Diabetic & Vascular Wound Care in San Antonio, TX
A non-healing wound on a diabetic or vascular patient is not a minor problem — it is a potential limb-threatening situation that requires prompt specialist management. Dr. Andrew Gunter provides podiatric wound care coordinated with vascular surgery and your full medical team. Same-day appointments available.
Call (210) 581-9800
Why a Non-Healing Wound Needs More Than a Bandage
A wound that is not healing is not simply a skin problem — it is a sign that the underlying conditions required for tissue repair are compromised. In patients with diabetes, peripheral vascular disease, or peripheral neuropathy, the normal wound healing cascade is disrupted at multiple levels: impaired circulation reduces the delivery of oxygen and immune cells; elevated blood glucose interferes with cellular repair mechanisms; neuropathy removes the pain signals that would normally prompt protective behavior; and the mechanical environment of the foot — pressure and shear forces with every step — continuously disrupts the healing wound surface.
The consequence is a wound that does not progress through the normal stages of healing despite adequate home care. Many patients with diabetic or vascular foot wounds have been managing them at home for weeks or months before seeking professional evaluation — applying dressings, changing bandages, hoping for improvement that does not come. This delay is one of the most significant contributors to poor wound outcomes. A small wound that is evaluated and professionally managed early is a fundamentally different clinical situation from a wound that has been present for months and has developed biofilm, necrotic tissue, or deep tissue involvement.
Professional wound care for diabetic and vascular patients is not simply dressing changes. It involves debridement of necrotic and callused tissue that impedes healing; assessment and offloading of the mechanical forces maintaining the wound; evaluation and optimization of the vascular supply that determines whether healing is biologically possible; infection surveillance and management; and coordination with the patient's medical team to address the systemic factors — blood glucose control, circulation, nutrition — that drive wound healing capacity.
Dr. Gunter approaches wound care as a component of comprehensive limb preservation — not as an isolated service. The podiatric wound care he provides is coordinated with vascular surgery when circulation requires assessment or intervention, with endocrinology and primary care for metabolic optimization, and with the patient's full medical team to address every factor influencing healing. The goal is not simply wound closure — it is durable tissue health in a patient whose systemic conditions will continue to create risk.
A SUMMARY:
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Non-healing wounds in diabetic or vascular patients require specialist care — not continued home management
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Early evaluation produces significantly better outcomes
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Coordinated with vascular surgery when circulation requires intervention
- Debridement, offloading, and wound surveillance at every visit
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Same-day appointments available for urgent wound concerns
Wound Types We Treat
Diabetic foot ulcers
The most common and highest-stakes wound type in podiatric wound care. Diabetic foot ulcers typically develop under pressure points — the ball of the foot, the heel, or bony prominences — in patients with neuropathy who cannot feel the early stages of tissue breakdown. Dr. Gunter evaluates the ulcer depth, extent, and surrounding tissue, debrides necrotic tissue, provides appropriate offloading, and manages the wound through to closure with systematic follow-up.
Ischemic & arterial wounds
Wounds in patients with peripheral vascular disease develop from compromised arterial supply — the tissue cannot receive adequate oxygen and nutrients for repair. These wounds require vascular assessment before and during wound care, as healing is not possible without adequate perfusion. Dr. Gunter coordinates with vascular surgery for revascularization assessment when indicated, managing the wound in parallel with the vascular team.
Infected foot wounds
Infection in a diabetic or vascular foot wound can progress with alarming speed — from superficial cellulitis to deep space infection, osteomyelitis, and sepsis in a matter of days in the most compromised patients. Dr. Gunter evaluates wound infection clinically and with imaging when deep tissue involvement is suspected, manages appropriate antibiotic therapy, and performs surgical debridement when the extent of infection requires it.
Post-surgical wound complications
Surgical wounds that are slow to heal or have dehisced — separated — in diabetic or vascular patients require careful wound management to achieve closure without reoperation when possible. Dr. Gunter manages post-surgical wound complications in his own patients and accepts referrals for wound complications following foot and ankle surgery performed elsewhere.
Related conditions: Diabetic foot care · Peripheral vascular disease · Peripheral neuropathy
What Wound Care Looks Like at Every Visit
Diabetic and vascular wound care is not a single procedure — it is an ongoing management process that typically involves multiple visits over weeks to months, depending on wound severity and healing response. Each visit serves several purposes simultaneously.
Wound assessment at every visit tracks the dimensions, depth, tissue quality, and surrounding skin condition of the wound — documenting progress or identifying deterioration that requires management adjustment. Photography provides an objective record that supports insurance documentation and tracks progress over time.
Debridement removes necrotic tissue, callus, and biofilm that impede healing and harbor infection. Sharp debridement — the most effective method for removing devitalized tissue — is performed at most visits in wounds with non-viable tissue. Debridement is not simply cleaning a wound; it is a skilled procedure that must be performed by someone who understands the tissue planes and the wound biology.
Offloading addresses the mechanical environment that is often the primary driver of wound non-healing — particularly in plantar diabetic foot ulcers where weight-bearing pressure with every step continuously disrupts the wound surface. Appropriate offloading — total contact casting, removable cast walkers, or custom offloading devices — is one of the most evidence-supported interventions in diabetic wound care and is underutilized in non-specialist settings.
Occasionally, depending on the wound location, an in-office procedure can be performed to offload the ulcerated the area to dramatically speed up the healing process. Other times, surgical procedures can be performed in an operating room to achieve that goal.
Wound dressing selection is matched to the wound's specific characteristics — its exudate level, tissue quality, infection status, and depth. The appropriate dressing for a clean granulating wound is different from the appropriate dressing for an infected or necrotic wound. Dr. Gunter selects and adjusts dressings based on wound status at each visit rather than applying a protocol regardless of wound condition.
Vascular and infection surveillance at each visit identifies new clinical findings — changes in perfusion, signs of deep infection, bone involvement — that require management escalation or specialist coordination.
Wound Care as Part of a Coordinated Team
Diabetic and vascular wound healing depends on factors that extend well beyond the wound itself. Blood glucose control, arterial circulation, nutritional status, infection management, and offloading compliance all determine whether a wound heals — and none of them can be fully addressed by a single provider working in isolation.
Dr. Gunter's approach to wound care is explicitly coordinated. When vascular assessment indicates that arterial circulation is insufficient for healing, he communicates directly with vascular surgery for revascularization evaluation — the wound cannot heal without adequate perfusion, and attempting wound management without addressing the circulatory deficit produces poor outcomes regardless of how skilled the wound care is. When blood glucose control is inadequate, he coordinates with the patient's endocrinologist or primary care physician. When deep tissue infection or osteomyelitis is suspected, he obtains appropriate imaging and manages or refers antibiotic therapy accordingly.
For referring providers — PCPs, hospitalists, endocrinologists, and vascular surgeons — Dr. Gunter provides timely written communication after every wound care visit, documents wound progress with photography and objective measurements, and communicates promptly when findings require management changes or specialist involvement. A podiatrist who manages diabetic wounds well and communicates reliably becomes a trusted partner in the care of complex patients — and that relationship benefits everyone, most importantly the patient.
Why Patients Choose Dr. Gunter
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5,000+ Patients
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100% Focused
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Frequently Asked Questions — Diabetic & Vascular Wound Care
Non-healing wound on a diabetic or vascular foot?
Prompt evaluation changes outcomes.
Dr. Andrew Gunter, DPM provides podiatric wound care for diabetic and vascular patients — comprehensive assessment, debridement, offloading, and coordination with vascular surgery and your full medical team. A wound managed early is a wound managed well. Serving San Antonio and surrounding communities. Same-day appointments available. Most insurance plans accepted including Medicare.
Call (210) 581-9800