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In order to achieve a complete removal of nonviable tissue, surgical debridement of the wound with the use of the scalpel and tissue forceps or nail nippers may be the most effective method of treatment. Because excessive pain in the sensate patient and bleeding in the severely coagulopathic patient may occur, care must be taken with the use of this modality. The authors suggest that sterile tissue forceps and scalpel should be used for larger size wounds while tissue nippers or scissors may be used in smaller wounds.  The skin may be incised  or the nipper may be introduced to the fullest extent of the undermining between the epidermis and dermis .  When debriding the skin, all nonviable, non-bleeding tissue such as callus, necrotic tissue, and eschar, which prohibit healing of the wound, should be excised en toto.  If the border between the viable and nonviable tissue is clearly demarcated, then skin should be excised along the border.  When wound borders are not clearly defined, one should start in the center of the wound and remove concentric circles of skin until viable tissue is attained.  Tissue should be removed circumferentially about the wound until the periphery of the wound exhibits a firm connection between epidermis and dermis.   Normal bleeding should occur once the wound edges are reached.  If clotted venules at the skin edge are noted, further dissection should be carried out until normal bleeding is encountered. Once normal bleeding is achieved at the wound edges, digital pressure may be applied as necessary to the wound in order to achieve hemostasis. Following this, the wound base may be curreted to remove any non-viable tissue. The wound may then be probed to assess the involvement of underlying tissue and for the presence of occult infection.  The wound will then be dressed with a standard wound dressing and properly off-loaded.  The hallmark of an appropriately off-loaded wound is the noticeable lack of undermining at the wound’s edge at follow up. Quality offloading will, in our experience, reduce the frequency of debridements because of protection of the wound.