One of the defining features of chronic wounds is their high levels of inflammation. Patients present with high levels of inflammation, around 80%, of cells at the wound margin being macrophages and with wound fluid laden with proinflammatory cytokines. The latter is in part responsible for preventing wound closure, along with the low levels of growth factors. In healthy acute wounds, two types of macrophages can be found: pro-inflammatory M1 macrophages and antiinflammatory M2 macrophages, with more M1 cells present early post-injury and M2 appearing later to regulate repair and wound closure. This pro-repair M2 phenotype, that secrete a range of mediators including growth factors that regulate re-vascularisation and closure of a wound, is lacking in chronic wounds, leading to excessive inflammation, enhanced degradation within the wound, reduced matrix deposition and lack of closure … read more
Category: Articles
Texas Health Plano Saving More Limbs with Non-Traditional Procedure
More than two million Americans are living as amputees, and that’s expected to double by 2050. In an attempt to change the projection, Texas Health Plano is trying something different. A new and unique catheterization procedure can help salvage the legs of more would-be amputee patients.
The multidisciplinary program includes emergency physicians, orthopedic surgeons, wound care physicians, podiatry, internal medicine and interventional cardiology. “The goal is to provide a cohesive plan of care for patients presenting to the ER or wound care center with ischemic ulcers of the legs (or) feet,” says Dr. Vijay Ramanath, medical director of Texas Health Plano’s Limb Preservation Program. “We want to prevent leg (and) foot amputations and return patients to a high-quality of life.” read more
How To Ensure Effective Offloading With Total Contact Casting
I recently had the opportunity to speak at a dinner meeting to a group of wound care clinicians. During a question and answer session, the topic of discussion drifted toward the use of total contact casting (TCC). I asked the meeting participants to indicate, with a show a hands, how many of them were using this modality regularly in their practice. I was shocked to see that the number was less than 10 percent.
Numerous authors have described the underlying pathology in the development of lower extremity ulcerations. Perhaps one of the greatest difficulties in managing complex lower extremity ulcerations is offloading the wound site effectively. A review of the literature demonstrates that TCC is the “gold standard” for offloading non-infected, non-ischemic plantar foot ulcerations.1,2
There are several mechanisms that combine to provide the reduction of peak plantar pressures via the use of TCC. Studies have established that the use of TCC decreases altered gait mechanics with shortened stride length and an overall reduction of walking velocity, both of which contribute to the reduction of plantar pressures.3 Furthermore, given the “cone effect” provided by the physical structure of the patient’s leg (an inverted cone), the TCC (a conical receptacle) also allows more even distribution of the patient’s weight read more
Medicare Changes That May Affect You (Tennessee, Alabama, and Georgia)
The Medicare Administrative Contractor (MAC) for Jurisdiction J (Tennessee, Alabama, and Georgia) is transitioning from Cahaba to Palmetto. The Part A transition went into effect January 26, 2018 and Part A providers should already be submitting claims to Palmetto GBA. Cahaba has discontinued the receipt of Part A redetermination, reopening, and ADR submissions via the InSite Web Portal … read more
Managing chronic venous leg ulcers
what’s the latest evidence?
Chronic venous leg ulcers (CVLUs) affect nearly 2.2 million Americans annually, including an estimated 3.6% of people over the age of 65. Given that CVLU risk increases with age, the global incidence is predicted to escalate dramatically because of the growing population of older adults. Annual CVLU treatment-related costs to the U.S. healthcare system alone are upwards of $3.5 billion, which are directly related to long healing times and recurrence rates of over 50%.
CVLUs are not only challenging and costly to treat, but the associated morbidity significantly reduces quality of life. That makes it critical for clinicians to choose evidence-based treatment strategies to achieve maximum healing outcomes and minimize recurrence rates of these common debilitating conditions. These strategies, which include compression therapy, specialized dressings, topical and oral medications, and surgery, are used to reduce edema, facilitate healing, and avert recurrence read more
Spend a Minute, Save a Life
Inlow’s 60-Second Diabetic Foot Screen
Boulton states that “throughout our medical training, we are taught how to manage patients who present with symptoms, which usually leads to a clinical examination, a diagnosis, and a treatment and management plan. However, virtually no time is spent on teaching how to manage patients who have no symptoms because they have lost the ability to feel pain; that is, they have peripheral neuropathy.”1 Clinical experience and the literature1 have shown us that the lack of symptoms Boulton referred to in those with or at risk for diabetic foot complications can have devastating effects on the person, their family and health systems. As clinicians, we have the opportunity, and the obligation, to step in and fill the gap left when peripheral neuropathy is present, or potentially present, in any of our patients. The key is a simple, quick procedure: foot screening … read more
Acute and Impaired Wound Healing
Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care
Acute and chronic wounds affect millions of people in the United States and around the world. In recent decades, clinicians have gained a better understanding of the mechanisms of normal wound repair process and causes of delays in healing. This progress has led to significant improvement in the quality of life of affected patients. This article reviews the latest insights and opportunities for wound repair science and innovations in wound care.
Acute wounds are a common health problem, with 11 million people affected1 and approximately 300,000 people hospitalized yearly in the United States.2 Typically, acute wound healing is a well-organized process leading to predictable tissue repair where platelets, keratinocytes, immune surveillance cells, microvascular cells, and fibroblasts play key roles in the restoration of tissue integrity.3,4 The wound repair process can be divided into 4 temporarily and spatially overlapping phases: coagulation, inflammation, formation of granulation tissue (proliferative phase), and remodeling or scar formation phase … read more
Topical Nystatin Treatment for Candida Infection
Abstract
Introduction. Wound infection is an important cause of nonhealing wounds and graft rejection. Objective. A series of 5 patients (4 females, 1 male; median age, 50; age range, 1.5–83 years) with nosocomial Candida infection of burns and chronic wounds that were reconstructed with split-thickness skin grafts is presented.
Materials and Methods. This case series was carried out between February 2011 and June 2014. Based on tissue cultures, wounds were treated with 100 000 units/mL of nystatin and 25 mg in 500 cc normal saline of mafenide acetate, which resulted in regression of wound infection symptoms and improvement of skin graft take. Conclusions. The authors propose this simple, nontoxic, and economic topical treatment for wounds and skin grafts with positive Candida cultures.
Infection is a common local factor that impedes wound healing. Hence, a topical antimicrobial dressing is frequently used to control bacterial proliferation.1 Since the introduction of effective topical antibacterial therapy, fungal infections have become more prevalent, especially in burn patients … read more
Scientists Create New Self-Repairing Material
While some people might think comic books are a fun distraction, they’ve made a difference in the real world. Case in point: Several noteworthy characters have inspired exciting new developments in the wound care industry. In spring 2016, a team of scientists from the UK used the web-shooter of the iconic Spider-Man as the basis for a gun that can create customizable dressings.
Now, a group of researchers from the University of California, Riverside have found similar inspiration in Wolverine, a mutant hero with claws and powers of regeneration. It’s the latter ability that most interested the team, and as they detail in a new study in the journal Advanced Materials, they’ve created a self-healing material that has multiple purposes … read more
Venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, pressure …
Are You Confident of the Diagnosis?
Leg ulcers are skin lesions with full-thickness loss of epidermis and dermis on the lower extremities. Among a wide variety of etiologies for chronic leg ulcers, four common types are venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, and pressure ulcers. By definition, chronic leg ulcers last greater than 6 weeks. Acute ulcers such as traumatic wounds undergo normal healing in healthy patients without the need for further treatment. As a result, only chronic leg ulcers will be discussed here.
Patients with venous leg ulcers commonly complain of swelling and aching of the legs that is worse at the end of the day and improves with leg elevation. The medial lower leg is the most common site. The borders of venous ulcers are typically saucer-shaped, initially with a shallow wound base. The surrounding skin often exhibits pitting edema, induration, hemosiderosis, varicosities, lipodermatosclerosis, atrophie blanche, and/or stasis dermatitis read more
Assessing footwear in patients with diabetes
Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration.
Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking … read more
Wound Care Manual and Clinical Guidelines for Nurses
When faced with a complex instance of wound care, many first time or novice clinicians will ask, ‘What wound is this? What dressing should I use? How will this wound heal?’
An aspect of wound care management often overlooked is defining the wound itself. The guiding principles of wound care have always been focused around defining the wound, identifying any associated factors that may influence the healing process, then selecting the appropriate wound dressing or treatment device to meet the aim and aid the healing process.
This structured approach is essential, as the most common error in wound care management is rushing in to select the latest and greatest new wound dressings without actually giving thought to wound aetiology, tissue type and immediate aim.
This overview of wounds and dressings will identify some of the most common wound types and guide you in setting your aim of care and selecting a product or device to achieve that aim … read more
Conducting Your HIPAA-Required Security Risk Assessment
A company based in the state of Pennsylvania that develops wireless technology that’s used to assist physicians in the care of their cardiology patients was recently fined in excess of $2 million for a HIPAA breach that occurred when the protected health information (PHI) belonging to nearly 1,400 individuals was compromised after a company employee’s laptop was stolen. The Office for Civil Rights (OCR), the body within the U.S. Department of Health & Human Services (HHS) tasked with enforcing HIPAA’s privacy and security rules, found, specifically, that “[the company] had insufficient risk analysis and risk management processes in place at the time the theft occurred; failed to conduct an accurate and thorough risk analysis to assess the potential risks and vulnerabilities to the confidentiality, integrity, and availability of [electronic] PHI (ePHI); and failed to plan for and implement security measures sufficient to reduce those risks and vulnerabilities. (Code of Federal Regulations [CFR] 45 164.308(a)(1)).” This article will discuss the processes of HIPAA risk analysis and risk management to educate providers in the outpatient wound clinic setting on how to better protect their patients’ PHI and ePHI. The authors will also describe the general process of the security risk assessment (SRA) and offer direction and resources for providers to utilize … read more
SIGNS OF WOUND INFECTION THAT EVERYONE SHOULD KNOW
Wound infection is such a common condition and presents so often that every wound care professional will recognize the major signs and symptoms almost instantly. However, the consequences of diagnosing wound infection late, or missing the signs of wound infection completely, are such that it is worth spending a few moments every now and again to remind ourselves of all the signs of wound infection.
As we are taught during training, the principal signs of wound infection are rubor, calor, tumor, functio laesa, drainage, and a decline in wound status. Rubor in an infected wound describes a poorly defined erythemal border with a disproportionate amount of erythema, while calor describes a magnified localized increase in temperature with warmth extending further away from the site and a possible systemic increase in body temperature … read more
Hyperbaric oxygen add-on may not aid wound healing in diabetes
The addition of hyperbaric oxygen therapy to standard care did not substantially improve outcomes in adults with diabetes with an ischemic wound compared with standard care treatment alone, according to findings published in Diabetes Care.
Dirk T. Ubbink, MD, PhD, of the department of surgery at Academic Medical Center in Amsterdam, and colleagues evaluated data from the DAMO2CLES trial on 120 adults with diabetes and an ischemic wound randomly assigned to standard care with (n = 60) or without hyperbaric oxygen therapy (n = 60) to determine whether hyperbaric oxygen therapy is beneficial for ischemic wound treatment. Participants were recruited between June 2013 and December 2015. The primary outcomes included limb salvage and wound healing after 12 months. Follow-up visits occurred at 3, 6 and 12 months after recruitment … read more
Mathematics Used to Improve Wound Healing
Chandan Sen, a research professor in the surgery department at Ohio State University, teamed up with Avner Friedman, professor of mathematicians at the university, and Chuan Xue, a postdoc at Ohio State’s Mathematical Biosciences Institute, to create a mathematical model for ischemic wounds. This new computational tool should provide predictive guidance on how a given wound might progress, allowing researchers to develop more precise protocols to deal with wounds and dehiscences.
The mathematical model, to date, simulates both non-ischemic wounds – those typical of wounds in healthy people with good circulation – and ischemic wounds. The current model produced results that generally match pre-clinical expectations: that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed.
The model also showed that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process … read more
Guidelines for safe negative-pressure wound therapy
Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable negative pressure evenly through a wound filler (foam or gauze). Drainage tubing adheres to an occlusive transparent dressing; drainage is removed through the tubing into a collection canister. NWPT increases local vascularity and oxygenation of the wound bed and reduces edema by removing wound fluid, exudate, and bacteria … read more
Inflammation in Chronic Wounds
Non-healing chronic wounds present a major biological, psychological, social, and financial burden on both individual patients and the broader health system. Pathologically extensive inflammation plays a major role in the disruption of the normal healing cascade. The causes of chronic wounds (venous, arterial, pressure, and diabetic ulcers) can be examined through a juxtaposition of normal healing and the rogue inflammatory response created by the common components within chronic wounds (ageing, hypoxia, ischaemia-reperfusion injury, and bacterial colonisation). Wound bed care through debridement, dressings, and antibiotics currently form the basic mode of treatment. Despite recent setbacks, pharmaceutical adjuncts form an interesting area of research.
The skin forms an important and effective barrier against the environment. It plays a vital role in protection against insults such as bacteria, xenobiotics and dehydration. When a cutaneous injury occurs, the body initiates a series of complex events to re-establish this protection. Wound healing can be roughly divided into four continuous and overlapping phases: (1) haemostasis; (2) an immediate inflammatory response defined by an infiltration of cytokine-releasing leukocytes with antimicrobial functions; (3) these cytokines kick off a proliferative phase where new epithelium, blood vessels, and extracellular matrix (ECM) are laid down; (4) over a period of weeks to months, the wound contracts as the ECM is remodelled [1]. These highly regulated cellular, humoral and molecular processes have been described as an orchestral performance—a potential flawless interplay can lead to perfect regeneration; however, human adult wounds undergo a repair process that leads to scarring, and, in some cases, non-healing chronic wounds …. read more
Self-sealing miniature ‘wound’ created by engineers
Biomedical engineers have developed a miniature self-sealing model system for studying bleeding and the clotting of wounds. The researchers envision the device as a drug discovery platform and potential diagnostic tool.
A description of the system, and representative movies, were published Tuesday online by Nature Communications.
Lead author Wilbur Lam, MD, PhD says that blood clotting involves the damaged blood vessel, platelets, blood clotting proteins that form a net-like mesh, and the flow of the blood itself.
“Current methods to study blood clotting require isolation of each of these components, which prevents us from seeing the big picture of what’s going with the patient’s blood clotting system,” says Lam, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University read more
Screenshot from video showing blood cells streaming through a “wound” and a clot forming. The red-stained cells are actually white blood cells. A green extracellular glue can be seen at the top of the wound; this is fibrin, which holds the clot together. See the full video at: https://youtu.be/l7k1dGfKG0g
Reducing infection in chronic leg ulcers with an activated carbon cloth dressing
Chronic wounds are likely to have an increased bioburden, which in turn increases the risk of local infection. Indeed, infection is one of the most frequent complications of non-healing wounds, resulting in longer treatment times, increased risk of morbidity, greater resource use (of both dressings and nurse time) and, most importantly, a high personal cost to patients and their families (Cooper et al, 2014). While the ultimate aim is to treat the underlying wound, use of antimicrobial dressings is the cornerstone of the treatment of infected wounds. Most antimicrobial dressings work by killing the bacteria, and are indicated for use only when there are clear signs of increased bioburden and/or clinical signs of infections. As such, their use is assessed after 2 weeks, at which point it is advised that the clinician switches to another type of dressing if the wound is observed to be healing (Cooper et al, 2014) … read more
Unexpected helpers in wound healing
Nerve cells in the skin help wounds to heal. When an injury occurs, cells known as glial cells change into repair cells and disseminate into the wound, where they help the skin to regenerate, researchers from the University of Zurich have shown.
An essential step in skin wound healing is wound closure, which is why shortly after an injury occurs, blood coagulates and seals the wound. For the injury to be able to heal permanently, however, the affected layers of the skin need to be newly formed. For that to happen, a complex, only partially understood interplay takes place between various cell types in our skin. Together with a team from ETH, Lukas Sommer, a professor in the Institute of Anatomy at the University of Zurich … read more
Total Contact Cast Use in Patients With Peripheral Arterial Disease
As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. Objective. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use … read more
CERTIFIED WOUND CARE PROFESSIONALS IN THE IN-HOME HEALTHCARE INDUSTRY
In-home health care is increasingly on the rise. Research shows that 91% of American seniors favor the Medicare home health benefit and 87% of all Americans prefer to receive medical treatment in the comfort of their own home.
Becoming educated in advanced wound care, and achieving an accredited wound care certification can help to skyrocket your career as an independent contractor!
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Cell signals that trigger wound healing are surprisingly complex
In a sharp and pointy world, wound healing is a critical and marvelous process.
Despite a tremendous amount of scientific study, many outstanding mysteries still surround the way in which cells in living tissue respond to and repair physical damage.
One prominent mystery is exactly how wound-healing is triggered: A better understanding of this process is essential for developing new and improved methods for treating wounds of all types.
Using an ultrafast, ultraprecise ultraviolet laser, a team of physicists and biologists at Vanderbilt University has taken an important step toward understanding the nature of these trigger signals. Their new insights are described in a paper titled “Multiple mechanisms drive calcium signal dynamics around laser induced epithelial wounds” published Oct. 3 by the Biophysical Journal read more
Atypical Wounds: Causes and Management
Part 1 in a series discussing the etiology, assessment and management of atypical wounds.
As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.
An atypical wound, also known as a wound of unknown etiology, is caused by a disease or condition that doesn’t cause a wound typically …. read more
DermaStream CST for Active Wound Management
Israel21C is reporting that EnzySurge out of Rosh Ha’ayin, Israel is expecting to begin FDA approval process for the complete DermaStream CST system. The wound healing device is designed to be placed over a wound to provide continuous cleaning and washing away of debris and extravasated fluid. Although the device itself received FDA clearance, the bio-active chemical solution that it is supposed to work with it has yet to get a green light … read more
What you need to know about transparent film dressings
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes.
Transparent film dressings provide a moist, healing environment; promote autolytic debridement; protect the wound from mechanical trauma and bacterial invasion; and act as a blister roof or “second skin.” Because they’re flexible, these dressings can conform to wounds located in awkward locations such as the elbow. The transparency makes it easy to visualize the wound bed … read more
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 … read more
Wound Documentation Dos & Don’ts
Scope of Practice and Standards of Practice guide nurses1 and other members of the interprofessional wound care team2 in caring for patients with wounds. Documentation in the medical record is a key aspect of the Standard of Practice and serves to record he care delivered to the patient. Your documentation should follow your facility guideline for documentation. This WoundSource Trending Topic blog considers general wound documentation dos and don’ts and presents 10 tips for success … read more
New technology for accelerated wound healing discovered
Researchers have found a new way of accelerating wound healing. The technology and the mode of action involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Researchers at Uppsala University and SLU have found a new way of accelerating wound healing. The technology and the mode of action method published in the highly ranked journal PNAS involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Treatment of large and chronic wounds are a high cost burden to the health care system since effective tools to accelerate healing are lacking. Wound care is today limited to mechanical debridement, use of different dressings and significant amounts of antibiotics preventing or treating wound infections. With the aging population, occurrence of chronic diseases such as diabetes and the alarming global spread of antibiotic resistance, a treatment that kick-starts and accelerates wound healing … read more
Hollister Inc. shifts away from wound care
Hollister Inc. on Feb. 2 announced its decision to divest portions of its wound care business. Hollister, which manufactures products for not only the wound care market, but also the ostomy, continence and critical care markets, is in the process of transitioning its Hydrofera Blue and Endoform businesses to new owners, according to a press release. The new owners, who plan to continue manufacturing and delivering the products, will be named in a “forthcoming” communication, the release says … read more
Diabetic foot ulcers heal faster with probiotic supplementation
Findings from a randomized controlled trial revealed that 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 a placebo … read more.
Green Fluorescent Protein Helps Therapeutic Proteins …..
Researchers from Harvard University seem to have created a method to overcome the challenge of getting specific proteins to enter mammalian cells through the typically very restrictive cell membranes. The scientists achieved this feat by using highly positive ionizing green fluorescent protein (GFP) and attaching a ligand protein to it. Because of the high positive charge on the GFP, the package gets sucked into the cell’s interior by the negatively charged intracellular molecules called proteoglycans. It is hoped that this methodology will make protein based drugs a lot more effective, as currently they have to rely on doing their signaling work while remaining outside the cell … read more
Seeking Advice Can Be The Foundation of Optimal Wound Care
I purchased a rental home that needed an extensive renovation from the get-go 15 years ago. This same house recently required a complete re-renovation due to extensive moisture damage. I am someone who loves a good challenge, and so I gutted this property not only because it was necessary to make the home livable, but because I was in search of answers as to the “what,” “where,” “why,” and “how” everything came to be. As of this writing, my work on the house is (at least for the time being) finished, the result is better than I had expected, and I believe future problems will be prevented. During this long and physically, emotionally, and financially painful journey, which turned up everything from sluggish and corroded galvanized pipes to rain-damaged structures, many questions were raised in my mind that seemed all too familiar to the questions I ask myself while working as a healthcare clinician, such as: How often do we truly get to the underlying cause of our patients’ problems? How many of us are willing to make superficial “repairs” while forgoing the opportunity to “fix” the deeper, serious issues at large? Are we always willing to ask for help when we are unsure of what the best thing for a particular patient may be?
Amazon, health care and the first American chaebol
Abe Kasbo, CEO, Verasoni Worldwide.
Amazon’s recent landmark partnership with Berkshire Hathaway and JPMorgan Chase is yet another example of how certain sectors continue to underestimate Amazon’s imagination, never mind business prowess. I honestly believe some businesses, though fully capable, simply do not know how to respond to Amazon, and therefore don’t even try. Or they may want to try, but are afraid to fail. Amazon has led the way in industries where there’s prodigious inertia, like retail, entertainment, grocery and now health care.
The announcement, which is short on details, spurred a sell-off in some of health care’s most popular stocks like CVS, Cardinal Health, Walgreen and United Healthcare, among others. If the Whole Foods acquisition wasn’t a wakeup call, this particular venture into health care is a shot across the bow to every industry in America. It seems the financial markets were nervous that Amazon and partners will do what no American government could achieve to date: get better control of health care costs and deliver efficiencies and results where they matter. The cornerstone of the announcement, in my estimation, is the intention by this coalition to deliver health care “free from profit-making incentives.” American health care’s long resistance to price transparency seems to be have been dealt a blow with this announcement and that is a good thing for patients, and for health care providers, who can now compete on price, experience and outcomes … read more
Effective Wound Dressing Securement for Infection Prevention
In order to promote rapid healing, improve patient comfort and prevent complications, it is important that healthcare professionals actively work to prevent infection. One key component of that effort is wound dressing securement. Secure, gentle and effective dressings can help prevent the ingress of foreign material, reduce damage during dressing changes and help foster an ideal healing environment. This can help reduce the risk of infection, improving patient outcomes and lowering costs.1 In this post, we will explore the importance of infection prevention and effective dressing securement strategies to help prevent infection … read more
Venous Ulcers: The Evidence for Intervention
Even with optimal treatment of venous ulcers, healing may be prolonged and/or ineffective, and recurrence rates remain quite high. How should wound care clinicians and vascular specialists collaborate with care planning? Venous ulceration represents the most advanced stage of chronic venous disease and is responsible for approximately 70% of all chronic leg ulcers.1-3 These ulcers affect approximately 1% of the population and are responsible for significant morbidity, decreased quality of life, and economic costs. Advanced venous disease may result from primary degenerative disorders or may be secondary to a previous episode of deep vein thrombosis (DVT). Additionally, venous ulceration may arise from venous valvular incompetence (reflux) in the superficial, deep, or perforating veins; from venous obstruction; or from a combination of both. Regardless of the underlying etiology, the final consequence is venous hypertension resulting in activation of the microvascular endothelium; leukocyte activation, adhesion, and migration; and inflammation ultimately leading to skin changes and ulceration … read more
The Death of the Kennedy Terminal Ulcer
The concept of the Kennedy Terminal Ulcer (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur …. read more
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
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
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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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.
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
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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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.
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.”
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
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
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
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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
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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 …
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.
website
Adimarket announces agreement with Alolotl Biologix
Adimarket, a subsidiary of Global Stem Cells Group, has announced an agreement with biotechnology company Alolotl Biologix to distribute biological products for regenerative medicine applications worldwide.
Adimarket, a subsidiary of Global Stem Cells Group (GSCG), and its subsidiary has announced an agreement with Phoenix, Arizona-based Alolotl Biologix to distribute the biotechnology company’s products for regenerative medicine applications worldwide.
Alolotl Biologix focuses on research to optimize the use of human biologicals and to develop biological-related products to foster regeneration and healing for a range of conditions, including orthopedic impairments, wound care, pain management, ophthalmic, cardiovascular, cosmetic, and more.
Adimarket will make the following amniotic liquid products available to qualified practitioners through its online store www.adimarket.net:
AxoBioFluid® C Amniotic Allograft Cryopreserved Liquid, cryopreserved liquid allograft derived from the amniotic membrane that provides structural tissue to advance soft tissue repair, replacement, and reconstruction. Product details:
Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
A rich source of growth factors, proteins, cytokines, hyaluronic acid, and collagen scaffolds
Contains extracellular matrix components for cellular attachment and proliferation
Cryopreserved for an extended shelf life
AxoBioFluid® physician benefits
Procedures are efficient and do not require special instrumentation.
• The use of AxoBioFluid® is billed as patient pays, which makes it a great alternative revenue source.
• A library of research papers to demonstrate efficacy degenerated tissue is provided.
AxoBioFluid® patient benefits
Relevant Conditions
AxoBioFluidâ C Amniotic Allograft Cryopreserved Liquid, cryopreserved liquid allograft derived from the amniotic membrane that provides structural tissue to advance soft tissue repair, replacement, and reconstruction. Product details:
Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
A rich source of growth factors, proteins, cytokines, hyaluronic acid, and collagen scaffolds
Contains extracellular matrix components for cellular attachment and proliferation
Cryopreserved for an extended shelf life
AxoBioFluidâ physician benefits
Procedures are efficient and do not require special instrumentation.
• The use of AxoBioFluid® is billed as patient pays, which makes it a great alternative revenue source.
• A library of research papers to demonstrate efficacy is provided.
AxoBioFluid® Amniotic Allograft Cryopreserved Liquid is a cryopreserved liquid allograft derived from the placental components of the amnion to advance soft tissue repair, replacement, and reconstruction. It is classified as minimally manipulated under FDA regulation 21 CFR Part 1271 and section 361 of the PHS. Benefits of AxoBioFluid® AxoBioFluid® is a human allograft fluid derived from the amniotic layer of the placenta. The two primary cell lines which reside in the amnion are human mesenchymal stromal cells (hMSC) and human amnion epithelial cells (hAEC). Both of these cells are considered to be pluripotent stem cells. AxoBioFluid® contains growth factors released while amniotic cells are grown in culture such as epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and transforming growth factor – beta (TGF-β). These proteins are essential for fetal growth and development and express significant therapeutic benefits when used as a treatment for various injuries and degenerative conditions. AxoBioFluid® is immuneprivileged, anti-inflammatory, anti-fibrotic, pro-vascular, and cytoprotective because of the cells being sourced from the amnion. These secreted factors also signal endogenous progenitor cells to promote regeneration and repair of damaged or degenerated tissue.
AxoBioFluid
Degenerative disorders such as osteoarthritis
• Joint pain
• Inflammatory conditions such as:
Bursitis
Tendonitis
Fasciitis
Epicondylitis
Soft tissue injuries such as:
Ligament & Tendon sprains
Muscle & Meniscus tears
Wound Care
AxoBioMembrane, a dehydrated allograft membrane patch derived from the amnion that advances wound repair, skin replacement, and reconstruction. Product details:
Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
Contains extracellular matrix components for cellular attachment and proliferation
Dehydrated and terminally e-beam sterilized for an extended shelf life.
AxoBioMembraneä Amniotic Allograft Membrane, like all allograft tissue products, has been subjected to recovery microbiological study and has been terminally sterilized with electron beam sterilization. It works by forming fibrin-elastin bonds at the wound site, ensuring excellent wound adherence. This generates a barrier that protects exposed nerve endings from irritants, providing pain relief while creating a favorable environment for tissue repair and regeneration. In addition, the AxoBioMembrane™ prevents excessive moisture loss by creating a vapor barrier at the wound surface. Growth factors present in the membrane are released into the wound bed, promoting angiogenesis leading to new blood supply needed for cellular migration, proliferation and ultimately, wound repair. Infection is one of the biggest concerns with chronic wounds. AxoBioMembrane™ functions as a bacteriostatic agent, which can inhibit the growth of bacteria at the wound site and reduce the rate infection. It has also been reported to have anti-fibrotic properties, which can reduce scarring. The membrane contains glycoprtoteins found exclusively in the amnion. AxoBioMembrane™ lacks specific surface antigens, which make it immune-privileged and anti-inflammatory.
AxoBioMembraneä physician benefits
Procedures are efficient and do not require special instrumentation.
AxoBioMembrane™ is billed as patient pays, which makes it a great alternative revenue source.
We provide a library of research and white papers to demonstrate efficacy.
AxoBioMembraneä patient benefits:
Pain Reduction
Wound Adherence
Less Scarring
Faster Healing
Neovascularization
Wound Barrier
Anti-bacterial
Immune Privileged
AxoBio products are available to purchase on the Adimarket Website.
For more information, visit the Adimarket regenerative medicine online store website, email info@stemcellsgroup.com, or call 305-560-5337.
About Global Stem Cells Group
Global Stem Cells Group (GSCG) is a worldwide network that combines seven major medical corporations, each focused on furthering scientific and technological advancements to lead cutting-edge stem cell development, treatments, and training. The united efforts of GSCG’s affiliate companies provide medical practitioners with a one-stop hub for stem cell solutions that adhere to the highest medical standards.
The Challenge of Lower Extremity Wounds
Wound clinicians across the nation (and the world) are commonly faced with the difficult task of managing lower extremity wounds. Lower extremity wounds come in many different forms. We are not faced with a generic type, but several—in fact, we never know what we’ll be presented with day-to-day …
Navamedic ASA: Enters into partnership agreement for distribution of Zorflex® in Sweden and Finland
Navamedic ASA (OSE: NAVA), the Norwegian medtech and pharmaceutical products company, today announced it has entered into an agreement with Chemviron Carbon Ltd. (Chemviron) for the launch and commercialisation of Zorflex® wound care contact dressings in Sweden and Finland. Zorflex®, a naturally antimicrobial, 100 percent activated carbon wound contact dressing, helps accelerate treatment of a wide range of chronic and non-chronic wounds …..
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Hydrogel: An Overused Wound Care Modality?
While I’m on rounds with students I like to ask, “What is the active ingredient of hydrogel?” My query is usually met with puzzled looks. It’s a trick question, because the term “active ingredient” generally applies to pharmacologic agents that undergo metabolic change in biologic systems. The active ingredient of hydrogel which gives this substance its name is water. Compounds are added to thicken the mixture and provide viscosity, such as glycerine. Other ingredients common in cosmetics, such as aloe vera, methyl paraben, hydrogenated castor oil, and propyl paraben, are added to hydrogel depending on the manufacturer …
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Meeting report: antimicrobial stewardship in wound management
At the 27th conference of the European Wound Management Association (EWMA), which was held in Amsterdam on May 3–5, 2017, a joint symposium was held between EWMA and the British Society for Antimicrobial Chemotherapy. The symposium was organised into two sessions. The first focused specifically on wound care issues and the second concerned antimicrobial stewardship programmes.
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Use of ALLEVYN LIFE foam dressing to manage a heavily exudating venous leg ulcer
A 62-year-old man presented with a left lower leg venous ulcer on the shin. The ulcer had high exudate levels, which was resulting in strike-through of dressings and there was some evidence of surrounding skin maceration. Investigations revealed an ankle brachial pressure index (ABPI) of 1.4. ALLEVYN◊ LIFE Non-Bordered foam dressing (Smith & Nephew) was selected to manage and absorb high-levels of exudate and minimise the risk of trauma to the fragile surrounding skin. Multi-layer compression therapy was also used. After 3 weeks, the ulcer had reduced in size and there was a visible improvement in viable skin [Figures 2–5]. The patient found the dressing comfortable with excellent conformability to the lower leg and minimal pain on dressing removal …
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Device Images Bacteria in Wounds
Smith & Nephew’s MolecuLight iX is designed to detect bacteria in hard-to-heal wounds using only light. 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 ….
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The Triangle of Wound Assessment
The negative impact of wounds on patients is significant, and includes pain, reduced quality of life and social isolation. Optimal wound healing can reduce the burden of chronic wounds on patients and the health economy. The Triangle of Wound Assessment is a holistic framework that clinicians can use to improve wound assessment, with particular focus on the wound bed, wound edge and periwound skin (World Union of Wound Healing Societies, 2016). This framework can help guide clinicians to select the most appropriate and effective intervention to improve patient outcomes and to ensure prudent use of healthcare resources …
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My Journey as a Certified Wound, Ostomy and Continence Nurse
Nursing has given me great opportunities; some of them I never imagined possible. I started as a medical surgical nurse in an oncology unit where the treatment of the day was gauze soaked in Dakin’s solution for the management of post op radical neck surgery. I moved on to intensive care, travel nursing, Army nursing, and endoscopy. It was in endoscopy and working with the colorectal surgeons, who helped me get my clinical experience while pursuing a master’s degree in nursing, where I found out that it all could be tied together with a certification in wound, ostomy, and continence (WOC), and a wound care nurse is born!
Skin and tissue trauma caused by self-harm
Patients who deliberately self-harm and cause skin and tissue trauma are increasing in number across primary and secondary care settings (Nice, 2011b). Self-harm has often been considered a taboo subject and an unnecessary burden to the NHS (Kilroy-Findley and Bateman, 2016). Despite the growing need for effective care, services for assessment, diagnosis and intervention are often overstretched and unable to meet the holistic needs of patients who self-harm (National Institute for Health and Care Excellence [NICE], 2011a; Mind, 2013) …
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the Sandy Grading System for Surgical Wound Dehiscence Classification
The worldwide volume of surgery is considerable, with an estimated 234.2mn major surgical procedures carried out every year (Weiser et al, 2008). While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence, although not commonplace, are a major disruptor to patient wellbeing and wound healing outcomes. Moreover, the importance of classification, documentation and reporting of this type of wound must not be underestimated. Accurate diagnosis and reporting of the type of dehiscence and underlying aetiology is key to understanding the extent of the problem. This paper presents a novel classification system that uses a systematic approach for the diagnosis of the type of dehiscence following surgery …
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Medical grade honey and diabetic ulcers
The prevalence of diabetes is rising globally with increasing budgetary
burdens from the disease and its complications. In resource-limited
environments, affordable treatment strategies are urgently needed. Wound
care utilises diverse modalities, such as hydrogel, polyurethane and alginate
dressings, as well as silver-containing agents. Honey is a well established
treatment and is cost-effective. In a resource-limited setting, the authors detail
a case report whereby the use of an affordable, easy-to-use agent was used
in conjunction with patient education and self-care, which resulted in rapid
wound healing without side-effects …
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New Study Documents Cost and Impact of Chronic Wounds
October 4, 2017 – A new study published online in the International Society For Pharmacoeconomics and Outcomes Research’s (ISPOR) Value in Health journal demonstrates the economic impact of chronic nonhealing wounds in Medicare patients. The findings highlight the need for Federal research funding, quality measures and reimbursement models that are relevant to wound care. Such measures are not currently included under Centers for Medicare and Medicaid Services (CMS) payment policies, including the Medicare Access and CHIP Reauthorization Act (MACRA).
The study, “An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds,” analyzed the Medicare 5% Limited Data Set for calendar year 2014 and determined that chronic nonhealing wounds impact nearly 15% (8.2 million) of Medicare beneficiaries, far more than suggested by previous studies. Furthermore, conservative estimates for total Medicare annual spending for all wound types ranged from $28.1 billion to $31.7 billion. Treatment and management of infected or re-opened (dehisced) surgical wounds account for the highest per-wound costs. Hospital outpatient care drove the highest site-of-service costs, demonstrating the shift from hospital inpatient to outpatient services in the wound care space …
How Diabetes Impacts Wound Healing
For individuals with diabetes, all wounds are a serious health concern and require careful attention. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed until they become more complicated to heal. In addition, internal wounds such as ingrown toenails, skin ulcers, or calluses can cause breakdown of tissue and an increased risk of infection. Even small cuts and insect bites can cause wound healing difficulties in patients with diabetes. Here are common factors of diabetes that impact wound healing …
Preventative Skin Care in Wound Management
Prevention is one of the most important components of wound and ostomy care. Factors such as hydration, pressure, excessive moisture, cleanliness, and erythema can all affect wound healing rate, patient comfort, and the incidence of new wounds. By taking a proactive stance, health care professionals can reduce the risk of infection, reduce costs, and improve patient outcomes.1
Why Preventative Skin Care is Important
Wounds affect 35% of all hospice patients, and 120,000 new ostomy surgeries are performed each year.2,3 This makes these two of the most prevalent conditions faced by nurses and other health care professionals …
10 Tips for Effectively Bandaging a Wound
Wrapping wounds is an art, and hence, it comes easily to some and more difficult to others. This post won’t make you a wound dressing artist, but it does provide some tips for good bandaging techniques. The word “bandage” (in the US) often refers to a primary dressing, so “wrap” better describes a bandage that is long, narrow, and may be used to secure a primary dressing or obtain graduated compression on a limb.
Daniel D. Caviness, DPM will be Noted in the Worldwide Leaders in Healthcare
The International Association of HealthCare Professionals is pleased to welcome Daniel D. Caviness, DPM to their prestigious organization with his upcoming publication in the Worldwide Leaders in Healthcare. Dr. Daniel D. Caviness is a highly trained and qualified podiatrist currently serving patients within the Chico Podiatry Group in Chico, California and affiliated with Enloe Medical Center. Featuring over two decades of experience in his field, he has a special expertise in foot care, podiatric surgery and podiatric wound care.
AAWC Announces Chief Executive Officer
MALVERN, Pa., Oct. 10, 2017 /PRNewswire-USNewswire/ — The Association for the Advancement of Wound Care (AAWC)announces Victoria E. Elliott, RPh, MBA, CAE, as the new Chief Executive Officer. Ms. Elliott brings a wealth of experience in association management. As a Certified Association Executive (CAE), her qualifications include alliance building, membership growth, volunteer engagement and leadership development. Ms. Elliott has served as Executive Director for the American Neurological Association, Dermatology Nurses’ Association, Attention Deficit Disorder Association, Society For Biomaterials and the Pennsylvania Society of Health System Pharmacists. Most recently she was Director of Development at the University of the Sciences where she focused on individual alumni giving, and student and parent fundraising campaigns.
Victoria E. Elliott, RPh, MBA, CAE, Chief Executive Officer, Association for the Advancement of Wound Care (PRNewsfoto/Association for the Advancement)
Healthcare is Ready for Alexa, as Soon as HIPAA Issue Resolved
A voice-enabled bathroom scale that can scan for diabetic foot ulcers uses Amazon’s voice service, Alexa, to instruct patients to step on when they’re ready to begin. In one test, a patient responded to Alexa’s prompt by declaring, “Ready when you are.”
Anne Weiler, co-founder and CEO of Wellpepper, a Seattle company that developed the prototype scale as part of its entry in the Alexa Diabetes Challenge, might say the same thing to Amazon (NASDAQ: AMZN) itself.
She’s among those healthcare IT entrepreneurs convinced that the future of healthcare will include human-computer voice interactions—just as soon as Amazon makes its voice services compliant with healthcare privacy laws.
This student has invented a new wound care technology
InMEDBio LLC, a company founded by University of Virginia fourth-year student Ashwinraj Karthikeyan, will be one of six undergraduate entrants to compete in the prestigious Collegiate Inventors Competition in November.
The competition has promoted innovation and entrepreneurship among college graduate and undergraduate students since 1990. Not only do participants receive encouragement and feedback, but they compete for cash prizes as well. Since its inception, the event has awarded more than $1 million to college students.
See How Your Smartphone Could Be Used To Activate This Smart Bandage
Smart cars, smart homes, smart cities. We’re living in an era of smart devices that can help us be healthier, safer and live more responsibly. Now, there’s a chance we’ll be able to heal own wounds using a smart bandage we control with our smartphones.
Researchers from the University of Nebraska-Lincoln say they’ve designed a prototype smart bandage that could eventually heal chronic wounds through the medically coated fibers in the bandage.
At-Risk Patient: Diabetic Foot Ulcers
Patients with diabetes have a higher risk of ulceration, typically on the lower extremities. Other factors contributing to the risk of foot ulceration include peripheral neuropathy, peripheral arterial disease, infection and pressure.
Symptoms of Diabetic Foots Ulcers
Neuropathy, a major contributing factor in the development of diabetic foot ulcers, may present as a stinging, burning or shooting pain in the lower extremities that over time may progress to a loss of sensation in the feet or may initially develop as a progressive loss of sensation. This loss of feeling can cause patients with diabetes to further injure their feet and legs, opening them to infection and thus, ulceration.
Review: Comparing the Effectiveness of Cellular and/or Tissue-Based Products for Treating Diabetic Foot Ulcers
One fourth of the approximately 22.3 million patients with diabetes in the United States are expected to develop a diabetic foot ulcer (DFU) at some point during their lives, and it is estimated to affect 1-8% of individuals with diabetes annually. DFUs have shown to be challenging to treat, and often result in extended hospital stays, increased risk of infection, and subsequent amputation in certain patients. A major concern regarding amputees is a 5-year mortality rate that rivals that of patients with colon cancer. In addition, DFUs contribute heavily to the financial load of payers, with an estimated annual medical cost of up to $13 billion.
Prior studies have indicated that wounds that penetrate bone, are prolonged and recurrent, and those associated with peripheral vascular disease pose a great risk for eventual amputation. Studies have shown that, even with proper care of DFUs by podiatric physicians and other clinical personnel, these wounds are slow to heal. Advanced therapies are often explored to improve outcomes.
Wound Care Basics: Understanding Lymphedema and the Lymphatic System
When I talk to my patients with lymphedema, I often need to tell them about their lymphatic system. Beyond knowing of lymph nodes or glands in their neck, most don’t recall having heard anything about it. Surprisingly, today’s medical students often have less than 1 hour on the lymphatic system education in medical school. In physical therapy school (35 years ago), instruction was woefully inadequate. Today, more is known – and most therapy schools do spend significant time on the lymphatic system and lymphedema. For those who missed it, here is the lymphatic system in a nutshell.
The Lymphatic System: An Overview
The lymphatic system includes the thoracic duct (main vessel), which receives the lymph fluid from smaller vessels called lymph collectors. The latter receive lymph fluid from the initial lymphatic vessels read more
Providing Hope to Patients with Wounds
I have written about so many things over the past years… Maybe now is a good time to announce that I am writing a book called Hear Our Cry, an autobiographical story about 20 years of wound care and limb salvage. The process has had quite an impact on me, reviewing all the pictures and notes from my wound patients from the past two decades.
The Importance of Hope
What a tragedy has been spread out in front of me when I consider all the pain and heartache due to limb wounds and limb loss read more
Wound Consulting Business: How to Get Started
So, you’ve been thinking about starting that wound care business you’ve always dreamed about. What’s next?
First of all, start by taking a look at Wound Consulting Business: Do You Have What It Takes?, to see what factors you should consider before taking the plunge. It’ll help you decide if you’re cut out to be your own boss. Then, if you still think being a wound consultant is for you, let’s talk about getting started … read more
The Next Generation of Negative Pressure Wound Therapy – V.A.C. VERAFLO™ Therapy
I first got to work with V.A.C. VERAFLO™ Therapy in 2015. I had a complex patient who had a very large wound from a surgical wound dehiscence after a lymphedema thigh lobule excision. She was growing a variety of bacteria, and the surgical team managed her wound with Acetic Acid packings BID. After a week and a half of no clinical improvement, heavy nursing time, and use of IV narcotics, they called the wound care team for management. I applied V.A.C. VERAFLO™ Therapy with 100mL of 0.25% acetic acid to her wound and was able to transfer her to a lower level of care within one week … read more
Three Common Reasons You Might Get Sued
Patients often sue for reasons that have nothing to do with the quality of the medical care rendered, but rather for the human care that is perceived as lacking.
The last few weeks were very difficult for my family and friends in the medical sense. I had one family member in an intensive care unit on the West Coast, one friend’s father in a rehab facility on the East Coast, and one friend’s son having problems in the outpatient setting in the Midwest. These patients are male and female, young and old, and have very different medical histories, but they all have one thing in common. They all want to sue about their medical care or lack thereof. These cases illustrate three common reasons you might get sued …. read more
We’ve Always Done It This Way: Flagyl Crushing & Other Wound Care Bad Habits
Off-label drug use and questionable documentation are just two wound care bad habits that can get clinicians into trouble. Don’t just accept it because “We’ve Always Done It This Way” .
As clinicians, we use our knowledge, training and experience to find solutions and take care of patients in the best way possible. We learn about standards of care, scope of practice, and facility policies and procedures to guide our actions and care-giving …
Top Tips for Best Wound Cleansing Practices
Are your wound cleansing practices up-to-date? Find out with these top tips for cleaning wounds properly and choosing the right cleansers.
When you get clinicians together to talk about wounds, dressing choices are usually a popular topic. Wound cleansing? Not so much.
Cleaning a wound thoroughly – and frequently – is a crucial part of wound care. In fact, you should clean a wound every time you change a dressing – unless it’s contraindicated. Why is it so important? Cleaning a wound …. read more
ViroMed Gene Therapy for Non-Healing Diabetic Foot Ulcers Starts Phase III Trial
The first patient has been dosed in a Phase III trial assessing ViroMed’s VM202, the first pivotal study of a gene therapy indicated for patients with nonhealing diabetic foot ulcers (NHU) and concomitant peripheral artery disease (PAD).
The Phase III trial (NCT02563522) is a double-blind, placebo-controlled, multicenter study designed to evaluate VM202 for safety and efficacy in 300 adults with a diabetic foot ulcer and concomitant PAD. Two hundred patients will be randomized to VM202 and the other 100 to placebo, ViroMed’s U.S. division VM BioPharma said yesterday. … read more