Osteomyelitis
Infection reaching bone, one of the most consequential turns a chronic wound can take.
The flagship framework
The CWS Surgical
Escalation Pathway™
Recognizing when conservative wound care is no longer enough. A clear, educational framework for the moment a wound stops progressing, and what should happen next.
The logic
Most wounds heal. Some stall. The difference deserves a decision.
Most wounds heal with appropriate conservative treatment: dressings, offloading, compression, infection control, and consistent local care. That work is the foundation of wound medicine, and nothing about the pathway replaces it.
But some wounds stop progressing despite everything being done right. When there is limited or no meaningful progression despite appropriate care, the answer is not to repeat the same month again. It’s time for a surgical evaluation.
The wound plateaued. The provider didn’t. An evaluation is a decision point, not a verdict: many evaluated wounds return to conservative care with a refined plan.
The pathway, end to end
From stalled healing to surgical recovery.
01 · Foundation
Conservative treatment
Evidence-based local care with the existing provider. Wound progress assessed at every encounter.
02 · The signal
Healing stalls
Limited or no meaningful progression despite appropriate care. The plateau is the trigger, not a failure.
03 · The missing step
CWS surgical evaluation
- Virtual consultation
- Wound-certified provider assessment
- Imaging review
- Surgical candidacy determination
04 · When appropriate
Surgical intervention
- Debridement
- Advanced reconstruction
- Skin grafting
- Biologics
05 · Continuity
Return to community
- Home health
- Skilled nursing
- Assisted living & LTC
06 · To closure
Virtual follow-up
Healing tracked to closure, with structured notes back to the existing care team.
Evaluation is the pathway’s center of gravity. Everything else follows from that decision.
An educational callout
The CWS 4 Visit Rule™
If a wound has failed to demonstrate meaningful progression after four appropriate wound-care encounters, it may deserve a surgical evaluation.
Four visits is not a deadline and not a protocol. It’s a prompt: a simple, memorable moment to step back and ask whether the current plan is still moving the wound forward, or whether another level of evaluation would help.
Why timing matters
Don’t wait for a chronic wound to become a complicated one.
A stalled wound is rarely static. Left without re-evaluation, it can progress toward complications that are harder on the patient and harder to treat.
Progressive infection
Cellulitis and deep-space infection that outgrow what dressings can control.
Extensive tissue loss
Undermining and necrosis that turn a manageable wound into a reconstructive problem.
Systemic & limb-threatening complications
Sepsis and limb-threatening progression, the outcomes the entire pathway exists to help avoid.
Earlier evaluation, appropriate intervention, and continuity with the existing care team. That order is the whole idea.
Request a Surgical Evaluation →Evaluate · Intervene when appropriate · Return
Think a wound has reached the pathway?
Request a surgical wound evaluation, virtually or in person. If intervention isn’t appropriate, you’ll get a clear assessment back, and the wound returns to conservative care with better information.