Fig. (1) Photographic montage of the alpha patient for which the anterior offloading aperture pad was created. Initial appearance at the time of dressing change 7-days post-operative demonstrating pressure necrosis and surrounding incisional unstageable deep tissue injury (A). Completed anterior offloading aperture pad with additional medial cut-out to reduce pressure throughout the region of pressure necrosis (B). Note that a non-adherent contact layer dressing has been applied between the skin and aperture dressing. Subsequent appearance 4-weeks post-operative demonstrating stabilization of the anterior ankle incision and extent of dry eschar (C) that underwent excision and layered closure in the office setting at this time (D). Well-healed anterior ankle incision demonstrated at 8-weeks post-operative (E).