LIMBWatch Series: Dr. Shilpa Rajan Mulki- Look at Your Feet Before You Sleep: Saving Limbs in Resource-Limited Settings

LIMBWatch: Closing the Surgical Access Gap — How Portable Operating Room Technology Could Change Limb Salvage What if a sterile surgical environment could be created in minutes, virtually anywhere? In this episode of LIMBWatch by Diabetic Foot Files, Dr. G welcomes Kelly Laurel, President and CEO of SurgiBox, to explore the groundbreaking potential of the SurgiField System, a portable surgical environment developed through collaboration involving MIT, Harvard trauma surgeons, and the U.S. military. We discuss how this compact, backpack-portable technology uses HEPA-filtered air and positive pressure to create an ISO Class 7-equivalent surgical environment, potentially expanding access to procedures in settings where conventional operating room infrastructure is unavailable or difficult to access. Kelly shares lessons from nearly 25 years of military service, her personal experience waiting weeks for a brief hand surgery, and a remarkable demonstration in Jordan in which a vascular surgeon performed a diabetic foot ulcer debridement using the SurgiField System during a medical congress. For diabetic foot care professionals, the conversation explores a critical question: Could portable surgical technology help bridge the gap between recognizing a limb-threatening problem and delivering timely intervention? Dr. G and Kelly examine the consequences of operating room delays, the challenges of prioritizing foot and hand procedures, and the potential applications of portable surgical environments in wound debridement, limb salvage, dialysis access procedures, emergency care, and selected procedures in remote or resource-limited settings. The discussion also addresses the practical realities of bringing medical innovation to patients, including regulatory approval, insurance reimbursement, affordability, and the challenge of translating promising technology into sustainable clinical practice. From military medicine to global health, this episode challenges conventional thinking about where surgery can take place and how healthcare systems can respond when time is critical. Because in limb salvage, time is tissue. And when access to timely surgical care is the missing link, innovation may offer a new path forward. 🎙️ Guest: Kelly Laurel, President and CEO of SurgiBox🎧 Host: Dr. Gabrielle Hutcheson Donaldson, DPM, CWSP, DABPM🌍 Series: LIMBWatch by Diabetic Foot Files🦶 Focus: Diabetic foot care, limb salvage, surgical innovation, global health, and access to timely intervention. Interested in exploring the SurgiField System or collaborating on potential clinical applications? Healthcare professionals interested in learning more or discussing potential pilot programs can contact Kelly Laurel at [email protected]. This episode explores emerging applications of portable surgical technology. Appropriate use depends on the procedure, clinical circumstances, applicable regulatory authorizations, and professional judgment.

Dr. G highlights the life and work of Dr. Elliot P. Joslin, an early diabetes specialist who pioneered prevention, patient education, and multidisciplinary care for diabetic foot problems. The episode explains Dr Joslin creation of one of the first diabetes registries, the establishment of a dedicated hospital foot clinic, and how his principles continue to underpin modern limb salvage programs.

Dr. G traces the scalpel's evolution and compares surgical technique to calligraphy while explaining the differences between common blades (10, 11, 15) and why blade choice matters in diabetic foot care. She emphasizes assessing perfusion, infection, anatomy, and pressure before sharp debridement, and stresses that the right instrument, judgment, and team-based care are essential for limb salvage.

LIMBWatch: Oxygen, Wound Healing & The Science of Saving Limbs with Dr. J. B Shah What if a wound that refuses to heal is telling us something we have yet to recognize? In this episode of LIMBWatch, the diabetic foot surveillance series brought to you by Diabetic Foot Files, welcomes Dr. J.B Shah, an experienced physician leader in wound care, hyperbaric medicine, and limb preservation, with more than three decades dedicated to treating complex wounds and educating clinicians. Dr. Shah is the founder of TIMEO2 Healing Concepts and has held prominent leadership positions in organized medicine, including serving as President of the Texas Medical Association. His work emphasizes the critical role of oxygen in wound healing and the importance of evidence-based, multidisciplinary care. Together, we explore the science behind oxygen delivery, tissue hypoxia, and chronic wound healing, examining why some diabetic foot ulcers fail to heal even when the patient appears to have adequate blood flow. In this episode, we discuss: 🩺 The Oxygen–Wound Healing Connection: Why oxygen is essential for cellular function, collagen synthesis, immune defense, and tissue repair. 🩸 Hypoxia vs. Ischemia: Understanding the difference between inadequate blood supply and inadequate oxygen availability at the tissue level—and why this distinction matters when evaluating a non-healing wound. 🔬 The Hidden Biology of Chronic Wounds: How prolonged tissue hypoxia can impair cellular function, disrupt healing, and contribute to persistent wounds. 🫁 Hyperbaric Oxygen Therapy Explained: How systemic hyperbaric oxygen therapy works, how it differs from topical oxygen therapy, and why patient selection and clinical evidence matter. 📊 Selecting the Right Patient: The role of transcutaneous oxygen measurements, identifying potentially correctable causes of hypoxia, and evaluating whether a patient may benefit from oxygen-based therapies. 🦶 Beyond the Chamber: Why hyperbaric oxygen therapy is not a miracle cure—and why debridement, offloading, infection management, vascular assessment, glucose control, nutrition, and comprehensive wound care remain essential. ⚠️ The Importance of Early Intervention: Why even a small diabetic foot wound can become limb-threatening, particularly when neuropathy, infection, and vascular disease coexist. 🤝 The Power of Multidisciplinary Limb Salvage: Why timely referrals, coordinated care, and collaboration among podiatrists, vascular specialists, wound care clinicians, and other healthcare professionals can make a meaningful difference. 🤖 The Future of Wound Care: Dr. Shah shares his perspective on how artificial intelligence and point-of-care technologies could help clinicians identify wound complications earlier, stratify risk, and guide patients toward appropriate treatment pathways. 💡 LIMBWatch Rapid Fire: Dr. Shah answers important questions about the most overlooked factors in wound healing, the importance of individualized offloading, the biggest mistakes clinicians make, and the need to treat the whole patient—not just the wound. One of the most powerful messages from this conversation is that a diabetic foot ulcer should never be dismissed as a minor problem simply because it looks small. Early recognition, appropriate specialist assessment, and timely intervention can be critical to preventing complications and preserving a patient’s independence. Dr. Shah also challenges us to reconsider how healthcare systems approach amputation prevention. Rather than viewing every amputation as an inevitable outcome, we must examine opportunities for earlier intervention, better coordination, and improved standards of care. Because wound healing is never just about closing a wound. It is about understanding why healing has stalled, addressing the underlying causes, and remembering the person whose life is affected. A limb worth saving is a life worth protecting. 🎙️ About LIMBWatch LIMBWatch

Dr. G explores the vital role of helpers in diabetic foot care, sharing stories of negligence and the impact of timely intervention. She emphasizes recognizing wounds early, advocating for patients, and ensuring they access the right specialists. The episode explains how helpers can be anyone — family members, pharmacists, receptionists, or physicians — and outlines practical limits like avoiding procedures outside your competence while encouraging collaboration and sustainable systems. Ultimately, Dr. G urges listeners to speak up, act compassionately, and work together to preserve limbs, independence, and dignity for people with diabetes.