Wound Care and Limb Salvage

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Wound Care and Limb Salvage

• St. Lukes Roosevelt Hospital Center

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Goals

• Retain limbs
• Minimally invasive and invasive therapy
• Aggressive treatment of wounds
• Wound care team algorithms
• Clinical trial access
• Cutting edge therapeutic interventions
• Aggressive rehabilitation services

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How we achieve these goals?

• Aggressive attempts at limb salvage
• Using a combination of techniques
• When a wound is inevitable
• Inpatient wound care team
• Outpatient wound care team
• Standardized formulary
• Individualized plan for each patient

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Invasive surgical options
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Minimally invasive techniques
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Outcomes of Aggressive intervention

• 5 year 1 patency 65 to 70
• 5 year 2 patency 80 to 85
• 5 year limb salvage 85 to 90

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Wound care team

• Speeds time to recovery
• Integrates different experience
• Integrates different perspectives
• Provides increased continuity
• Decreases contradictory treatment application

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Wound care team

• Allows for better development and application of
  algorithms
• Aids in patient and caregiver education
• Provides for equal voice from various care
  backgrounds
• Much easier to implement preventive strategies

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Application of the Team Concept/ Standardized
Formulary

• Further sub-specialization
• Diabetic foot team
• Amputation team
• Decubitus team
• Stoma team

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Standardized Formulary

• Allows for less caregiver and patient confusion
• Decreases cost
• Decreases lapses in therapy once initiated
• Improves time to recovery ?

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Specific team requirements

• Diabetic foot
• Diabetologist- Inpatient and Outpatient
• Nurse specialist - VNS liason
• Nutritionist
• Physical therapist - Outpatient liason
• Podiatrist
• Prosthetist
• Social worker
• Vascular surgeon (Team leader)

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Specific team requirements

• Amputation Team
• Nurse specialist - VNS liason
• Nutritionist
• Physical therapist - Outpatient liason
• Podiatrist
• Prosthetist
• Vascular / Orthopedic surgeon
• Social worker
• Psychologist

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Novel approaches and clinical trials

• Growth factor studies
• Vacuum Assisted Closure Device studies
• Drug eluting stent trials
• At present seven active clinical trials focused
  at these problems
• Multidisciplinary plan of care