For referring physicians
A clear pathway for difficult wounds and continuity of care.
Refer when a wound is not progressing, tissue viability is uncertain, deep structures are threatened or the problem may require reconstruction.
Referral philosophy
Preserve continuity. Escalate complexity when needed.
The original Klapper Wound site served local physicians and out-of-state centers whose patients spent part of the year in South Florida. That remains a useful model: continue a sound existing plan when possible, identify when the wound has changed, and escalate to vascular, infectious, surgical or reconstructive care when the biology or anatomy demands it.
A referral is most useful when the clinical question is explicit: Why is this wound not healing? Is perfusion adequate? Is this tissue viable? Is there deep infection? Can the wound close with local care? Does the patient need grafting or flap coverage?
What helps us help your patient
Send the clinical story, not just the wound dimensions.
Mechanism, duration, prior treatment, surgeries and why the wound is not progressing.
Vascular studies, cultures, imaging, antibiotics, inflammatory markers and systemic signs when available.
Exposed structures, tissue loss, avulsed skin, hardware, pressure points and functional threat.
Dressings, off-loading, compression, home health, operative history and specialty involvement.
Skin tears & avulsions
Please preserve potentially useful traumatic skin.
Dr. Klapper’s published work supports a reconstructive concept that is especially relevant in elderly fragile skin: do not assume the remaining traumatic attachment provides dependable flap perfusion, but do not assume the tissue is useless either. Suitable avulsed skin may function as autologous graft tissue if it is preserved and properly apposed to a viable bed.
Protect avulsed skin from desiccation and additional trauma. Avoid reflexive disposal of potentially usable tissue before reconstructive assessment when clinically safe.
Seasonal continuity
“Snowbird” wound care without starting over.
Patients who move between states can lose momentum when each new team has to reconstruct the wound history. Prior measurements, photographs, operative reports, vascular studies, pathology, cultures and home-health orders help maintain continuity.
The aim is to respect the established plan when it remains appropriate and communicate meaningful changes back to the originating clinician.
Common questions
Questions from referring clinicians
These answers summarize the referral workflow and when reconstructive escalation is useful.
What wounds are appropriate for referral?
Appropriate referrals include wounds that are not progressing as expected, skin tears or avulsions with uncertain tissue viability, diabetic or neuropathic ulcers, pressure injuries, venous wounds, postoperative breakdown, exposed structures, chronic infection and wounds that may require grafting or flap reconstruction.
How quickly can a patient be seen?
Scheduling depends on current availability and clinical urgency. Call the center directly so the problem can be described and triaged appropriately.
What records are most useful?
Mechanism and timeline, operative reports, vascular studies, imaging, culture or pathology results, antibiotic history, current wound orders, off-loading or compression plan and relevant comorbidities are particularly useful.
Should avulsed skin be discarded before referral?
No, not solely because the remaining attachment looks tenuous. Potentially useful avulsed tissue should be protected from desiccation and further trauma and evaluated for possible salvage when clinically safe.
Can you continue an out-of-state wound plan for seasonal patients?
Yes. The center’s historical “snowbird” model is designed to preserve continuity when patients spend part of the year in South Florida. Prior orders, measurements, photos, operative records and vascular data are helpful.
Will the referring clinician receive updates?
The goal is coordinated care. Meaningful findings and changes can be communicated to the referring team when contact information and appropriate permissions are available.
When should a patient go to the hospital instead of the wound clinic?
Major trauma, uncontrolled bleeding, threatened limb perfusion, rapidly progressive infection, necrotizing soft-tissue infection, severe systemic illness or other immediately dangerous conditions require emergency or hospital-level care.
When should plastic surgery be involved early?
Early reconstructive input is useful for exposed bone, tendon, joint, nerve, vessel or hardware; major tissue loss; degloving or avulsion; uncertain skin viability; recurrent postoperative breakdown; and wounds where delayed coverage may increase tissue loss.
