Medical director
A wound is not a template.
Andrew Klapper, MD explains the program’s approach to individualized wound care, tissue preservation and reconstructive decision-making.
Andrew Klapper, MD
A wound is not a template.
Dear patients and colleagues:
Plastic surgery is built on adaptability. Every wound has a different combination of tissue quality, blood supply, contamination, pressure, systemic disease and functional consequence. For that reason, difficult wounds should not be pushed through a single protocol.
Our first responsibility is diagnostic: understand why the wound is failing. The second is preservative: keep useful tissue whenever it can safely contribute to healing or reconstruction. The third is mechanical: correct the force—pressure, shear, edema, tension or repeated trauma—that is keeping the wound open. Only then does the choice of dressing, procedure or reconstruction make sense.
This philosophy is especially visible in our work with geriatric skin tears and traumatic avulsion injuries. The traditional instinct is often to judge the skin by the reliability of its remaining attachment. Our published work asked a different question: can the tissue survive by graft biology even when that attachment is not dependable? In selected injuries, preserving the avulsed skin can convert tissue that might otherwise be discarded into useful autologous coverage.
Research matters because the standard approach is not automatically the best approach. Clinical observation should lead to better questions, and better questions should improve care for the next patient.
We are here for patients and for the clinicians who refer them. When we can support an existing plan, we do. When the wound needs a different level of treatment, we say so.
Common questions
Questions about the program philosophy
The principles below explain how the center approaches complex wound decisions.
Why does the program emphasize individualized treatment?
Because wounds fail for different reasons. A venous ulcer, a diabetic neuropathic ulcer, a pressure injury and a traumatic avulsion may all be open wounds, but the treatment logic is different.
Why is research part of the program philosophy?
Research allows clinical observations to be tested, documented and shared. Dr. Klapper’s skin-tear and traumatic-skin publications grew directly from the practical question of whether tissue traditionally assumed to be nonviable could instead be preserved.
What does “preserve what can be preserved” mean?
It means avoiding unnecessary loss of viable tissue, function and limb while still removing tissue that is truly nonviable or dangerous. Preservation is not the same as refusing debridement; it is making tissue decisions deliberately.
Does reconstructive surgery always mean a major operation?
No. Reconstruction ranges from direct closure and skin grafting to local tissue rearrangement, regional flaps and microsurgical free tissue transfer. The least complex durable solution is generally preferred.
