haywanchiudpm

haywanchiudpm Husband. Father of 2. Podiatric foot and ankle surgeon specializing in wounds and limb salvage. Same-day appointments are available for urgent needs.

Dr. Chiu specializes in diabetic wound care, bone infections, and advanced techniques to prevent amputation. He also provides general foot care and accepts all major insurance plans. If you become an established patient, Dr. Chiu will do everything possible to keep you ulcer-free. If wounds do occur, he provides hands-on care himself—often weekly—and manages all aspects of treatment including the

antibiotics. If hospitalization is ever needed, Dr. Chiu or one of his trusted colleagues will care for you directly, with seamless coordination. He is one of the foot doctors at Albuquerque Associated Podiatrists who lead the wound care clinic.

See previous post to see how we got to this point. The donor site where the ABductor muscle belly lies re-granulated tha...
04/20/2026

See previous post to see how we got to this point.

The donor site where the ABductor muscle belly lies re-granulated that defect in time for STSG in a month. He eventually was able to get the whole thing healed in 4 months from time to presentation to the hospital. He will still need a lot of work to let that TMA stump soft tissue mature to be able to withstand the shear of walking, and will need to be closely monitored, high chance of re-ulceration, but we gave him the a good chance of long-term meaningful ambulation with the severity of infection he had.

Lots of questions about if I used wound vac. I did not use wound vac for this case. Not wrong to use it, but there are so many issues with the wound vac that I decided to cut it out from my practice altogether, I have not applied or ordered one for 2 years and it has not impacted my ability to get good results. There’s even a recent Lancet article talking about how wound vacs do not help with post-surgical secondary wound healing.

For STSG, I use xeroform gauze wrap, I don’t do tie-over bolster dressings anymore, found out a simple wrap works. There’s plastic surgery articles to support that. There’s a Georgetown article that suggest 3:1 mesh ratio has the least complications, I haven’t noticed a big difference so I used 1.5:1 in this case, sometimes 3:1 for larger wounds. There’s another Georgetown article that suggests STSG for plantar foot wounds are a viable option. I think this is true, because so many other factors contribute to longevity of a plantar wound, such as distance between skin and bone (need soft tissue bulk to cover bone for high level ambulators).

Lastly, it’s important if you want to specialize in this, to eventually build a reliable team around you that are like-minded, hard-working, and passionate about limb salvage. Because it’s difficult to do this alone and you can handle only so much. Emergency surgeries never happen at convenient times, and you’re never always available (nor should you be). We have a staggered schedule of availability of limb salvage podiatrists that work together in private practice and we are thriving while helping the community.

This case shows a young man newly diagnosed with diabetes who unfortunately developed a necrotizing great toe infection ...
04/20/2026

This case shows a young man newly diagnosed with diabetes who unfortunately developed a necrotizing great toe infection that spread into the midfoot requiring transmetatarsal amputation and multiple debridement surgeries. Go through the slides to see all the clinical clues I look for. MRI or CT scan will not know whether the pathologic findings are edema or necrosis, and it’s the soft tissue damage that dictates surgical treatment of these acute infection cases.

Luckily this was a strep infection, which likes to stay superficial, so most of the damage was more to skin and soft tissue (albeit widespread) but this is easier to replace than anaerobic infections that like to go deep and cause damage to the muscles which is harder to replace.

He was eventually discharge with a little remaining necrosis still present, which is not recommended for weaker hosts, but this is a young strong host with good flow who doesn’t smoke, so he could handle the debridement and logistics associated with subsequent staged outpatient surgeries. I got him to granulate with weekly debridements, and dressing changes consisting of xeroform, gauze, kerlix, ABDs. Only issue remaining is the plantar flap that needs to be tacked down, and the 1st met bone that was necrotic. Simply cutting it flush to create a guillotine type wound might be fine for lower level ambulators, but for a younger person who needs to walk a lot, this will not do well, it needs bulk. I decided to do a random rotational flap using the granular tissue under the ABductor muscle belly. Granulation tissue is extracellular matrix with a random network of capillaries, basically it’s a vascularized skin substitute, perfect product to use to cover bone and tendons. I got the bone covered using this granulation tissue random rotational flap, tacked down that plantar flap, and continued with the usual weekly debridements and xeroform betadine gauze dressing changes.

See the next post to see what happened next.

This case involves a newly diagnosed diabetic who found out when he had a necrotizing infection to his great toe. It was...
04/20/2026

This case involves a newly diagnosed diabetic who found out when he had a necrotizing infection to his great toe. It was so severe it ended up requiring a transmetatarsal amputation and a wide debridement, leaving him with a large soft tissue defect. Luckily, it was strep, which tends to like to erode superficial spaces, not deep. I say luckily because it’s easier to replace superficial structures such as skin, harder if it went deep for example into the master knot of Henry, it could erode the deep layers of the plantar foot which leaves us with not much to work with. If you go through the slides I discuss in detail some of the clinical clues I look for. MRI or CT scan can only detect edema, so it won’t know if the muscle edema is myonecrosis or simply inflammation. Same with the subcutaneous fat, MRI can just detect edema, it won’t know if it’s necrotizing, which is a 100% clinical diagnosis. Also this case came back as negative for osteomyelitis on pathology, but it’s a good example of how acute diabetic foot infections are soft tissue dominant that sometimes just so happen to involve bone. It doesn’t matter whether the bone is infected, the soft tissue damage dictates our amputation decision.

He eventually was discharged with still some residual necrosis which isn’t recommended for weaker hosts, but this was a young strong host who could handle the outpatient management. He was seen by me in office weekly for debridements, and through simple xeroform betadine gauze ABD dressing changes several times a week he granulated without the need for a wound vac. The only hard part was the residual necrotic 1st metatarsal that had no viable periosteum to help granulate, plus with the plantar flap sorta loose, he needs an OR debridement, so I was focused on getting the rest of the wound ready for partial closure and 1st metatarsal resection. The problem was that in young patients who need to walk a lot, guillotine style closures don’t do well long-term. That 1st metatarsal stump will need more than just a skin sub, it needs bulk for it to be functional. See my next post to see what happens.

This is the followup to the previous post. Here’s the X-rays of the arthritis after pin placement. Yes it can happen, bu...
04/13/2026

This is the followup to the previous post. Here’s the X-rays of the arthritis after pin placement. Yes it can happen, but I’ll take it over the risk of an unstable graft that won’t help cover the FHL tendon. I think in the future I might try to use a monorail ex-fix instead of a pin.

The case I posted on Nov 7, 2023 is much more dramatic, involving a wound with actually joint capsule necrosis, and I used 3 pins instead of 1 because of his restless leg syndrome. He would otherwise have had no chance of healing that complex wound involving bone and joint. Just scroll down to find that post series!

Here is a repost of a recent Instagram stories, grand rounds style case I presented of a diabetic foot infection in a yo...
04/13/2026

Here is a repost of a recent Instagram stories, grand rounds style case I presented of a diabetic foot infection in a young man with neuropathy, and even though these cases are technically simple “first year” cases, the thought that goes behind it is not something to be taken lightly. What I find interesting is that this toe could have gone on to amputation and no one would bat an eye, however, I when I try to save it, I get a lot of concerns about my method of putting a pin across the joint to stabilize a graft in the setting of an acute infection. I’ve learned over the years is that the zone of infection is predictable and not something to be feared.

If you look closely to the location of the pin, you will realize that I did not put it in the zone of infection, there was no pus or necrosis involving the bone or the tip of the great toe. Also, the time of pin placement was during the subsequent surgery where I confirmed adequate source control, clean enough to apply a skin sub. I used Dermacell because it has better long term durability and is pliable so it can be shaped into the irregular sized wound.

Another point to bring up about the pin is that we really should scrutinize the cleanliness of the wound prior to scaffold graft application. I see people apply skin subs on wounds that are still infected, yet blame the graft for not working rather than scrutinize the cleanliness of the wound bed. My criteria for source control is absence of necrosis or thrombosis.

For a more dramatic example of why it’s important to immobilize a joint for graft healing, see the case I posted on November 7, 2023.

This is a 60 year old female, history of smoking, hypothyroidism, she slipped on ice, fell, and broke her ankle. She und...
03/09/2026

This is a 60 year old female, history of smoking, hypothyroidism, she slipped on ice, fell, and broke her ankle. She underwent ORIF by a colleague, and had trouble healing both the bone and the skin. She eventually had hardware exposed and was sent to me to help with coverage. I got a CT scan to see if the bone is healed, it’s not. So hardware removal was not an option yet. Arterial duplex confirmed good flow, and so I got her admitted for presumed osteomyelitis, scheduled a 2-stage procedure 1 week apart. First stage consisted of the following:

Debridement
Flap elevation
Skin substitute application to cover the donor site
Antibiotic cement application

Second stage was a repeat debridement, removal of cement, and inset of the flap.

Cultures grew skin contaminant, biopsy was negative. I didn’t get MRI because post-surgical changes and presence of hardware were definitely going to reduce specificity of detecting osteomyelitis. She was eventually discharged on oral antibiotics.

During the recovery, she had no edge necrosis of the flap, but there was a distal dehiscence that required an in-office revision wound closure. She was not happy about the aesthetics of the closure, but at least we got her healed, otherwise this could become a lot more complicated had the hardware gotten infected.

Common question I get is the glove. I use it to prevent the elevated paddle from healing back into the donor site. Technically I don’t need it since I covered the donor site with Integra, so we already have an interface to prevent the paddle from healing back in. The importance of staging the inset is so that the pedicle can be given time to open up choke vessels to improve the vascularity to the paddle. That 180 degree turn can create a kink which disrupts the pedicle’s vascularity.

This case is a followup from a prior case, scroll 14 rows back to see the 2 posts describing his initial infection and w...
02/10/2026

This case is a followup from a prior case, scroll 14 rows back to see the 2 posts describing his initial infection and wound that I treated, posted on August 16, 2024.

50M with DM, hammertoe, rubbed a wound in his shoe due to the deformity. It’s down to bone, and obviously MRI will show changes concerning for osteomyelitis. However a common misconception is that osteomyelitis can only be treated with amputation. That is not true, toes can definitely be saved even if confirmed osteomyelitis. The trick is to rely on one clinical question… is it necrotic? Don’t worry about swelling, redness, or pus… those are all signs of the host fighting back. They are reversible. After his short hospital course of IV antibiotics he was sent home on 10 days of doxy and augmentin right after the closure.

So the thing is, a lot of docs would recommend amputating this toe, I know that for a fact because I get second opinions all the time for this exact scenario. And so anything I try has close to zero risk, because if the alternative is a toe amputation, what do I have to lose? Pinning across a zone of infection is typically not recommended, but I’m finding that as long as there is no necrosis or pus after debridement, it doesn’t seed infection. Once the pin comes out, it heals and seal.

Lots of dogma out there, but the host is more resilient than we think. Osteomyelitis shouldn’t be feared, it’s simply misunderstood. Remember, Cierny-Mader classification is based on mostly long bone chronic infection, what most podiatrists deal with are acute contiguous spread bone infection. Completely different. Limb salvage starts by learning to fine tune and reframe what we think is a salvageable toe, only then we can move on to evolving the definition of a salvageable limb.

This is a patient with a chronic non-healing diabetic foot ulcer to the hallux, with history of COPD, smoking, PAD (s/p ...
02/01/2026

This is a patient with a chronic non-healing diabetic foot ulcer to the hallux, with history of COPD, smoking, PAD (s/p open aorto-internal iliac artery bypass for aneurysmal disease), failed outpatient treatment at wound care clinic. He ended up having a wound that probes to bone and was admitted for osteomyelitis. MRI lights up on T2, that is clear. The impression was then read as osteomyelitis, so he was told he needed amputation. And a lot of surgeons would amputate this toe. There’s a lot of issues with this. First, you need a geographic T1 marrow signal dropout to diagnose it as osteomyelitis on MRI. Look closely at the photo of the T1 mri. I think this patient’s T1 signal dropout is debatable, I would argue it’s not there and that the radiology read is wrong. Sometimes if I need to I’ll even call the radiologist to read it again and ask to change the impression. But that’s not even the main issue. The question we should be asking is... what is a surgically relevant finding? To me, MRI for acute contiguous spread osteomyelitis is surgically irrelevant. EVEN IF there is geographic T1 signal dropout, it does not require surgical removal. Are we doing radical corpectomies with multilevel spinal fusion for every vertebral osteomyelitis that has T1 signal changes? No. They do it based on symptoms and spinal instability. For toes? There are so many toes and legs being amputated based on MRI findings alone, and that has to change.

I had this patient discharged on Augmentin that I kept him on for 10 days because I did think he had osteomyelitis at all. He had a wound with bone exposed due to microrepetitive trauma, neuropathy, and a mild cellulitis. I did an in-office medial band plantar fasciotomy, followed by weekly modified felt football dressings and got him healed without major surgery or amputation.

The felt football I do 1-2 layers of 1/8” felt with a cutout over the ulcer, sometimes the felt is direct to skin, sometimes over a thin layer of kling, followed by betadine gauze kling and coban. I remove the insert and it should fit most DM shoes. They leave the dressing alone for a week. They can then walk in regular shoes.

01/12/2026

After working with our first fellow over the past 5 months, we believe we definitely can teach someone how to manage a high-volume diabetic limb salvage practice efficiently and sustainably. My partners and I are excited to announce that we are accepting applications for the Albuquerque Associated Podiatrists Lower Extremity Salvage (AAPLES) Fellowship!

This fellowship focuses on:

High-volume inpatient limb salvage

Efficient hospital workflows so time is not wasted

Confident management of on-call podiatry cases, including necrotizing fasciitis and low-energy trauma

Emphasis on early source control, followed by technically simple techniques to achieve wound healing and closure of large defects

Most limbs and wounds in our program are treated without complex reconstruction. Flaps, frames, and Charcot reconstruction are not a focus. Many of our outcomes are achieved using straightforward, reproducible techniques. If advanced reconstruction is your primary goal, this is not the right program for you.

The fellow is hired as an associate employee under our mentorship, with their own podiatry license. There are times where our fellow were primary and sometimes solo. Cases performed as primary surgeon are eligible for board certification. Our first fellow already has sufficient case numbers and variety to submit for ABFAS foot surgery.

Case volume (first fellow):

Start date: Aug 1, 2025

325 cases scrubbed to date

121 cases directly with me

Compensation:

$80,000 salary

Health insurance

Malpractice with tail coverage

CME and conference allowance

Clinic exposure:

1–2 half days of clinic per week

Dedicated teaching on billing, coding, and private practice fundamentals

If you’re interested and willing to take call with us for ~40 weeks next year, send me a DM.

This is a 52F with DM, well controlled diabetes, developed a left Charcot foot deformity via navicular collapse, underwe...
09/24/2025

This is a 52F with DM, well controlled diabetes, developed a left Charcot foot deformity via navicular collapse, underwent attempted ORIF with monorail by a colleague. She was sent to me for reconstruction. Traditional treatment involved fusion of the midfoot and STJ using beams. But those cases are never easy, and results vary greatly. Recently more and more surgeons are starting to fuse the hindfoot and ankle, by locking the talus in the desired alignment the midfoot won’t collapse any further. It is also an easier recovery (and technically easier surgery to perform) than the traditional approach with potentially less risks and better outcomes. I did the standard lateral approach with fibular takedown, and IM nail. She was fusing nicely at 3 months and at that point was permitted to walk and drive, but must wear the CAM boot for any walking activities over 3 minutes. She will need to be in a boot for a year post-op. Final xrays in this post show the 9 months post-op xrays showing excellent fusion.

This is a case I treated recently, straightforward 2-stage surgery of a 3rd toe necrotizing type infection. The key is l...
09/21/2025

This is a case I treated recently, straightforward 2-stage surgery of a 3rd toe necrotizing type infection. The key is looking for that vascular thrombosis which tells me where the bacteria is hiding. Single-stage treatment of necrotizing type infections especially in someone immunocompromised like this patient with DM and ESRD on PD, would be a mistake. Even if the tissues “looked good” at the time, because you don’t know if the bacteria is still in the tissues somewhere. I suggest at least giving it 48 hours, if it’s there it’ll continue to create exotoxin which leads to platelet leukocyte aggregates, and that will manifest itself as the little bits of thrombus. I do rely on broad spec antibiotics to suppress the spread of infection and to continue to kill bacteria, but I still need to do my job as the surgeon to physically remove any remnant of bacteria that the host and antibiotics struggle to completely eradicate. If you’re not sure whether to close or not, I suggest leave it completely open and come back in a few days to re-evaluate.

Reintroducing the Terashi TMA, published in our home journal (JFAS) in 2011, but its idea deserves more attention. Tradi...
09/14/2025

Reintroducing the Terashi TMA, published in our home journal (JFAS) in 2011, but its idea deserves more attention. Traditional TMA pays no attention to the soft tissue muscle and periosteum bulk, we make a skin and fascia flap to cover over bone. But if you look at how we do BKA and AKA surgery, we use muscle to cover the tibia or femur. The more you can pad the bone prominence the better the stump can remain ulcer free in a prosthetic. Same for the foot. The more vascularized soft tissue you can put between bone and skin, the better the TMA will remain ulcer free. Look at the next slide, it’ll show a video of how this patient was able to use the intrinsic muscle to flex his foot, he even joked that he can pick up marbles with his TMA foot!

The paper does not describe in detail exactly how to do this. I show several videos of how I do the Terashi TMA on our website footandanklesurgeryacademy.com but basically, it involves a traditional fishmouth incision to bone, key elevator all periosteum off each metatarsal shaft. I now protect interosseous muscles with Hohmann or Senn retractors while performing the osteotomies. I then use a McGlamry elevator in an antegrade direction to reflect the plantar soft tissue off the bone to the level of the plantar plate origin. Then I use a scalpel to dissect the forefoot off, leaving what resembles a rack of lamb. The remainder is a super bulky plantar soft tissue flap that I can use to cover the bone stumps, typically with multilayer closure. It also gives us options to use these intrinsics as muscle flaps to cover defects created from infection.

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