ESSENTIALS OF WOUND CARE PRINCIPLES AND TECHNIQUES. Abilio A. Coello MD FACS Miami Vascular Specialists Miami Cardiac & Vascular Institute

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1 ESSENTIALS OF WOUND CARE PRINCIPLES AND TECHNIQUES Abilio A. Coello MD FACS Miami Vascular Specialists Miami Cardiac & Vascular Institute

2 Abilio Coello, MD No Relevant Financial Relationship Reported

3 MANTRAS YOU CAN CURE THE SICK BUT YOU CAN T RAISE THE DEAD - D. HUTSON MD WHAT HAVE WE LEARNED?

4 DRY IT DEBRIDE IT DON T DELAY IT DON T LOSE SIGHT OF IT GANGRENE

5 DRY IT USE DESSICANTS LIKE POVIDONE IODINE OR ALCOHOL APPLY ONLY TO GANGRENOUS SKIN PAINT IT ON- BE AN ARTIST APPLY AND LET AIR DRY COVER ONLY AFTER DRIES-A/C IS YOUR FRIEND DECOLORIZE BETADINE WITH ALCOHOL TO PREVENT ACCUMULATION INTERDIGITAL ABSORBERS-GAUZE, SHEEPSKIN etc.

6 DEBRIDE IT WET GANGRENE KILLS THE TISSUE NEXT TO IT MUST REMOVE ALL DEAD TISSUE FOLLOW THE RABBITT HOLE ALICE! HOW WILL THE EXPOSED LIVE TISSUE RESPOND? DEBRIDE FIRST OR REVASCULARIZE FIRST SIMULTANEOUSLY? ENZYMATIC DEBRIDERS HELP SAVE GOOD TISSUE

7 DON T DELAY IT HAVE A TEAM OF SPECIALISTS READY-COMMUNICATE YOUR CONCERN PODIATRIST, VASC. SURG., VASC MED., NEPHROLOGIST, ENDO, CARDIO, INFECTIOUS DISEASES WOUND CARE TEAM --CONSULT FREELY NUTRITIONIST, SMOKING CESSATION PROGRAM, PERS. TRAINER WT. LOSS PROGRAM, BARIATRIST, HYPERBARIC DOC

8 DON T LOSE SIGHT OF IT FOLLOW-UP APPOINTMENT IN DAYS MAYBE WEEKS NOT MONTHS! WHAT IS THE FATE OF THE NEWLY EXPOSED TISSUE WORSENING : TRIGGERS IMMEDIATE CALL TO YOUR TEAM MEMBERS

9 NURSING YOU ARE THE GATEKEEPER! INSIST ON BEING PRESENT FOR DRESSING CHANGES ASK QUESTIONS AND CHALLENGE TEAM MEMBERS BE A PATIENT ADVOCATE

10 OFF-LOADING BEST OFF-LOADING IS ZERO PRESSURE AVOID PRESSURE INJURY ELSEWHERE WHEN OFF-LOADING- ie Achilles area ulcer from brace used to off-load heel LOOK OUT FOR CONTRALATERAL DEVELOPMENTS ASSISTIVE DEVICES-CRUTCHES, CANES, WALKERS, FOOTWEAR ISCHEMIC HEEL FAT PAD WITHOUT SKIN MANIFESTATIONS

11 INFECTION CULTURE,CULTURE,CULTURE! BIOFILM IS A BACTERIA-LADEN BARRIER APPROPIATE ANTIBIOTICS AT APPROPIATE DOSE FOR THE PATIENT

12 TOPICALS SILVER SULFAS Abx CREAMS AND OINTMENTS Saline, Dakin s, Aceitic Acid ABX IMPREGNATED GAUZE GELS IODINATED PRODUCTS DESSICANTS ZINC + COMPRESSION LUBRICANTS ENZYMATIC DEBRIDERS MOISTURE SEALERS

13 DRESSINGS WET TO DRY WET TO WET OCCLUSIVE DRESSING NO DRESSING BREATHER NON-BREATHER IMPREGNATED- ANTIBIOTIC/ANTISEPTIC IMPREGNATED-ZINC OXIDE(UNNA S BOOT) ABSORBERS-DRAW FLUID AWAY HYDROLYTIC / AUTOLYTIC COMPRESSIVE- PUMP FLUID OUT

14 ULCERS-LEARN THE DIFFERENCE PAINFUL SMALL INFRA-MALLEOLAR HEAPED-UP EDGES SINGLE/MULTIPLE PRESSURE BEARING AREAS NEEDS BLOOD NOT PAINFUL LARGE SUPRA-MALLEOLAR FLAT EDGES SINGLE PERFORATOR AREAS MEDIAL PIGMENT DEPOSIT / CARDBOARD SKIN NEEDS DECONGESTION / COMPSRESSION

15 TOE ULCERS INFECTED ISCHEMIC NEUROPATHIC

16 TOE ULCERS WALKS BAREFOOT IN THE YARD-HEALTHY HOMELESS-NO SHOES- NO BATH PARKINSONS- LIKES TO SLEEP ON SIDE DM- GOOD SENSATION- TOOK GRANDKIDS TO DISNEY FOR 3 DAYS WITH GOOD SHOES

17 Beware What Lies Underneath

18 DECUBITI Pressure Points Compression and Shear

19

20 BRADEN SCALE

21 Ulcer Staging Redness Blistering Exposed Fat Muscle and Bone

22 Ulcer Staging

23 CIRCULATION ASSESSEMENT CLINICAL EXAM DUPLEX SCAN PULSE VOLUME RECORDINGS ANKLE BRACHIAL INDICES MRA CT ANGIOGRAM ARTERIOGRAM

24 CIRCULATION IMPROVEMENT ANGIOPLASTY-DRUG ELUTING BALLOONS STENTS-OPEN/COVERED/DRUG ELUTING ATHERECTOMY OPEN ENDARTERECTOMY PATCHING BYPASS COMBINATION PROCEDURES-ENDO/OPEN

25 HYPERBARIC OXYGEN THERAPY CONTROVERSY EXISTS DOES NOT WORK IN A BLOOD-POOR ENVIRONMENT CLAUSTROPHOBIA- SINGLE TUBE vs COMMUNITY CABIN DOES NOT CURE ANAEROBIC INFECTIONS IDEAL FOR THE DEBRIDED AND REVASCULARIZED PATIENT

26 VACUUM ASSISTED CLOSURE BEST ADVANCE IN WOUND CLOSURE THERAPY WOUND NEEDS TO BE CLEAN AND DEBRIDED MUST HAVE CLOSE OUTPATIENT FOLLOW-UP FREQUENT OFFICE VISITS RELEASES TENSION, SUCKS OUT FLUIDS, PROMOTES GRANULATION CAREFUL WITH UNDERLYING GRAFTS

27 GIVE ME BLOOD OR GIVE ME DEATH!! REVASCULARIZATION TECHNIQUES- ENDO OPEN WOUND DETERIORATION POST REVASC. -- EDEMA, DVT, INCREASE RBC s ALSO WBC S AND MACROPHAGES TURN DRY GANGRENE INTO WET GANGRENE

28 CRITICAL BALANCING ACT TOO DRY DESSICATION TISSUE DEATH

29 MACERATION

30 DIRECT CONTACT EXPAND TO ABSORB FULL CONTACT JEVAPORATION,

31 WHICH IS BEST?

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33 CONCLUSIONS THINK OUTSIDE THE SHOE BOX! WHAT ARE ALL THE FACTORS IN PLAY TO CAUSE PATIENT S CONDITION? TEAMWORK-DEPLOY AN ARMY-BE A GATEKEEPER EVERY PATIENT IS SPECIAL AND DIFFERENT WHAT WILL YOU DO DIFFERENT IN YOUR PRACTICE AFTER THIS CONF.? REMEMBER..

34 TEAMWORK IS THE KEY TO SUCCESS!

35 THANK YOU