policy changes that prioritize health equity over profit to reduce the 175,000 annual amputations in the U.S. and improve limb salvage for everyone.

Dr. G explores phantom limb pain in amputees—what it feels like, how it differs from residual stump pain, and the multi-level mechanisms (peripheral nerves, spinal cord, brain prediction errors) that cause it. Special focus is given to why diabetic patients are especially vulnerable.

The episode outlines clinical evaluation, red flags to rule out, and a practical, multidisciplinary care plan including mirror therapy, graded motor imagery, neuromodulation, targeted nerve surgery, and when to refer to specialists.

Dr. G explains Marjolin ulcer, a form of squamous cell carcinoma that can arise in long-standing, chronically inflamed or scarred wounds—especially diabetic foot ulcers—and why early recognition matters for limb salvage and survival.

Key signs include changing or hypertrophic margins, rolled or friable edges, unexplained bleeding, disproportionate pain, non-healing despite treatment, and nearby enlarged lymph nodes. Diagnosis requires a deep biopsy and imaging; treatment often involves wide surgical excision, possible lymph node assessment, and sometimes amputation or adjunct radiation.

Prevention and vigilance are crucial: optimize diabetes and vascular care, monitor chronic wounds closely, and refer promptly for suspicious changes. Emerging research on biomarkers, targeted therapies, and AI imaging aims to detect malignant transformation earlier.

This episode reviews radiation dermatitis — its history, how ionizing radiation creates free radicals and double‑strand DNA breaks, and which skin cells are damaged (basal stem cells, keratinocytes, endothelial cells, fibroblasts, lymphatics), leading to microvascular loss, fibrosis, and impaired healing.

Learn how radiation wounds present (geometric borders, fibrosis, poor bleeding, delayed healing), the typical timelines from acute to chronic changes, and why patients with diabetes are at much higher risk for chronic ulcers and complications.

Practical steps covered include gentle wound care and moisture balance, topical antimicrobials, hyperbaric oxygen for selected cases, avoiding aggressive early debridement, and when surgical reconstruction is indicated; plus prevention tips like skin moisturization, avoiding friction, and early wound surveillance.

This episode breaks down uncontrolled vasculitis — inflammation of blood vessels that can mimic diabetic, arterial, or pressure ulcers. It reviews pathophysiology (immune complex and ANCA‑mediated mechanisms), types by vessel size, key signs (palpable purpura, necrotic toes, sudden ischemia), and essential diagnostics (ESR/CRP, ANCA, complement, urinalysis, biopsy, CTA).

It highlights urgent management (high‑dose steroids, immunosuppressants, biologics), wound‑care cautions (avoid unnecessary debridement in ischemic vasculitic ulcers), and the importance of early vascular and autoimmune referral to prevent organ damage and amputation.

Dr. G explains how pantothenic acid (vitamin B5) serves as the precursor to coenzyme A and powers cellular metabolism essential for wound healing, collagen and lipid synthesis, and skin barrier repair.

The episode reviews dietary sources, signs of deficiency, the topical provitamin dexpanthenol and its effects on hydration and barrier recovery, and how B5 fits into a broader approach to improving tissue regeneration in patients with high wound‑healing needs.