In this podcast episode, Stephen G. Bergquist, MD, CWSP, discusses new and emerging technologies and their impacts on the wound care industry with guest Matthew MacEwan, PhD, president and chief scientist at Acera Surgical. Click here to listen.
Month: January 2018
New Negative Pressure Wound Care Device from Smith & Nephew
At the ongoing American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas, Smith & Nephew has just introduced a new negative pressure wound therapy system called RENASYS EZ.
Features and functions according to the manufacturer …. In addition to a simple control that varies pressure from 40 to 200 mmHg and the ability to use both foam and gauze dressings, Smith & Nephew designed RENASYS EZ with additional features that enhance the patient experience and facilitate its ease of use … read more
How to Measure a Wound
How to Measure a Wound presented by Nurse Practitioner Wound Management, Sue Templeton
Medicare reimbursement for hyperbaric oxygen therapy
In an atmosphere of changing reimbursement, it’s important to understand indications and utilization guidelines for healthcare services. Otherwise, facilities won’t receive appropriate reimbursement for provided services. This article focuses on Medicare reimbursement for hyperbaric oxygen therapy (HBOT).
Indications and documentation requirements
The Centers for Medicare & Medicaid Services (CMS) National Coverage Determination for HBOT lists covered conditions for HBOT, as do the individual Medicare Administrative Contractor’s (MAC) Local Coverage Determination policies and/or articles. (See Conditions for which CMS approves use of HBOT.) Providers should thoroughly review the indications and utilization guidelines to ensure coverage criteria are met for each clinical condition … read more
The Future of Wound Healing: Autologous Patient Gels
Seems like yesterday that those of us with gaping lacerations were told to “walk it off.” These days, instead of just using sutures, surgeons have been using a natural fibrin glue to close up wounds and secure fractured bones. The next step in the process is actually using a patient’s own wound-healing cells like platelets to pseudo-naturally speed up the process.
A sample of blood is taken from the patient and the red blood cells are removed. The platelets are concentrated and when combined with thrombin, form a very strong gel that is not too different from the body’s natural healing process.
Pilot studies are springing up all over the place demonstrating reduced wound healing … read more
Wound Healing Sped Up by Patient’s Own Platelets
The University of Cincinnati is reporting that a team of clinicians under David Hom, MD, an otolaryngologist, completed a study that demonstrated that a gel containing a patient’s own platelets (autologous platelet gel or APG) is more effective in promoting skin wound healing than a control antibiotic ointment.
It is believed to be one of the earliest preliminary studies comparing the effectiveness of APG on skin wounds in healthy humans.
Four male and four female volunteers aged 21-58 received five full-thickness skin punch wounds (4 mm diameter) on each thigh. APG was applied topically to the punch sites (one to two times) on one thigh and antibiotic ointment to the other, and the wounds were monitored for six months … read more
When and how to culture a chronic wound
Chronic wound infections are a significant healthcare burden, contributing to increased morbidity and mortality, prolonged hospitalization, limb loss, and higher medical costs. What’s more, they pose a potential sepsis risk for patients. For wound care providers, the goal is to eliminate the infection before these consequences arise.
Most chronic wounds are colonized by polymicrobial aerobic-anaerobic microflora. However, practitioners continue to debate whether wound cultures are relevant. Typically, chronic wounds aren’t cultured unless the patient has signs and symptoms of infection, which vary depending on whether the wound is acute or chronic … read more
New Biocompatible Hydrogel for Wound Healing
Researchers at Harvard’s Brigham and Women’s Hospital engineered a new material that looks highly promising for use in accelerating wound healing, building replacement tissues, and growing new blood vessels. The photocrosslinkable elastin-like polypeptide-based (ELP) hydrogel is biocompatible, having characteristics similar to many soft tissues within the human body, and is activated using ultraviolet light. The mechanical properties and swelling of the final material can be controlled ahead of time by changing the concentration of the ingredients, potentially making it viable for use in widely differing applications … read more
Enzymatic debridement: No perfect solution yet
A recently published study on procedures for determining the effectiveness of various enzymatic wound debriding agents illustrates the continuing need for a reliable, cost-effective enzymatic debrider for use in wound care.
Researchers concluded that the automated in vitro procedure used in the study can produce useful information for evaluating the effects topical antimicrobials, wound cleansers, wound dressings, and drug infiltrates have on the effectiveness of debriding agents. The study used porcine skin and muscle tissue as substrates in an automated Franz-type in vitro diffusion cell system … read more
5 Questions to Consider Before Launching Your New Hospital-Based Wound Care Program
Opening a wound clinic is not without its risks and challenges. These five questions will help clinicians and program directors decide if the outpatient wound care service line is truly appropriate for them.
Hospital-based outpatient wound care programs have experienced explosive growth in a relatively short period of time, despite being relatively “new” to the healthcare industry. An aging population has brought significant health concerns among older patients, including type 2 diabetes, venous insufficiency, obesity, increasingly sedentary lifestyles, tobacco use, and other comorbidities that are taxing our healthcare system. Care of chronic wounds provides a cost-effective solution for this patient demographic, with a primary goal of amputation prevention and a secondary benefit of reduced hospital admissions and/or readmissions seen as motivation. The wound care product industry has also driven outpatient care and is expected to grow to $22 billion in the United States by 2022.1 The product industry has largely driven advancements in the field of wound care research while increasing awareness about wound management. Currently, there are approximately 1,500 wound care centers nationwide, based on conservative estimates collected during the authors’ research for this article, with many more hospitals considering adding a wound care program to their outpatient service lines. There’s no question that wound care programs offer a viable solution for hospitals; however, opening and operating an outpatient wound care program is not easily accomplished. It’s a unique service line that takes committed leadership, upfront capital, and a clinical staff that deeply believes in the service line to make it operate successfully and provide long-term value to the community.
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How to assess wound exudate
Exudate (drainage), a liquid produced by the body in response to tissue damage, is present in wounds as they heal. It consists of fluid that has leaked out of blood vessels and closely resembles blood plasma. Exudate can result also from conditions that cause edema, such as inflammation, immobility, limb dependence, and venous and lymphatic insufficiency.
Accurate assessment of exudate is important throughout the healing process because the color, consistency, odor, and amount change as a result of various physiologic processes and underlying complications.
Consistent terminology is crucial to ensure accurate communication among clinicians. Here are terms you should keep in mind when observing the wound and documenting your findings …. read more
Topical gel containing blood pressure drugs shown effective in healing chronic wounds …
Topical Gel Made From Oral Blood Pressure Drugs Shown Effective in Healing Chronic Wounds in Test Animals
An international team of researchers led by Johns Hopkins has shown that a topical gel made from a class of common blood pressure pills that block inflammation pathways speeds the healing of chronic skin wounds in mice and pigs.
A report of the findings, published Oct. 16 in the Journal of Investigative Dermatology, marks efforts to seek approval from the U.S. Food and Drug Administration (FDA) to use the gel application in treatment-resistant skin wounds among diabetics and others, particularly older adults.
“The FDA has not issued any new drug approval for wound healing in the past 10 years,” says Peter Abadir, M.D., associate professor …. read more
New Study, Same Conclusion …
New Study, Same Conclusion. It is time to take another look at Total Contact Casting
Total Contact Cast
The most recent and perhaps the most conclusive study of for treatment of the diabetic foot is a collaboration of three prominent organizations, The Society for Vascular Surgery, the American Podiatric Medical Association and the Society for Vascular Medicine. The guidelines, “The Management of the Diabetic Foot,” were developed after three years of studies and are published online and in print in the Journal for Vascular Surgery. Dr. Anil P. Hingorani is the lead author that researched and wrote the guidelines. With diabetes a major worldwide problem and little data on treatments, the need for detailed, diabetic foot clinical guidelines from multiple disciplines was great, said Hingorani.
The committee synthesized the points of view of the three different medical professions by researching one another’s treatment protocols. Vascular surgeons and vascular medicine specialists read literature from podiatry and vice versa, for example, and all participants concentrated on infectious disease control and guidelines, a large component of the finished document. Collaboration was key, Hingorani said. “We had multiple disciplines looking at the problem to bring the best information from each field to develop the guidelines,” he said, though only limited “high-quality evidence” was available for many of the critical questions.
One of the findings that physicians may find surprising, it was the importance of the total contact cast in the treatment of plantar diabetic foot ulcers, which the committee found was is supported by robust data. Off-loading takes all direct pressure off the ulcer through use of a total contact cast. “total contact casting is so under-utilized,” Hingorani said. “I think some surgeons may find it surprising and it may raise a few eyebrows. Many surgeons are not aware of how strong the evidence is for total contact casting. It is not new but not widely understood or implemented.”
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The Save A Leg, Save A Life Foundation was incorporated as a new non-profit organization in the State of Florida during May of 2015. We are poised and excited to make an impact on reducing the number of amputations. We will shape and build SALSAL to achieve its goals and to make Save A Leg, Save A Life into a universally recognized phrase and concept, one that resonates and “connects the dots” between non-healing wounds, Peripheral Arterial Disease and Amputations, as well as catastrophic events such as heart attack and stroke … website
Docs In Socks
Injectable gel holds promise as wound-healing material
A research team led by UCLA biomolecular engineers and doctors has demonstrated a therapeutic material that could one day promote better tissue regeneration following a wound or a stroke.
During the body’s typical healing process, when tissues like skin are damaged the body grows replacement cells. Integrins are class of proteins that are important in the cellular processes critical to creating new tissue. One of the processes is cell adhesion, when new cells “stick” to the materials between cells, called the extracellular matrix. Another is cell migration, where at the cell’s surface, integrins help “pull” the cell along through the extracellular matrix to move cells into place. However, these processes do not occur in brain tissue that has been damaged during a stroke. This is why scientists are trying to develop therapeutic materials that could promote this form of healing.
The injectable gel-like material, which is called a hydrogel, that the UCLA researchers developed helps this repair process by forming a scaffold inside the wound … read more
Diabetic Ulcer Debridement….
Originally appears to be a typical looking callus on a diabetic; this is NOT a callus and is actually a diabetic foot ulcer that is superficially infected. These are serious wounds and are the beginnings of what lead to foot and leg amputations if they are not treated promptly by your healthcare provider, AKA Podiatrist. (or wound care doc – editors note)
Medicare Spending on Wound Care: The First Comprehensive Study
Did you ever wonder how much it really costs to treat and heal various wounds? Patients, family members, and healthcare team members often complain to me that $5/day for nutrition therapy is “too expensive.” Cost is relative, because according to the first comprehensive study of Medicare spending on wound care, it appears that an investment in medical nutrition therapy is a wise investment indeed.
A new study entitled An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds1, demonstrates the economic impact of chronic nonhealing wounds in the Medicare population and highlights the associated need for quality measures and reimbursement models for wound care within the US Centers for Medicare & Medicaid Services (CMS) payment policies. The study analyzed 2014 Medicare data to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by care setting …. read more
Wound Documentation and Measurement with WoundZoom
Does your facility have a system in place for wound documentation and measurement? Our partners at WoundZoom offer an overview of their wound management system. Find out it it’s right for you.
What are you using for wound documentation and measurement? Is it saving you time and helping your patients?
As wound clinicians, we all have the same goal: to reduce wound size and eventually heal them completely. Wound measurement is key to determining our progress and guiding our treatment decisions. In this short slide show, WoundZoom discusses how their wound management system can drive better wound care practices. And as we know, better practices mean better outcomes … read more
Introducing WoundZoom Wound Management System
Probiotic supplementation aids wound healing in diabetic foot ulcer
Patients with a diabetic foot ulcer who received probiotic supplementation for 12 weeks experienced faster wound healing coupled with an improved glycemic and lipid profile compared with patients assigned placebo, according to findings from a randomized controlled trial.
Sima Mohseni, of the infectious diseases and tropical medicine research center at Babol University of Medical Sciences in Iran, and colleagues analyzed data from 60 adults aged 40 years to 85 years with grade 3 diabetic foot ulcer, who randomly received either probiotic supplementation (n = 30) or placebo (n = 30) daily for 12 weeks between March and June 2016. Probiotic capsules contained lactobacillus acidophilus, lactobacillus casei, lactobacillus fermentum and Bifidobacterium bifidum. All participants also underwent standard treatment for wound care … read more
Lower Extremity Amputation and Reamputation Predictors ….
Review: Lower Extremity Amputation and Reamputation Predictors in Patients with Diabetic Foot Wounds
A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.
The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included … read more
FDA approves shock wave device for treatment of diabetic foot ulcers
Today, the U.S. Food and Drug Administration permitted the marketing of the Dermapace System, the first shock wave device intended to treat diabetic foot ulcers.
“Diabetes is the leading cause of lower limb amputations,” said Binita Ashar, M.D., director of the division of surgical devices in FDA’s Center for Devices and Radiological Health. “The FDA is dedicated to making technologies available that can help improve the quality of life for those with chronic diseases. Additional options for successfully treating and healing ulcer wounds may help prevent lower limb amputations.”
An estimated 30.3 million people in the United States have been diagnosed with diabetes, according to the Centers for Disease Control and Prevention. Diabetes damages blood vessels and nerves, particularly in the feet, and can lead to severe infections that are difficult to treat. About 25 percent of people with diabetes will experience a foot ulcer in their lifetime. Amputation is sometimes necessary when circulation is so poor that a foot ulcer fails to heal or when treatment fails to stop the spread of an infection … read more
Assessing Stress During Wound Care
Review: Assessing Stress During Wound Care in Real-Time Using Wearable Sensors
Introduction: The Stress Response in Wound Care in Diabetic Foot Ulcers
Within the last decade, the rise of diabetes in the U.S. population has been matched with a rise in diabetic foot ulcers requiring amputations. Because many of these diabetic foot ulcers develop secondary to poor wound healing and susceptibility to infection after surgery, some important risk factors have been evaluated. Stress, among other factors, has been shown not only to affect the psychological state of a patient, but also biologically to impair immunity and induce an inflammatory microenvironment within patients.
Although previous studies have measured stress by using heart rate and respiration rate during a dressing change lasting three to five minutes, no studies have continuously quantified stress in patients with diabetic foot ulcers during a routine visit. This particular study attempted to examine the stress response in patients with diabetic foot ulcers by using a chest-worn sensor displaying heart rate data. The research team relied on an algorithm to estimate stress that used changes in heart rate variability, a measurement that is taken between two consecutive R waves of an electrocardiogram.
Materials and Methods: Electrocardiographic Monitoring of Wound Dressing Changes in Diabetic Foot Ulcers
Twenty patients with diabetic foot ulcers were recruited from a wound care center and were given the BioHarness3, an FDA approved body device to evaluate single-channel electrocardiogram activity, respiration rate, posture, and core body temperature. To ensure quality control, the team used a smart phone to monitor data in a real-time fashion. This smart phone and BioHarness3 system had a biomodule that was linked to the patient’s body via a biopatch and electrocardiogram electrodes.
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SANUWAVE Announces Exhibition at SAWC
SUWANEE, Ga., Jan. 19, 2018 (GLOBE NEWSWIRE) — SANUWAVE Health, Inc. (OTCQB:SNWV) is pleased to announce that the company will exhibit, SAWC (Symposium on Advanced Wound Care) in Charlotte, NC on April 25 – 29, 2018. This will be SANUWAVE’s first opportunity to present their flagship wound care device, the dermaPACE System, to the U.S. market since receiving US FDA clearance in December, allowing the Company to market the device in the US.
“We are excited to be back presenting at SAWC spring in Charlotte, our first time as an exhibitor in 8 years. Since FDA clearance, the support coming from the wound care community has been overwhelmingly positive,” Stated Kevin R. Richardson, CEO and Chairman of the Board. Mr. Richardson continued, “We are glad to be making our shift from an R&D centered company to a marketing based company. This will be the start of our reemergence in the wound care space.” The Company is using this occasion to formally introduce their lead wound care product, the dermaPACE® System. This Extracorporeal Shockwave Technology … read more
Tissue Analytics raises $5M to make wound care more efficient
There’s a problem in healthcare when it comes to quality and accessibility of data in medicine, especially when it comes to chronic wound care, such as bed sores and ulcers that have to be cared for over years. For the most part, it has been done manually and, therefore, inaccurately.
“The old way that a doctor would manage and track the wound was with a ruler. Then they’d have to remember the last visit to figure out how it looked. This was holding the field back,” said Kevin Keenahan, CEO and co-founder of Tissue Analytics, a company that provides a solutions to increase efficiency and accuracy for wound and skin tracking.
MolecuLight i:X in Action
The MolecuLight i:X Imaging Device allows clinicians to quickly, safely, and easily visualize bacteria and measure wounds at the point of care, so they have maximum insights for accurate treatment selection and accelerated healing.
How Technology Is Supporting Smarter Wound Care
Smart bandage technology is something I’ve touched on a few times. Most of the time, the technology has involved being able to monitor the health of a wound without ‘undressing’ the bandage. Some take on a more active role however, such as administering insulin to manage blood glucose levels.
A team from the University of Nebraska-Lincoln, Harvard Medical School and MIT believe their smart bandage could eventually heal wounds on its own … read more
MolecuLight
This advanced CME course aims to inform clinicians and researchers on pressure ulcer management and provide continuing education for physicians, podiatrists, nurses and physical therapists.
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HIIN Brings Advanced Wound Care Training To …
Donna Meador has been a nurse for over 30 years. Today, she works at the Kentucky Hospital Association (KHA) to oversee quality and patient safety activities. Along with 34 other state associations, KHA is pursuing ambitious goals under the Health Research & Educational Trust (HRET) Hospital Improvement Innovation Network (HIIN) project. As the project’s director at KHA, Meador is working closely with hospital leadership and teams to ensure hospitals meet the goals set out by Centers for Medicare & Medicaid Services as part of the HRET HIIN project. KHA is striving to reduce inpatient harm by 20 percent and readmissions by 12 percent by 2019. Among the 12 areas of focus for the goals is pressure ulcers.
To ensure hospitals have the training they need to reduce pressure ulcers, KHA and Wound Care Education Institute® (WCEI®) formalized a partnership in June 2017. WCEI will bring the Skin and Wound Management course to a group of KHA member hospital clinicians in a live classroom setting in February 2018 … read more
Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and …
Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and Practice. Data from the US Wound Registry
Off-loading was documented in only 2.2% of 221,192 visits from January 2, 2007, to January 6, 2013. The most common off-loading option was the postoperative shoe (36.8%) and TCC (16.0%). There were significantly more amputations within 1 year for non-TCC–treated DFUs compared with TCC-treated DFUs (5.2% vs 2.2%; P = .001). The proportion of healed wounds was slightly higher for TCC-treated DFUs versus non-TCC–treated DFUs (39.4% vs 37.2%). Infection rates were significantly higher for non-TCC–treated DFUs compared with TCC-treated DFUs (2.6 vs 1.6; P = 2.1 × 10−10). Only 59 clinics used TCC (61%) … read more
Should Patients Buy Offloading Footwear From You?
It is a challenging, common situation: wound care patients require offloading devices for diabetic and/or neuropathic plantar ulcers, but there is no insurance coverage for those items. You explain that they will bear the cost of the product(s), but they believe the expenses should be covered by you. When you offer to sell the product(s) directly or suggest the patients purchase them elsewhere, they refuse. Ultimately, their wounds worsen or don’t improve.
It is well documented that shoe-based offloading approaches are used more frequently than any other modality in the treatment of plantar diabetic foot ulcers (DFUs).1,2 It is equally well established that supporting data are limited.3 Additionally, since there is no reimbursement for shoe-based offloading, the products and materials that physicians select to create offloading structures may be based as much on acquisition cost and availability than on any empirical review. When a DFU is the sole indication, the only offloading options that are routinely covered by Medicare (or insurance) are total contact casting and Crow walkers, both of which are used infrequently and are not “accepted” by many physicians or patients.1,2 The result of this disconnect between modalities that are reimbursed versus approaches that most physicians use is that there is no broadly recognized standard of care and actual care is highly variable from facility to facility …
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Ten years ago, when Wound Clinic Business began, nearly all of our wound care reimbursement information was found in printed books, manuals, and newsletters.
In 2018, nearly all of our reimbursement information is found somewhere online.
Your 2018 faculty will be giving this year’s attendees a gift to celebrate the 10th anniversary of Wound Clinic Business: hands-on interaction with reimbursement resources found online.
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Reexamining The Gold Standard For Offloading Of DFUs
Although the total contact cast can be effective for offloading diabetic foot ulcers, it is not in wide usage. These authors assert the gold standard for offloading lies in the non-removability of the device and offer a closer look at the merits of transitional offloading.
According to the American Diabetes Association, there are approximately 29.1 million Americans, or 9.3 percent of the population, who suffer from diabetes.1 Twenty-one million of these people have already been diagnosed with the disease and 8.1 million remain undiagnosed.
This number, although large, pales in comparison with the 86 million Americans who have been classified as “pre-diabetic” and who are at risk of having diabetes in the near future.1 Each year, 1.7 million Americans 20 years of age or older add to this number. This amounts to 4,660 people per day or one new patient with diabetes every 19 seconds. A full 25.9 percent of Americans age 65 or older suffer from diabetes and its complications. Almost twice as many American Indians (15.9 percent) and African-Americans (13.2 percent) develop the disease as Caucasians (7.6 percent) with Hispanics close behind (12.8 percent). Asian-Americans are not spared as 9 percent of this population will develop the disease and its many complications.
Glycosylation affects all organ systems and leads to complications such as dyslipidemia with an increased incidence of hypertension, and systemic vascular disease. It also leads to the development of a progressive ascending peripheral neuropathy with a loss of sensation and sweat gland function. This in turn leads to ulceration and, in some cases, amputation when infection of the wounds goes unchecked by an immune system that is also compromised by the process …
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Will Mobile Apps Bring Wound Care Technology to the “Cutting Edge”?
For wound care providers and other clinicians, 2017 continued to bring about a chaotic storm of healthcare reform based on quality measures, data registry requirements, and documentation standards. As has been previously stated in this journal, it remains to be seen if wound care practitioners will pool their limited resources and harness the power of their electronic health records to battle the “giant of healthcare reform.”1 This country’s push to enact and substantiate quality of care delivery can be seen through the uniting of clinical practice with increasingly sophisticated digital technology that allows for more accurate documentation and communication. For good reason, the focus of this union is being placed on the perspective of the patient (ie, how the patient receives healthcare information). However, it is becoming increasingly clear that there is a need for clinicians to be armed with devices that more easily and effectively facilitate the means to that end. This article will discuss the proliferation of healthcare-related digital apps that are both patient and clinician focused in an attempt to lay a foundation for wound care clinicians to become more technologically savvy and clinically compliant.
NAWCO Initiates Wound Care Certification Internationally
ST. JOSEPH, Mich., Dec. 11, 2017 /PRNewswire-USNewswire/ — National Alliance of Wound Care and Ostomy® (NAWCO®) announced today, the international expansion of its WCC® (Wound Care Certified) credential. The first group of international candidates sat for the proctored WCC® board certification exam at the conclusion of the NAWCO® approved Skin and Wound Management course in Nassau, The Bahamas on December 8, 2017.
“We are honored to be chosen as the approved credential for the Public Hospitals Authority, one of the best healthcare systems in the Caribbean. We would also like to congratulate the Wound Care Education Institute® for being chosen as the preferred education provider for the system as well. This milestone represents our continued commitment to grow the number one wound care certification in the United States to areas throughout the world where the need for more qualified wound care clinicians is great. We are excited to now offer WCC® certification beyond our American boundaries”, said Cindy Broadus, Executive Director NAWCO®.
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Wound care company introduces new technology
Swift Medical has introduced Swift AutoDepth technology, which lets clinicians take wound depth measurements at the point of care using a smartphone camera.
PointClickCare Skin and Wound, which is powered by Swift Medical technology, will be one of the first solutions to integrate Swift AutoDepth, the company said.
“Wounds heal from the inside out, and wound depth measurement is an important indicator in determining if a wound is healing properly,” says Carlo Perez, CEO of Swift Medical. “We saw the need for a touch-free and painless way to automate wound depth measurement and delivered with AutoDepth.”
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Research reveals the true impact of diabetic foot ulcers
The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research.
More than half the patients in the research study did not see their ulcer heal over a year – and one in seven had to have part or all of their foot amputated.
Foot ulcers are open wounds and they affect around a quarter of the 3.3 million people in the UK living with diabetes.
The wounds develop because diabetes damages the nerves and blood vessels in the feet.
These wounds are chronic, slow to heal and prone to infection, and it is infection that normally leads to some of the severe consequences such as losing a limb or multiple amputations.
The research, led by Professor Andrea Nelson at the University of Leeds, set out to examine the outcomes for people with infected diabetic foot ulcers and the results underline the need for people at risk of foot ulcers to be closely monitored.
Assessing Wound Depth with Smartphone Sensors
A new technological capability enables clinicians to gauge wound depth and severity using smartphone cameras, according to an announcement today from Swift Medical. The innovation could help to better manage wound outcomes.
The system, called AutoDepth, will be part of the PointClickCare Skin and Wound application, which is powered by Swift’s technology. In many cases, depth can be a key indicator as to whether a wound is healing properly. The system’s algorithms process dynamic changes in depth over time, and it also uses machine learning to improve its accuracy.
Carlo Perez, CEO of Swift Medical, equates the sensory techniques to those that enable autonomous driving.
Gauging wound severity with a smartphone has a few advantages … read more
Wound Care Startup Could Reduce Home Health Time
A biomedical engineer and a health care entrepreneur have teamed up to improve wound care with a product designed to prevent infection and reduce the need for some post-acute care, including home health.
FM Wound Care, LLC, based in Trenary, Michigan, is awaiting U.S. Food and Drug Administration approval on a nitric-oxide-infused, self-sterilizing wound dressing designed to kill bacteria following surgery. The post-op bandage could potentially reduce the need for some care performed by home health care providers, and lower overall wound care costs.
Megan C. Frost, PhD, and entrepreneur Jeff Millin believe their product—the Sentry Wound Dressing—prevents infections by slowly releasing nitric oxide (N.O.) over the course of seven days, allowing patients to wear the same wound dressing for a week.
“If a nurse has to change a dressing, that takes quite a bit of time,” Millin explained to Home Health Care News. “If you only had to do that once every seven days as opposed to once every other day, the savings could be significant.”
Healogics, Inc. Names David Bassin as New Chief Executive Officer
JACKSONVILLE, Fla.–(BUSINESS WIRE)–Healogics, Inc., the nation’s largest provider of advanced wound care services, today announced that it has appointed David Bassin to serve as Chief Executive Officer. Bassin joined Healogics in January 2016 as Chief Financial Officer.
“David has been an instrumental member of the executive leadership team and a catalyst for change within the organization,” said John Dineen, Chairman of the Board. Dineen went on to say, “David’s extensive leadership experience within healthcare, coupled with his understanding of the Healogics business, makes him uniquely qualified for this CEO role.”
David Bassin, Chief Executive Officer
Prior to Healogics, Bassin served as Chief Financial Officer at eviCore Healthcare, Inc., MedSolutions, Inc., and inVentiv Health, Inc. Over the course of his 20-year career, he has had the opportunity to touch many areas of healthcare, including clinical services, product management, payer strategies and, with Healogics, physician practice management. “His proven track record of driving company growth through strategic initiatives, acquisitions and operational efficiencies will allow him to seamlessly transition into this role. I am delighted that he has accepted this position,” said Dineen.
“I am excited by the opportunity to lead Healogics. It is an honor; and I’m grateful to the Board of Directors for this opportunity,” said David Bassin. “We have an exceptional organization of dedicated and talented professionals. It’s our people that make Healogics a special company and the preeminent provider of wound care. Together, with our hospital partners, we are making an incredible difference in the lives of our patients every day. This is truly an exciting time to be part of Healogics and to lead the company into the future of healthcare.”
“We are incredibly fortunate to have an executive like David leading Healogics
OnCourse Learning Acquires Leading Wound Care Training Company
Wound Care Education Institute will provide expanded offerings to healthcare clinicians
BROOKFIELD, Wis., Jan. 17, 2018 /PRNewswire/ — OnCourse Learning today announced the acquisition of Wound Care Education Institute, an internationally recognized wound care education leader for healthcare professionals.
“Wound care impacts patients along nearly the entire care continuum,” said Patrick Sheahan, President and CEO of OnCourse Learning. “By educating clinicians throughout the continuum, patient care can be more positively influenced thanks to Wound Care Education Institute’s library of courses.”
WCEI was founded in 2002 in Lake Geneva, Wis., by Nancy Morgan, RN, BSN, MBA, WOC, DWC, OMS, and Donna Sardina, RN, MHA, WCC, DWC, OMS. While working as registered nurses, they noticed a trend of nurses and healthcare professionals who had an interest in wound care but limited or non-existent access to specialized wound education. Morgan and Sardina decided to effect change by forming WCEI … read more
State of the Art Hydrogels for Wound Care and ….
State of the Art Hydrogels for Wound Care and Drug Delivery: Interview with CEO of Alliqua Inc.
Alliqua is a Langhorne, PA medical technology company that uses its proprietary hydrogel platform to develop wound care and drug delivery solutions. The company prides itself in having a broad range of wound care products that are not only different from competing products available on the market, but also in providing multiple options to clinicians to generate optimal wound healing outcomes with minimal risk of infections. Medgadget had the opportunity to interview David Johnson, CEO of Alliqua to learn about the latest products offered by the company and to get a better understanding of the next generation of wound care tools …. read more
How to apply a Total Contact Cast
This video demonstrates the application of the 901MF-WH Total Contact Casting Kit. Instructional dialog extends the length of the application considerably, actual application time of the Total Contact Casting Kit once comfortable with the process is approximately 5 minutes. For more information on the total contact casting kits being used visit: http://m-medusa.com
What Are Bacterial Biofilms? A Six Minute Montage
This is a six-minute video clip: a four minute montage of clips from early interviews with biofilm researchers, then a 3D animation showing the “life cycle” of bacterial biofilm — including its dispersal into the bloodstream.
Imbed Biosciences prepares to start selling its wound healing dressing …
Imbed Biosciences, Fitchburg, is poised to launch the sale of its wound-healing dressing, Microlyte Ag, a microfilm embedded with silver particles.
Imbed Biosciences, a young Fitchburg company that has developed an ultrathin film to heal wounds, is poised to launch its product this spring with the help of the latest injection of funds from investors.
A “national wound care company” will partner with Imbed and will market Microlyte Ag, said Ankit Agarwal, Imbed CEO and co-founder. The partner company’s name is not being released yet.
Microlyte Ag is a patented, ultrathin film coated with tiny silver particles that stick to the surface of the wound and kill bacteria. The U.S. Food and Drug Administration cleared it in August 2016 as a medical device, for prescription and over-the-counter use.
Mission Health’s hospital in Asheville, North Carolina is applying Microlyte Ag to 100 patients in a clinical study; results will be presented this spring. In a separate pilot project, doctors in about 25 hospitals across the U.S. are treating patients with the microfilm, Agarwal said.
Biofilm and Wound Healing
Composition of Biofilm
Biofilm is a complex microbial community containing self- and surface-attached microorganisms that are embedded in an extracellular polymeric substance.1,2 The extracellular polymeric substance is a primarily polysaccharide protective matrix synthesized and secreted by the microorganisms that attaches the biofilm firmly to a living or non-living surface. This protective covering does not allow the body’s immune system to recognize the presence of the microorganism; therefore, the bacteria evade an immune response, avoid detection by standard diagnostic techniques, and avoid destruction by standard treatments. Because of the tenacity of the attached biofilm, the microoganisms are able to resist physical forces, such shear, and are able to withstand nutrient and moisture deprivation, altered pH, and the impact of antibiotics and antiseptics. For the purposes of this discussion we break down the formation and actions of biofilms and discuss their impact on wound healing … read more
This Is Wound Care, the Coolest Specialty in Health Care
There are three little words in health care that without proper treatment can destroy your family’s finances and health. Despite this, the amount of people that have ever heard of the words — non-healing wounds — remains astonishingly low.
We are not talking about simple cuts, scrapes, or boo boos. Wound Care is a raw, gritty, extremely visual, and sometimes nauseating field of health care. It is certainly not for the squeamish. At the same time it is the coolest, most visual, and passion filled specialty of healthcare in which to be employed.
The passion runs deep
The wound care community is a segment of health care specialists that have dedicated their lives to the healing and treatment of non-healing wounds. These people live, sleep, eat, breath, and even dream about wound healing. When they are not doing that, they are posting about it on social media. I know this because I work with these amazing individuals every day at Wound Care Advantage (WCA), a company that runs and manages outpatient wound centers for hospitals. As the director of our S.O.A.R. department it is my job to help educate the nation on the dangers of non-healing wounds …. read more
WCC Recertification: It’s Easier Than You Think
Earning your Wound Care Certified® (WCC®) credential is one of the best feelings in the world. Once the exam is behind you (what a relief!), you can take all that new knowledge back to your practice and continue making a positive impact in wound care. So, it’s completely understandable how tempting it can be to delay even thinking about re-certification … read more
SAWC Fall
The Miller-Newgent Amputation Scale
A comprehensive scoring system to evaluate patient-centered risk factors regarding lower extremity amputation
Abstract: Care of the patient with a presumed life- or limb-threatening lower extremity wound poses many challenges. The mindset regarding potential outcomes of such conditions is mostly driven by the experiences and expertise of those providing the care. This mindset generally appears as two primary actions presented to the afflicted patient: attempted resolution of the problem via medical, surgical or combination treatment, with the hope of low recurrence risk, or exacerbation and amputation—amputations at a level sufficient to, at least in the mind of the surgeon, eliminate the problem. Achieving the former outcome is dependent on a number of factors associated with both patient and caregiver. If healing is achieved, the secondary goal of prevention of recurrence may be no less arduous, with failure most likely resulting in amputation. Clearly, these considerations appear to be based more on the health professionals perception, of the patient’s physical and medical status rather than on patient-centered considerations. This article will review considerations and recommendations for lower extremity amputation, and the short- and long-term implications. Based on our research, there is clear need for a set of criteria against which to weigh not just the medical issues, but also definitive patient-centered issues when considering a lower extremity amputation. We offer a set of patient-centered, easily verified and recognized criteria that we believe addresses this need. The goal of the Miller-Newgent Amputation Scale (MENACE) is to provide a decision base from which to consider and evaluate all factors in determining the need for a lower extremity amputation. This involves identification of patient-centered issues, which are likely to produce satisfactory short- and long-term physical and quality-of-life outcomes if the amputation does proceed.
Declaration of interest: The authors have no conflict of interest to declare. The lead author, as a Board Certified general surgeon with 23 years’ experience in the field of advanced wound care, has been involved in the different aspects to amputation and its considerations and a common thread my colleagues and I have identified is that the expertise of those attempting to heal and salvage limbs was largely ineffectual. More often than not, the progression of high-risk conditions mandated lower extremity amputation. The progression of technology, science and products to promote healing is thought to improve limb salvage rates; however, there has not been an appreciable reduction in amputations. The thought is that those possessing the skill, knowledge and desire to promote limb salvage (which entails greater time and effort with considerably lower compensation) are few and far between. Despite advances in medical care, the rates of lower extremity amputation are unchanged at best or are even increasing.
Despite educational programmes touting the newest technologies for vascular intervention and advanced wound healing to mitigate those conditions commonly leading to amputation, there has been minimal change in the willingness of health professionals to consider limb salvage and indications for amputation have changed minimally. There is a clear need for a matrix against which to compare and contrast the clinical and non-clinical considerations for amputation. Since the patient is the one undergoing this potentially horrific procedure, it is only fair that all aspects of the procedure must be considered as an integral part of the decisionmaking process. The Miller-Newgent Amputation Scale (MENACE) scale was created to provide a patientcentred guide using simple, easily identified information that directly impacts on all aspects of the amputation decision process.
Background Considerations for the intentional removal of a body part have their roots in antiquity. Matthew 5:29–30, 18:8–9 and Mark 9:43–47 are commonly recognised biblical references to amputation. Lower extremity amputation is one of the oldest known surgical practices with Hippocrates among others providing insights.
In the US, 30,000–40,000 amputations are performed annually. In 2005, there were an estimated 1.6 million individuals living with the loss of a limb; by 2050, this figure is expected to rise to 3.6 million.
In 1954, Silbert and Hamiovici published an article recommending that lower extremity amputation be avoided, preferring more conservative surgeries such as supracondylar amputations as opposed to mid-leg amputations. In the paper they cited the Handbook on Amputations, published in 1942 by the Council on Physical Therapy of the American Medical Association, which expressed the opinion of most surgeons, when it advised the use of supracondylar amputations and warned against mid-leg amputations: an opinion justifiable at the time before the advent of antibiotics.
The Netherlands Society of Physical and Rehabilitation Medicine in October 2012 published its guideline on Amputation and Prosthetics of the Lower Extremities in which it recommended that the interventional radiologist, vascular internist and rehabilitation physician collectively identify and resolve those clinical issues before proceeding with a lower extremity amputation. Further, the guidelines state that treatment by a multidisciplinary team (MDT) involving a surgeon, anaesthesiologist, pain specialist, rehabilitation specialist, and possibly an internist is necessary for treatment of pain, cardiovascular risks, comorbidity and the co-determination of the level of amputation. The article identified many of the clinical indications for lower extremity amputation found in the literature; however, there is the same omission of any patient-centred, non-clinical concerns.
Table 1. Estimated change in metabolic energy expenditure based on level of amputation
Reyzelman and Kim presented their idea of acceptable considerations for partial tissue removal (digital amputation) based on presenting conditions including: osteomyelitis, septic arthritis, gas gangrene, ischaemia/ gangrene and an advancing soft tissue infection. The authors concluded that early digital amputation in the appropriate patient allowed patients a return to normal activity with minimal disability.
Kalapatapu attempted to provide a compendium of indications for lower extremity amputation by providing an exhaustive listing of essentially all lower extremity morbidities. He stated:
‘Primary amputation may be the only option for
patients without an anatomic option for
revascularisation or those with medical risk factors that
contraindicate revascularisation.’
Recognising that the spectrum of surgical and medical skills is considerable, and that there are an almost limitless number of non-medical factors, even attempting to define specific conditions as the basis for amputations is extremely problematic and potentially precludes the surgeon and thus the patient from any consideration of limb salvage.
A patient presenting with a condition prompting even the slightest consideration for lower extremity amputation likely has other issues related directly or indirectly to the presenting condition itself. It is a small leap of faith to recognise that an increase in metabolic demand places greater stress systemically on the patient with a concurrent risk of exacerbating current comorbidities as well as promoting new ones. These increased energy expenditures clearly mandate the highest scrutiny of a patient’s physical condition, both pre- and postoperatively, before undertaking any surgical consideration including lower extremity amputation. Recognising that the loss of an extremity means a dramatic change in the metabolic as well as mental status of the body, the failure to include these considerations potentially impacts on the ability of the patient to engage in activities of daily living. Estimates of the changes in metabolic energy expenditure based on the level of the amputation are shown in Table 1.
However, the definitive consideration must be the effect of survival from a lower extremity amputation since this takes all factors together under a single irreversible endpoint. Survival rates for individuals with dysvascular pathology undergoing major lower extremity amputations including (above the knee amputation) AKA and BKA (below the knee amputation) have been reported as 69.7% and 34.7% at 1 and 5 years, respectively.12 Mortality was found to be significantly higher for patients who underwent AKA (50.6% and 22.5% at 1 and 5 years) as compared with BKA (74.5% and 37.8% at 1 and 5 years).
Although amputation can be considered a failure of treatment, the actual considerations must be based on a number of factors, even when the initial impression is that salvage of the limb is untenable. There are still general categories of lower extremity conditions in which limb salvage is not appropriate. These would include traumatic limb loss or significant tissue deformation from motor vehicle or industrial accidents, malignancies whose location or dissemination precluded salvage, and congenital malformations precluding use of prosthetics or achieving a functional end result. Excluding the majority of these still leaves a considerable number of lower extremity conditions, in which the end result, amputation, unquestionably puts the patient at a higher risk of morbidity and mortality than before the decision to perform the procedure.
At present, the decision to recommend lower extremity amputation appears to be universally based on objective medical issues. Without recognising and attending to the equally important and pervasive, nonclinical, patient-centred issues, the decision is usually made based on the surgeon’s tunnel vision. The most basic tenet becomes that of removing the problem as the key to resolving the problem. As Ertl aptly stated:
‘The only contraindication for amputation is poor
health that impairs the patient’s ability to tolerate
anaesthesia and surgery. However, the diseased limb is
often at the centre of the patient’s illness, leading to a
compromised medical status. The removal of the
diseased limb is necessary to eliminate systemic toxins
and save the patient’s life.’
Unfortunately, the mere removal of an afflicted lower extremity under the guise of resolving the issue takes on a ‘low-hanging fruit’ mentality as it fails to address equally important patient-centred issues that often define the progress and ultimate outcome.
The identification of any criteria regarding the appropriateness of a lower extremity amputation based on patient-centered, non-clinical criteria has been found to be nonexistent despite an exhaustive literature search. This covered 70 years and approximately 200 citations. Brigham and Women’s Hospital in Boston uses a Pre-Amputation Assessment Checklist that, while comprehensively identifying specific patient expectations and information, does not consider any patient-centered criteria for amputation. Therefore, the Brigham tool does not recognize the potential issues and ultimate outcomes surrounding amputation. In contrast, the MENACE SCALE and its patent-centered components focus the attention on those issues related to non-clinical outcomes when lower extremity amputation is considered.
Table 2
The MENACE scale
It is not enough to objectively quantify only the clinical considerations for lower extremity amputation. The resulting amputation and the effect on quality-oflife must be taken into account. For that reason, there must be a combination of clinical factors together with non-clinical factors. The impact of these patientcentred, non-clinical factors cannot be overstated. The loss of all or part of a limb has a major psychological impact on the patient’s mental status. The psychological effects of amputation can be related to postoperative pain, cosmetic appearance, cultural and social effects, all potentially causing or exacerbating anxiety and depression.
We believe that any initial consideration for lower extremity amputation, regardless of the presenting issues, can be based on two primary factors. Those two factors are intractable pain and functionality in the presence of a potentially life- or limb-threatening condition. While these factors may at first appear to be objective they are equally dependent on the patient’s subjective impressions of their condition.
In considering the issues that ‘open the door’ to amputation, the authors felt that this process is analogous to ‘looking through a keyhole’ from which only a narrowed view is possible. We chose the term ‘keyhole criteria’ to represent this process as initial consideration regarding amputation. The two criteria (Table 2) establish a platform that forms the basis for the critical decision of amputation. These criteria move the decision from one that is based solely on the surgeon’s experience to a more germane one that encompasses considerations of the patient as a whole.
Criterion 1 is significant in that there are lower extremity conditions including neurologic, musculoskeletal or other deficits where attempted preservation would offer no benefit to the patient. When these presentations are associated with debilitating pain, then this criterion would be met and consideration for an amputation at some level would be appropriate. This criterion would require that all attempts be made to mitigate the pain. Thus, an acute presentation (following traumatic accident, postoperative complications from prosthetic implantation, etc.) would arguably require some time to be allowed to pass before accepting these criteria.
The issues regarding criterion 2 include preservation of the patient’s functionality and assumed morbidity and mortality of the presenting condition and that of the procedure. The goal of MENACE is to assure full consideration of all aspects of limb salvage versus amputation. Recognising that lesser procedures may provide both short- and long-term satisfactory outcomes, the issue of when to perform a lesser procedure and what that procedure may be, must be based on preservation of maximum functionality. For these reasons, attention must be directed to the patientspecific issues since information obtained provides the necessary elements required for a successful outcome. For example, the presence of distal pedal gangrenous changes in a diabetic neuropathic ulcer with a history of osteomyelitis poses a daunting problem. Not surprisingly, these findings would, in the vast majority of cases, lead to a strong recommendation for amputation. However, the usual discussion of potential complications and progression of disease state will generally lead to at least a discussion of the ‘benefits’ of simply removing the entire problem-containing lower limb. In contrast, the consideration of functionality is integral because it changes the discussion from one that obviates a potential progression of the presenting problem to one that recognises that retained maximum functionality allows ongoing quality-of-life based on retaining the limb. In simplest terms, if the extremity is still used to bear weight, provide propulsion in a wheelchair, transfer from chair to bed to commode, or even ambulate for any distance, then maintenance of that functionality takes on the highest priority. The goal becomes maximising the longevity and functionality of that extremity.
The authors believe that the two keyhole criteria represent a mandatory check step for medical providers who either perform or refer to those performing lower extremity amputation. These two criteria need to be used to ascertain the appropriateness of amputation for a given patient. This represents a marked departure from the practice that the decision be based on the perception of perceived benefit of amputation.
Initial evaluation of the patient’s presenting status with respect to the keyhole criteria should be undertaken. If the result is a decision to amputate, the MENACE scale assures that patient-centred factors are considered in the decision to amputate. Those factors placing the patient at risk for quality-of-life issues after surgery should be addressed well before amputation.
Table 3
The initial tool used by the authors was the 1–2 point scale to assess patient-centred factors. However, we recognised that the keyhole criteria were needed to focus the attention of the surgeon on what the authors felt were the two critical issues: pain and functionality.
With the focus now placed on the patient, those factors that impact on their lives both pre- and postoperatively need to be considered. While there are an infinite number of both specific and general categories to be considered, we believe that those factors identified in Table 3 represent the most salient, recognising the interrelationship of these factors and others not specifically identified.
The social status of the patient is integral to mental and physical wellbeing. Considerations must include: Who else is in the home? What will be the patient’s functional capacity both before and after the amputation? What is the expected effect on the family after amputation? Is the patient the primary breadwinner/caretaker for the family? Are there others who will be affected by the patient’s amputation status in the same environment (young children, teenagers, young adults, middle-agers)?
Habitation factors must include: where does the patient live (both geographically and in terms of the actual residence)? The geographic location, including changes in elevation (mountainous, or San Francisco hills), whether there are stairs to navigate, or consistently functioning lifts, and old versus new construction (ADA, Standards for Accessible Design related to the Americans With Disabilities Act)15 are all considerations that must be addressed before amputation.
Economic factors are the underpinning of what transpires with the patient and their direct family and friends. How will the patient’s economic status change after the amputation? Financial considerations are the bedrock on which much of the other issues achieve stability. Are they ready for retirement? Are they employable after amputation? Is there another breadwinner? Are they financially able to withstand loss of leg? What about the costs of treatment, prosthetics, devices? Are there accessible and available sources available to provide external financial support and can the patient access them (social security, disability insurance, etc.)? Is there adequate and sustained financial means either through a health insurance or other entity to pay for ongoing care including rehabilitation, care for any complications, medications, therapies, home health care, and if so for how long?
Interpersonal support and functional issues have the potential to create effects that reverberate throughout the entire recuperative period and beyond. What other intrinsic/extrinsic factors do they have to contend with? Do they live with conditions such as a small cluttered house (hoarder), ‘bad’ neighbourhood, difficulty getting to the grocery store, doctors, and social events? Is there inter-family stress such as abusive or uncaring children or relatives?
What psycho-emotional and self-perception issues are present? Do they already have body-centred issues (too fat, too skinny, too old, too sick …)? Is there a history of behavioural or mental health issues (depression, anxiety, obsessive compulsive disorder (OCD), schizophrenia, bipolar disorder, etc.)? How are they dealing with the potential amputation? Do they consider the recommendation for amputation a ‘death sentence’? Is there the opportunity to do something besides see the wound specialist all the time? How will they deal with the resultant disfigurement? The ultimate question is clearly: how important is that toe, foot, or leg to their life?
An exhaustive online search of the available literature identified definitive criteria/guidelines for removal of the gallbladder, appendix and performance of caesarean sections as well as numerous other surgeries. However, regarding amputation of a lower extremity, the overwhelming majority of articles that even entertain the rationale for performing the procedure present surgeon-based clinical considerations as the primary decision criteria and mention patient-centred factors only in passing.
Based on the experiences of the authors, there clearly needs to be a set of patient-centred criteria to juxtapose with the experiences of the surgeon and other providers integral to the decision-making process. We recognise that there are a myriad of compounding factors that affect provider and patient considerations that are easily overlooked and so a set of guidelines for evaluation such as the MENACE scale identifies those factors that can be easily evaluated and rectified.
The MENACE scale including the keyhole criteria has been used by the primary author for 23 years in one form or another. Explanation and review of the MENACE critera has been undertaken with our patients for whom amputation was the only alternative offered before coming to our clinics. In clinical practice, numerous encounters have occurred with patients marked for amputation in which their presenting condition was clearly (and ultimately) salvageable. Based on extensive clinical use, we believe that the appropriate use of this tool can balance the patient’s presentation using both the accepted medical/surgical objective criteria and the less often considered patientcentred criteria. In those situations the decision for amputation gains more credence as evaluation progresses, for those MENACE scale categories in which the highest score (2 points) is not present, appropriate actions and interventions are taken to maximise that score. For example, the patient who lives in an upperfloor apartment with an unreliable lifts should have their residence changed to one with greater accessibility even if this is to occur immediately after the surgery. The planned change allows for the full score for that category to be considered as accomplished despite its implementation postoperatively. The same holds for caregivers needed in the home following surgery. The key to MENACE is to recognise that maximising a successful outcome after the elective performance of a lower extremity amputation must be based on resolving as many patient-centred stumbling blocks as possible. We recognise that the act of doing so may not be appropriate for the surgeon themselves but believe strongly that it can be appropriately achieved by other entities including social workers, local, state and federal entities.
Based on our use of the MENACE scale in our own practices, we believe that a score of less than seven strongly suggests the highest potential for postoperative issues that will have an impact on the patient’s shortand long-term recovery and status. The failure to address identified issues both individually and collectively in the preoperative/perioperative periods may preclude a safe and complication-free recovery. MENACE was created to fill an unmet need. We understand that MENACE will require ‘real-life’ testing and validation. It is our expectation that when used alongside other criteria, it will provide a basis for expansion, revision, confirmation or deletion of the considerations we have proposed when a lower extremity amputation is considered.
Conclusion
The recommendation for, and performance of, a lower extremity amputation appears to be based primarily on criteria that remain undefined despite advances in all aspects of medicine. Although certain lower extremity presentations preclude safe attempts at limb salvage, there is clearly a trend towards performance based more on subjective criteria of the attending health-care providers than on clear objective patient-based criteria.
Lower extremity amputation does not merely remove all or part of the lower extremity. The interdependence of structure and function, both before and after amputation, and the potentially catastrophic consequences of failing to consider these factors, mandates that there be a specific and definitive categorical assessment of patient-centred factors rather than the current criteria, which are based solely on the skill, education and experience of the medical providers. When these decisions are based solely on their own criteria rather than those of the patient—who represents the primary consideration regarding a successful outcome—then failure to identity and resolve potential patient-centred issues means that the patient is not truly the focus of the intended procedure, although they will suffer any untoward effects. The loss of a lower extremity does not merely mean that a pending problem has been resolved but that the potential loss of the limb now presents its own life-affecting challenges well beyond the time that the surgical incision heals.
| References 1 Quality Improvements Organization. Strategies to Help Reduce Diabetes-Related Lower Extremity Amputations Among Minority Populations. April 2017, https://tinyurl.com/yd3hcgrn (accessed 7 September 2017) 2 Murdoch G, Bennett-Wilson A Jr, Amputation: Surgical Practice and Patient Management. Butterworth-Heinemann Medical, 1996. 3 Tooms RE. Amputations. In: Crenshaw AH (ed). Campbell’s Operative Orthopedics (7th edn) Mosby-Year Book,1987: 597–637 4 Ertl JP. Amputations of the lower extremity. Medscape. 2016. http://bit. ly/2uUFuEv (accessed 14 August 2011) 5 Zeigler-Graham K, Mackenzie EJ, Ephraim PL et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89(3): 422-429. https://doi.org/10.1016/j. apmr.2007.11.005 6 Silbert S., Haimovici H. Criteria for the selection of the level of amputation for ischemic gangrene. JAMA 1954; 155(18): 1554–1558. https://doi.org/10.1001/jama.1954 7 Book Notices: Handbook on Amputations JAMA 1942; 120(9):724. https://doi.org/10.1001/jama.1942.02830440066028 8 Netherlands Society of Physical and Rehabilitation Medicine (Nederlandse Vereniging van Revalidatieartsen – VRA). Guideline: amputation and prosthetics of the lower extremities. Utrect. 2012. http://bit.ly/2uCbGRM |
9 Reyzelman A, Kim J. A guide to digital amputations in patients with diabetes. Podiatry Today. 2011; 24(9). http://bit.ly/2wX6Ew2 (accessed 14 August 2011) 10 Kalapataku V. Lower extremity amputations. UpToDate. 2017. http:// www.uptodate.com/contents/lower-extremity-amputation (accessed 14 August 2017) 11 Karadsheh M. Amputations. Orthobullets.com. 2017. http://www. orthobullets.com/trauma/1052/amputations (accessed 14 August 2017) 12 Brigham And Women’s Hospital Department of Rehabilitation Services. Physical therapy standard of care: lower extremity amputation. 2011. http://bit.ly/2vwFFct (accessed 14 August 2011) 13 Hakami, K. Pre-operative rehabilitation evaluation of the dysvascular patient prior to amputation. Phys Med Rehabil Clin N Am. 2009; 20(4): 677-688. https://doi.org/10.1016/j.pmr.2009.06.015 14 Bhuvaneswar CG, Epstein LA, Stern TA. Reactions to amputation: recognition and treatment. Prim Care Companion J Clin Psychiatry 2007; 9(4): 303–308 15 ADA. Information and technical assistance. standards for accessible design related to the Americans With Disabilities |
Demand for wound specialists
Are you considering wound certification? Perhaps you are wondering why you need to advance your education in wound management and validate your knowledge with wound certification?
Then think about these facts…
1. Over the past few years, the need for wound care specialists has increased dramatically. New treatment modalities and products arrive on the market weekly. This, coupled with a rapidly aging population has greatly increased the need for, and the importance of, wound care specialists.
2. To stay competitive, health care organizations must show improved patient outcomes and reduce the cost of the care provided. Wound specialists can help organizations achieve this goal by facilitating evidence-based, state-of-the-art wound management practices. Many healthcare organizations are seeking certified wound specialists specifically to meet this need.
3. Patients are more knowledgeable than ever before. They have access to current guidelines and expect to be treated according to the best standards. As a wound specialist, you will be in a unique position to improve patient satisfaction by ensuring your patients are receiving the most current evidence-based wound care.
4. In this day and age, job demands are high and job burnout is common. Studies show that advancing your knowledge will put you in a position of power, allowing you to have more options, higher income, and greater respect from your peers…all increasing job satisfaction and reducing burnout.
Certified wound care specialists are needed across the board, in every health care industry. By becoming certified, you will meet this increased demand and be in a position of strength in your career, and in your life. Don’t hesitate, register today!
Parable Technology for Wound Care Interview …
Parable is a software platform that allows doctors and home health workers to collaboratively monitor wound healing and to flag any issues. The technology has been designed by Parable Health and allows doctors to assess wound parameters and healing progress from “smart” photos taken using a phone’s camera.
Parable is a software platform that allows doctors and home health workers to collaboratively monitor wound healing
The doctor can schedule virtual check-ins with the patient. The idea is that this will reduce transportation costs in bringing patients to and from health care facilities for regular checkups, streamline data collection, and allow for collaborative care between various healthcare professionals. The technology allows wound size and topography to be measured easily and in a standardized way. The system can also provide alerts to helps doctors care for the most urgent or vulnerable patients. The technology is not just conceived for home use, but is also designed to be used in in-patient units, surgery departments, and for research.
Medgadget had the opportunity to ask Nathan Ie, Founder of Parable Health, some questions about the technology … read more
2018 Texas Regional Conference
Mölnlycke Partners With Tissue Analytics to Simplify Chronic Wound Care
WASHINGTON, Jan. 12, 2018 /PRNewswire/ –Mölnlycke, a world-leading medical solutions company, is pleased to announce a ground-breaking partnership with Tissue Analytics, a developer of a sophisticated digital wound imaging platforms. This exciting partnership brings together Mölnlycke’s outstanding expertise in wound care and Tissues Analytics’ advanced digital capabilities.
The two parties will jointly develop and commercialize innovative digital solutions for wound care practitioners including comprehensive clinical decision support tools that will significantly simplify and standardize wound assessment and treatment.
Today, practitioners are constrained by the quality of data available for wound assessment. Conditions, such as chronic wounds, burns and pressure ulcers are evaluated using only visual approximations.
read more
Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?
Obesity presents challenges to wound healing, but with knowledge and appropriate care interventions, we can provide optimal conditions to support the best possible outcome for every patient, no matter what size.
The US obesity epidemic reached a new all-time high in 2016, according to newly released Centers for Disease Control and Prevention data.1 Every single state has an obesity rate greater than 20%, and in five states it’s even greater than 35%. Topping the chart is West Virginia, at 37.7%.
Many of these people end up in the healthcare system because of obesity-related diseases and sometimes develop a wound, such as a pressure injury. As we know, wounds that do not heal after 12 weeks are termed chronic, and lawsuits because of chronic wounds and their consequences are rampant
read more
Electrochemical project wins Defense Innovation Award
A team of WSU researchers was awarded the Defense Innovation Award for developing a bandage-like adhesive with small embedded circuits to treat bacterial infections and facilitate wound healing.
Mia Kiamco, a doctoral candidate in chemical engineering at WSU, contributed to the study, and said the adhesive looks like a bandage, but acts as a wound dressing.
Sujala Saltana, left, and Mia Kiamco attend the Symposium of Advanced Wound Care in spring 2016
Five benefits of wound education
As you know, the need for wound certification is growing at a rapid pace so there is no better time to prepare for the wound certification examination. The exam is challenging, but with the stimulating online interactive wound certification courses from WoundEducators.com, you will have all the tools you need to sail through the exam and begin enjoying the benefits of wound certification.
Some of the highlights and benefits of our program include:
- Self-paced, on-demand instruction. Start and pause at any time.
- Interactive lessons that will keep you engaged and help you retain the information.
- Registration for a fraction of the cost of traditional seminar programs, while eliminating travel time, travel expenses and extensive absenteeism.
- All our courses are nationally recognized. Every course in the WoundEducators.com portfolio has been subject to intensive and systematic review by major independent accreditation providers, and all courses have been formally approved for continuing education hours. In particular, our physician, podiatrist, and nurse courses are approved for CME, CE, and CPME credits in all states.
- Plus, WoundEducators.com offers a risk-free guarantee allowing you to retake the course until you pass the wound certification examination.
Register today to begin your journey to becoming an expert in the field of wound management while you secure your position and advance your career.
Low-intensity workouts help wound healing for diabetics
Low-power exercise may be the key to speeding wound healing rates in patients with diabetes, a new study suggests.
Previous research showed moderate-intensity exercise to improve wound healing in both mice and human subjects, but little was known about the impact different intensities could have on healing rates, said researchers from Bowling Green State University.
Their study, published online in November in Wounds
read more
Mobile unit shows off telemedicine for VA patients
The lasers scanned across the large wound in the heel of the foot and soon its exact dimensions popped up in a line down the right hand side of the screen. This and other technologies on display Monday are how the U.S. Department of Veterans Affairs is using telemedicine and interactive devices to try and improve care and access to care for patients.
The Telehealth Education Delivered mobile unit stopped by the Charlie Norwood VA Medical Center in Augusta to show off telemedicine technology that the national VA is using to reach out to provide greater access, particularly through its 700 outpatient clinics. The Augusta VA has seen 2,500 telehealth visits in the last year, primarily through its community clinics in Athens, Aiken and Statesboro, said April Harris, facility telehealth coordinator. And it is looking to do more with what it calls clinical video telehealth, she said …
Role of Omega3 – Can Activate Anti-inflammatory…
LAS VEGAS, Oct. 20, 2017 (GLOBE NEWSWIRE) — Kerecis, the company using fish skin to heal human wounds and tissue damage, will present results of multiple studies of its technology at the Symposium on Advanced Wound Care (SAWC) Fall meeting to be held October 20 to 22. Kerecis is exhibiting in booth 610 at Caesars Palace Las Vegas.
One study, which is being presented by Dr. John C. Lantis of the Mount Sinai Health System, NY, starts to elucidate the potential impact of Kerecis fish skin on anti-inflammatory pathways in wound healing. A key stage to healing of the wound is inflammation; modulating this inflammation is important to getting wound bed to heal. The study compared the fatty acid content of Kerecis Omega3 Wound to human skin, human-amnion membrane and collagen matrices, and found that fish skin contains much more Omega3 fatty acids.
In addition, this was the first time a study demonstrated that the beneficial Omega3 fatty acids modulate inflammatory response in human keratinocytes. Specifically, the pivotal study showed that fatty acids from fish skin can activate anti-inflammatory pathways in adult human keratinocytes through a Specialized Pro-Resolvin (SPM) pathway.
Researchers involved in the study believe that these results shed new light on the mechanism of action of Kerecis Omega3 Wound and may in part explain why it has been shown to improve healing rates in full-thickness wounds….
Mobile Wound App Captures Patient Wound Data Faster ….
WoundWise IQ, a leader in capturing and analyzing wound care data, today announced their digital wound application performed four times faster than traditional methods and with approximately 96% accuracy.
“The time has come for app-based wound measurement systems and diagnostic predictive devices. WoundWise IQ and SerenaGroup are leading the way. I’m presenting the results of the clinical study this week at the 9th Symposium for Advanced Wound Care,” explained Thomas Serena, MD, FACS, CEO and Medical Director of SerenaGroup™.
“With the growing burden of chronic wounds, wound care providers require precise measurement and tracking to monitor the progress of a treatment plan. Better measurement and more accurate data improves patient care and saves lives,” noted Serena.
“We are excited to be partnering with Dr. Serena at SerenaGroup. Dr. Serena is the President of the Association for the Advancement of Wound Care, and is CEO of a premier wound care research company. He has dedicated his career to improving patient wound care,” noted Gary Ross, CEO, Med-Compliance IQ.
WoundWise IQ measures the planimetric area of a wound and is referred to in the industry as a Digital Wound Planimetric System. (DWPS). The application was developed to address the challenges with traditional measurement and monitoring methods such as the time required to capture and analyze data and the cost of accompanying hardware.
WoundWise IQ is an easy to-use and efficient mobile application which may be downloaded on most web-enabled mobile devices. Patient data is stored securely in the cloud and integrates with other patient data as needed. The clinical study noted above was performed independently by SerenaGroup and Strategic Solutions, Inc.
WoundWise IQ provides a cloud-based, digital mobile application that measures and evaluates wounds. The solution helps improve patient care and saves lives. Learn more about Med-Compliance IQ and WoundWise IQ at http://www.WoundWiseIQ.com
For the original version on PRWeb visit: http://www.prweb.com/releases/2017/10/prweb14831575.htm
Chronic Wound Factors and Management Strategies
What is a chronic wound? What changes must happen within a wound for clinicians to classify it as “chronic”? Is there a time frame for healing chronic wounds? And what should we clinicians do to prevent and/or reverse chronic wounds? These are all great questions that keep us on our toes, from the dedicated seasoned clinician to the clinicians new to our field. In this blog I will define what a chronic wound is, what it consists of, and whether there is a way to convert or reverse a wound.
By definition, a chronic wound is a wound that has “failed to proceed through an orderly and timely process to produce anatomical and functional integrity, or proceeded through the repair process without establishing, a sustained anatomic and functional result.”1 In layman’s terms, a chronic wound is a wound that does not proceed through the four phases of wound healing in an orderly fashion and decides to make one too many pit stops through the journey …
Organogenesis Highlights Latest Wound Care Research…..
For the first time since the recent acquisition of NuTech Medical, Organogenesis Inc. will present its expanded advanced wound care product portfolio at the Symposium on Advanced Wound Care Fall (SAWC Fall) meeting held this week in Las Vegas.
The newly-integrated company, which now offers a portfolio of products for the advanced wound care and surgical and sports medicine markets, will highlight important research and promote updates to its portfolio during SAWC Fall.
Scientific presentations will feature some of the latest developments regarding the continuum of care in wound healing …
Awarded first place in the ‘2016 AJN Book of the Year Award’ in the Medical Surgical Nursing category.
The newly expanded and updated Wound Care Essentials: Practice Principles, 4th edition is your go-to clinical guide to assessing and treating the full range of skin and wound conditions–from common to less common, simple to complex, and acute to chronic. This comprehensive, easy-read handbook provides practical guidance on the many aspects of wound care, including the legal, ethical, psychological, and social aspects. This is an essential guide for advanced practice nurses and nurse practitioners, nursing students, physician’s assistants, dermatology physicians, family physicians, and physical therapists. Tap into these evidence-based skills and care strategies, and handle the complexities of wound care with confidence.
Adopt wound care best practices with this fully illustrated, on-the-spot clinical guide …
· NEW more than 350 full-color photos and illustrations
· NEW content on areas including: Chronic wound quality-of-life and self-management care models; wound care regulations; skin assessment and skin tears; fistula management; wound bioburden; adjunctant therapies; pressure ulcers; support surfaces; nutrition; palliative care guideline updates
· NEW chapter featuring 36 photos of wounds with test questions, offering:
o An essential visual aid for students
o Crucial training aid for staff at wound centers and in every health care setting
o Vital preparation for Wound, Ostomy and Continence Nurse (WOCN) certification exam
· Step-by-step directions and guidance on wound assessment, healing stages, treatment options, dressings, pain management, legal and ethical issues, coping patterns, medical documentation
· Patient management strategies for all wound types, including: palliative wound care, sickle cell wounds, pressure ulcers, diabetic foot ulcers, surgical wounds, and more
· Chapter features include:
o Assessment Guidelines
o Pre-Chapter Objectives; Post-Chapter Summaries
o Practice Point boxes
o Show What You Know – Chapter review questions (with answers at end of book)
o Patient Teaching boxes
Invention aims at providing cost-efficient wound care globally
Undergraduate team led by fourth-year Engineering student Ashwinraj Karthikeyan emphasizes the importance of finding an alternative solution to wound care.
The Collegiate Inventors Competition gives college students the opportunity to present their inventions to be judged on the basis of degree of originality, development level of the product, potential benefit to society and level of student initiative. A team from the University, headed by fourth-year Engineering student Ashwinraj Karthikeyan and sponsored by Bala Mulloth, assistant professor of public policy, placed in the finals of the competition with an innovative product called “Phoenix-Aid.”
Karthikeyan began working on the project after taking Mulloth’s “Innovation and Social Impact” course in spring of 2016. He maintained contact with Mulloth over the summer and then asked Mulloth to be his faculty advisor in order to apply for grants. As a faculty advisor, Mulloth said he helped Karthikeyan by going over his business plan with him and providing him connections facilitate the growth of his project …
Molecular Methods to ID Unusual Pathogens in Wound Care
CogenDx recently launched a molecular testing product that it hopes can help expedite treatment of patients with infected wounds by providing a clearer picture of the infecting organisms and their resistance to antibiotics.
According to a 2009 study in Wound Repair and Regeneration, the total costs per year to treat the 6.5 million patients with wound related complications is around $25 billion. CogenDx wants to reduce the costs by offering its rapid tests clinically, providing doctors with information that will help guide antibiotic treatment.
The genetics brand of Millennium Health, CogenDx was established earlier this year to focus on developing genetic technologies of use to clinicians. CogenDx runs a CLIA-certified, full-service clinical lab with a national commercial footprint. Its new product, DxWound, examines the DNA of microorganisms in a patient’s wound that will potentially lead to life-threatening skin and soft tissue infections (SSTIs) …
Alliqua Announces Purchase Agreement with Celularity
Alliqua BioMedical, Inc. (NASDAQ:ALQA) (“Alliqua or the “Company”), a regenerative technologies company committed to restoring tissue and rebuilding lives, today announced a definitive agreement with Celularity, Inc. (“Celularity”), under which Celularity will acquire all of the property, assets and rights relating to the Company’s advanced biologic wound care business – including Biovance® amniotic membrane allograft and Interfyl® Human Connective Tissue Matrix – and the Company’s UltraMist® Therapy System and other therapeutic ultrasound platform products for an aggregate cash consideration of $29.0 million. No debt or significant liabilities are being assumed by Celularity in the transaction. Alliqua BioMedical’s Board of Directors unanimously approved entering into the agreement …
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Using mechanical forces to improve wound healing
“To some degree when you do an operation it’s much like manufacturing something in a factory,” explains Orgill SM ’80, PhD ’83, who serves as medical director at Brigham and Women’s Hospital’s Wound Care Center and as a professor at Harvard Medical School. “You want to have high quality control and be able to do it as efficiently as you can. Those engineering principles of process control are very important in surgery.”
In the early ’80s, Orgill earned his PhD in mechanical engineering at MIT through the Harvard-MIT Health Sciences and Technology (HST) program. Orgill’s particular course of study within HST was the Medical Engineering and Medical Physics program, which combines a traditional mechanical engineering education with clinical and medical exposure …
Alliqua BioMedical Buys Celularity Inc.’s Wound Care Business
Alliqua BioMedical, Inc. (NASDAQ: ALQA) today announced a definitive agreement with Celularity, Inc. (“Celularity”), under which Celularity will acquire all of the property, assets and rights relating to the Company’s advanced biologic wound care business – including Biovance® amniotic membrane allograft and Interfyl® Human Connective Tissue Matrix – and the Company’s UltraMist® Therapy System and other therapeutic ultrasound platform products for an aggregate cash consideration of $29.0 million. No debt or significant liabilities are being assumed by Celularity in the transaction. Alliqua BioMedical’s Board of Directors unanimously approved entering into the agreement.
“This is a transformative transaction for Alliqua,” said David Johnson, Chief Executive Officer of Alliqua. “First, we will be able to strengthen our balance sheet by paying our debt in full. Second, we believe we will have an appropriate amount of working capital to drive our operating business forward in a positive way. Finally, we will evaluate the appropriate options to allocate capital to maximize shareholder value.” …
Imbed Bio raises $1.6M for Infection Preventing Dressing
Imbed Biosciences has raised a funding round of nearly $1.6 million, which the Fitchburg, WI-based startup plans to use to begin selling an ultra-thin wound dressing material later this year, CEO Ankit Agarwal says.
Imbed has spent years working on its product platform, which was used to develop the dressing, Microlyte Ag. It’s underpinned by nanofilm technology that uses silver’s antimicrobial properties to kill infection-causing pathogens, helping wounds heal in a way that does not require treatment with potentially harmful levels of the metal …
AAWC Recognizes 2017 Corporate Sponsors
MALVERN, Pa., Jan. 3, 2018 /PRNewswire-USNewswire/ — The Association for the Advancement of Wound Care (AAWC) is pleased to acknowledge the generous support of its 2017 corporate sponsors and announces open enrollment for the 2018 sponsorship program.
Corporate support is vital for sustaining the AAWC’s valued, evidence-based and patient-focused programs and activities. The 2017 AAWC Corporate Sponsors include: Acelity, Molnlycke, Smith & Nephew, 3M, Convatec, Hollister, Integra Life Sciences, Medline, Osiris Therapeutics, BioCompression Systems, Boyd Technologies, MiMedx and Wellsense.
AAWC Corporate Sponsorship provides lucrative benefits based on level of support, including the exclusive opportunity for industry sponsors to meet with AAWC officers and other key wound care industry leaders at quarterly Corporate Advisory Panel meetings. As stakeholders with a common purpose of helping patients, the panel focuses on education and public awareness, with the ultimate goal of elevating standards of wound care practice worldwide …
SANUWAVE to market the dermaPACE® System
Suwanee, GA – January 2, 2018 – SANUWAVE Health, Inc. (OTCQB: SNWV) has announced that the US Food and Drug Administration (FDA) has issued its decision on the de novo submission for the dermaPACE® System. Their decision, dated December 28, 2017, permits the marketing of the dermaPACE System as a Class II medical device used for the treatment of Diabetic Foot Ulcers (DFU) in the U.S., the world’s largest medical device market. This order by FDA is the culmination of intensive clinical studies by SANUWAVE and diligent work by both SANUWAVE employees and their regulatory partners, Musculoskeletal Clinical Regulatory Advisers (MCRA) in successfully submitting documentation and interacting with FDA during the clearance process.
The dermaPACE system was evaluated using two studies under an FDA approved IDE. The studies were designed as prospective, randomized, double-blind, parallel-group, sham-controlled, multi-center 24-week studies at 39 centers. A total of 336 subjects were enrolled and treated with either active dermaPACE plus conventional therapy or sham dermaPACE plus conventional therapy (a.k.a. standard of care). Conventional therapy included, but was not limited to, debridement, saline-moistened gauze, and pressure reducing footwear. The objective of the studies was to compare the safety and efficacy of the dermaPACE System to sham-control application. The prospectively defined primary efficacy endpoint for the dermaPACE System studies was the incidence of complete wound closure at 12 weeks post-initial application of the dermaPACE system (active or sham). Complete wound closure was defined as complete skin re-epithelialization without drainage or dressing requirements, confirmed over two consecutive visits within 12-weeks. If the wound was considered closed for the first time at the 12-week visit, then the next visit was used to confirm closure. Investigators continued to follow subjects and evaluate wound closure through 24 weeks ….
Malnutrition and Pressure Injuries
Nutrition and Pressure Injury Healing
Current literature has identified more than 100 risk factors for pressure injury (PI) development. Some extrinsic (primary/non-physiological) and intrinsic (secondary/physiological) risk factors that contribute to PI development include diabetes mellitus, peripheral vascular disease, malignancy, prolonged pressure on an area of the body, being 70 years of age and older, smoking, urinary and fecal incontinence, a low body mass index (BMI), and malnutrition.
Pathophysiologic and intrinsic factors at the core of PI formation include nutrition. Maintaining adequate parameters of nutrition is considered a best practice in both the prevention and treatment of PIs. Individuals with PIs or who are at risk for developing PIs should strive to achieve or maintain adequate nutrition parameters. Meeting macronutrient and micronutrient requirements forms the foundation of good health. This translates to consuming wholesome, nutrient-dense foods!
S&N’s Device Images Bacteria in Wounds
Smith & Nephew’s MolecuLight iX is designed to detect bacteria in hard-to-heal wounds using only light.
Smith & Nephew has begun selling a handheld imaging device that can detect bacteria in hard-to-heal wounds and instantly measure wound surface area.
MolecuLight i:X is already available in Canada, where its inventor stumbled across the idea for the device. Ralph DaCosta, MD, now a principal investigator at Princess Margaret Cancer Center in Toronto, was a PhD student researching fluorescent imaging of gastrointestinal cancer in 2007. The big, expensive device he was using didn’t produce any green images, which would have indicated cancer, but a red image that he couldn’t identify …
Prescient Surgical wins FDA nod for CleanCision wound retraction system
Surgical device spin-out Prescient Surgical said today it won FDA clearance for its CleanCision wound retraction and protection system.
The San Carlos, Calif.-based company, which was spun out of the Stanford Byers Center for Biodesign in 2012, said its CleanCision device is the 1st in a new category of irrigating wound protection devices, as classified by the FDA.
Such devices are designed to provide access to the surgical site while protecting the incision with an impermeable barrier to defend against direct contamination.
How to turn clinicians into makers
In hospitals in North and South America, nurses are hacking medical equipment to improve patient care. Using off-the-shelf materials, they’ve created prescription bottles for the visually impaired, pipe systems to irrigate wounds of burn victims, low-cost feeding-tube holders, and other innovations.
Some of the most creative inventors work in wound care and critical care units, Young says. Jason Sheaffer of the University of Texas Medical Branch, for instance, erected a system of PVC pipes with holes in them over a burn unit tub where burn victims are treated. Running water through the pipes creates an irrigation system to aid in treatment. A wound vacuum kit, developed at the UnityPoint Health in Cedar Rapids, Iowa, has a modular alarm to alert the care team when suction is lost. There’s also a 3-D-printed simulation model, created by Roxana Reyna, a nurse in Corpus Christi, Texas, that has a deep hole in it, representing a wound. Nurses can practice treating the wound on the model, instead of on a live, suffering patient …
Breakthrough in Digital Wound Measurement
eKare Inc., a provider of digital wound management platform, announces partnership with Netherlands-based Woundworks. eKare Inc., developed the inSight 3D wound camera, which ensures a standardized and validated wound measurement in an easy to use application, and is used in post-acute and research institutions across the US. Woundworks has an extensive European network and expertise developing and marketing products in the wound care space. This partnership will jointly develop the European market to provide integrated wound care services, including care management, product supplies, home health, and workflow optimization to healthcare providers and patients.
Woundworks and its affiliated companies are the market leader in wound management services to major health plans in the Netherlands. Through novel delivery models and data-driven approaches, they have successfully lowered direct costs to payers by an average of 30% and reduced wound related hospitalizations by 45%.
“As an organization fully dedicated to improving wound care, we have been looking for a high quality 3D imaging solution for years. We believe that an easy to use, standardized way of 3D wound measurement is key in improving wound care,” says Kok van der Meij, CEO and founder of Woundworks, Excen, and QualityZorg. “Woundworks has a lot of expertise and experience concerning wound care products, advanced wound care, wound care protocols, and utilizing data analytics to improve outcome. The eKare solution provides unambiguous, comparable, and reproducible data on wound healing progress. Partnering with eKare fits very well with our vision and helps us to innovate and grow to new heights.”
“Woundworks brings a new level of service and management that will disrupt the wound care industry. We are proud to be a long-term partner of the company. We look forward to growing this relationship and helping the medical community improve outcomes and lower cost,” Patrick Cheng, CEO of eKare, remarks.
About eKare
eKare Inc. is dedicated to the design and development of wound assessment solutions, including 3D wound dimensions and tissue classification capabilities, using the latest computer-vision and mobile technology. eKare’s innovative technology is creating new possibilities in how we deliver wound care across the healthcare continuum, from inpatient hospital and skilled nursing facilities to ambulatory clinics and telemedicine. eKare’s mission is to advance the science and delivery of wound care by leveraging mobile and sensor technologies to connect patients, providers, and industry.
About Woundworks
Woundworks is a new company founded and backed by institutions with many years of experience in the field of wound care. Woundworks and its affiliated companies have been very successful in the wound care field and are now combining their strengths to expand their product offering in the European market. Woundworks will distribute the inSight 3D Wound imaging solution throughout Europe and will combine this with different segments of its own products and business lines; ensuring that patients all over Europe can receive the best possible wound care.
What Are Biofilms?
Identifying and managing biofilms have become two of the most important aspects of wound care. Biofilms can have a significant impact on wound healing, by contributing to bacterial infection, inflammation, and delayed wound healing.1 These issues make reducing biofilm presence a critical component of effective wound care. Although over 60% of chronic wounds contain a biofilm, many health care professionals are not able to identify biofilm formation in their patients.2 To manage this challenge effectively, health care professionals must understand what biofilms are, how to identify them, and how to take steps to reduce their impact on wound healing.
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Bio-ConneKt Wound Dressing
The purpose of this study is to assess the performance of the bio-ConneKt™ wound dressing and compare its performance with the standard of care at NFRMC Wound Therapy Services, for the treatment of chronic foot/leg ulcers (DFU/VLU) in a prospective single center open one-arm clinical study …
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