Will it heal? How to assess the probability of wound healing
|
|
- Gwendolyn Lyons
- 6 years ago
- Views:
Transcription
1 Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male Non-healing amputation site DM, ESRD, CHF Active tobacco use Prior angioplasty at outside hospital Posterior tibial Doppler signal with ABI > 1.0 1
2 Revascularization for healing Principles of revascularization Establish pulsatile perfusion Surgical bypass Endovascular therapy Angiosome concept Wound care As important as the revascularization Fillet of toe 1 m 2 m 2
3 Lower-extremity wound healing Wound etiology Arterial ulcer Venous ulcer Need intervention to heal? What type of intervention? Wound care Arterial Ulcers Arterial occlusion PMH Coronary artery disease Diabetes mellitus Hypertension Tobacco use Symptoms Rest pain Tissue loss Exam Skin shiny, hairless, cool Dependent rubor No pulses Treatment Revascularization 3
4 Venous Ulcers Venous hypertension PMH DVT Calf muscle pump dysfunction Symptoms Dull ache/heavy legs/itching Exam Skin hyperpigmented, eczema Edema Palpable pulses Treatment Compression therapy Venous intervention Arterial vs Venous Ulcers Type Venous Arterial Site Size Gaiter region Medial malleolus Variable Toes/feet/heel Start small Look Diffuse Shallow depth Granulation tissue Punched out Deep (tendon/bone) Necrotic base 4
5 Clinical disease Arterial vs Venous: Ulcer Location Arterial wounds Diabetes mellitus Neuropathy Sensory Motor Autonomic Decubitus Vascular Insufficiency Tibial disease Medial calcinosis Minor Trauma Infection Increased risk Defective host defense 5
6 Diabetic foot Arterial Insufficiency Ischemia involved in 50% diabetic tissue loss Tibial artery occlusive disease Non-invasive Vascular Lab Segmental waveforms Segmental pressures PVRs Digital pressures / PVRs Duplex imaging Tissue perfusion TcO2 Skin perfusion pressure 6
7 Ankle-Brachial Index Vascular EKG Brachial BP DP / PT BP Calculate ABI Falsely elevated in diabetics Normal >0.9 Claudication Rest pain <0.5 Critical ischemia < 0.3 ABI Compared to Other Common Screening Tests Diagnostic Test Sensitivity, % Specificity, % Pap smear Fecal occult blood test Mammography ABI AMA Archives of Internal Medicine Vol Apr 28,
8 Segmental pressures/waveforms Arm Pressures For ABI Ankle Pressures for ABI PVR Measureme nts Pulse Volume Recordings Measure change in volume Amplitude < 15mm Ischemia Amplitude < 5mm Non-healing (A) normal characteristics (B) mild obstruction (C) moderate obstruction (D) severe obstruction or occlusion 8
9 Digital photoplethysmography Reflection of light in microcirculation Toe pressures Toe Brachial index Non-healing < mmhg Toe Cuffs Arterial Study 9
10 Tests for tissue perfusion Tc02 Skin perfusion pressure Hyperspectral imaging SPY camera Questions Who needs revascularization? When is enough ---- enough? When should we work on the foot? Transcutaneous Oxygen Values measured at foot and chest wall Non-healing Value < mmhg Chest foot index < 0.4 TcO2 post bypass peaks two to four weeks after revascularization Caselli A, et al Diabetic Med 2005;22(4):
11 Laser Doppler Technology Skin perfusion pressure Delivers a laser signal 1.5mm below skin Pressure cuff occludes capillary flow Controlled release of pressure Laser collects the Doppler shift effect of capillary flow return Calculates the Skin Perfusion Pressure - the pressure at which blood flow first returns to the capillaries Capillary ABI SPP Wound Healing Potential < 30 mmhg - wound healing failure > 30 mmhg predictor of wound healing SPP diagnoses PAD/CLI with > 80% accuracy Probability of Healing Probability SPP Castronuovo, et al. J. Vasc. Surg. 1997, 26,
12 Who needs revascularization? Functional ischemia Disabling claudication Ischemic rest pain Tissue loss Non-healing ulcer Gangrene Severe ischemia on noninvasive testing Healing based on ulcer size 290 patients with ischemic wounds Grouped according to initial wound size Group A mm Group B mm Group C > 20 mm Neville, et al. SVS,
13 Healing based on revascularization Percent Bypass Endo Group A Group B Group C * 70 Neville, et al. Society for Vascular Surgery, 2010 * Log rank P value = 0.02 Healing based on angiosome concept Six distinct angiosomes: Posterior tibial artery (3) Calcaneal Medical plantar Lateral plantar Anterior tibial artery (1) Dorsalis pedis Peroneal artery (2) Lateral calcaneal Anterior perforator. Attinger C.E Plastic and Reconstr Surg 2006:117;261S-293S 13
14 Angiosomes Anterior Tibial Artery Dorsalis Pedis Anterior compartment Dorsum of foot Angiosomes Peroneal Artery Lateral Calcaneal branch Anterior Perforator branch Lateral ankle Lateral plantar heel Medial ankle 14
15 6/5/2014 Angiosome Posterior Tibial Artery Calcaneal Branch Medial Plantar Branch Lateral Plantar Branch Medial heel Medial plantar Lateral ankle/forefoot Lateral plantar Angiosomes of the Leg Indirect connections (Choke vessels) 15
16 Does it matter if the wound s angiosome is adequately perfused? Healing based on angiosome revascularization % Direct Fisher s exact P test = 0.03 P = % Indirect Complete healing Failed to heal 16
17 Principles of wound care Maximize functional length Biomechanically sound May need staged procedures Debridement Delayed wound closure VAC or other biologic adjuncts Wound care protocols 17
18 Debridement Principles Debride to viable tissue Culture exposed bone edges Reconstruct soft tissue When inflammation is gone Granulation tissue appears VAC as temporary dressing until closure Wet gangrene Debride ASAP Resect all necrotic tissue Explore tendon sheaths and fascial compartments VAC Mechanism Principle effects Decreases peri wound edema Increases granulation Decreases bacterial cell count MORYKWAS ET AL, APS 38:553,
19 Bio debridement Maggot therapy 7 DAYS Primary amputation May be the right choice Lack of tissue Non-ambulatory Dementia 19
20 Amputation principles Think biomechanics and anatomy Maximize viable tissue Especially plantar surface Skeletal stability No pressure points Rebalance tendons No pressure points Rigid post op dressing with early ambulation Type of amputations Symes 20
21 Amputation principles BIOMECHANICS AVOID ABNORMAL SHAPES AVOID EQUINO-VARUS DEFORMITY BELOW KNEE AMPUTATION DESIGN IS KEY 1) Posterior flap design 2) Cut tibia cm from tubercle 3) Bevel anterior tibial bone 4) Tenodese Achilles to anterior tibial bone 5) Shape posterior flap for funneled stump 21
22 Patient Support and Education Community lecture series Amputee support group Probability of wound healing Etiology of wound History and exam Vascular lab Need for revascularization? Clinical course Toe pressures, TcO2, SPP Type of revascularization Endovascular therapy Surgical bypass Wound care 22
23 Thank you 23
Fluorescent Angiography: Practical uses in the Clinical Setting
Fluorescent Angiography: Practical uses in the Clinical Setting Charles Andersen MD, FACS, MAPWCA Chief Vascular/Endovascular/ Limb Preservation Surgery Service (Emeritus) Chief of Wound Care Service Madigan
More informationEVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or
More informationUC SF. Disclosures. Vascular Assessment of the Diabetic Foot. What are the best predictors of wound healing? None. Non-Invasive Vascular Studies
Disclosures Vascular Assessment of the Diabetic Foot What are the best predictors of wound healing? None Shant Vartanian MD Assistant Professor of Vascular Surgery UCSF Vascular Symposium April 20, 2013
More informationNational Clinical Conference 2018 Baltimore, MD
National Clinical Conference 2018 Baltimore, MD No relevant financial relationships to disclose Wound Care Referral The patient has been maximized from a vascular standpoint. She has no other options.
More informationCritical Limb Ischemia A Collaborative Approach to Patient Care. Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017
Critical Limb Ischemia A Collaborative Approach to Patient Care Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017 Surgeons idea Surgeons idea represents the final stage of peripheral
More informationArterial Studies And The Diabetic Foot Patient
Arterial Studies And The Patient George L. Berdejo, BA, RVT, FSVU gberdejo@wphospital.org Disclosures I have nothing to disclose! Diabetes mellitus continues to grow in global prevalence and to consume
More informationPerfusion Assessment in Chronic Wounds
Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,
More informationDisclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium
Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb
More informationPractical Point in Holistic Diabetic Foot Care 3 March 2016
Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai
More informationPUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
More informationVASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE
More informationCHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS
CHAPTER 16 LOWER EXTREMITY Amanda K Silva, MD and Warren Ellsworth, MD, FACS The plastic and reconstructive surgeon is often called upon to treat many wound problems of the lower extremity. These include
More informationFluorescence Angiography in Limb Salvage
Fluorescence Angiography in Limb Salvage Ryan H. Fitzgerald, DPM, FACFAS Associate Professor of Surgery-University Of South Carolina School of Medicine, Greenville Etiology of Lower extremity wounds Neuropathy
More informationArterial & Venous Ulcers. A Comprehensive Review Assessment & Management
Arterial & Venous Ulcers A Comprehensive Review Assessment & Management 1 Objectives Understand Arterial & Venous disease Understand the etiology of lower extremities ulcers Understand assessment of lower
More informationPeripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound
Peripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound Craig M. Walker, MD, FACC, FACP Chairman, New Cardiovascular Horizons Clinical Professor of Medicine Tulane
More informationDisclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are
An initial strategy of open bypass is better for some CLI patients, and we can define who they are Fadi Saab, MD, FASE, FACC, FSCAI Metro Heart & Vascular Metro Health Hospital, Wyoming, MI Assistant Clinical
More informationCurrent Vascular and Endovascular Management in Diabetic Vasculopathy
Current Vascular and Endovascular Management in Diabetic Vasculopathy Yang-Jin Park Associate professor Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Peripheral artery
More informationDue to Perimed s commitment to continuous improvement of our products, all specifications are subject to change without notice.
A summary Disclaimer The information contained in this document is intended to provide general information only. It is not intended to be, nor does it constitute, medical advice. Under no circumstances
More informationPractical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
More informationAppendix D: Leg Ulcer Assessment Form
Nursing Best Practice Guideline Appendix D: Ulcer Assessment Form Person Completing Assessment: Date: Client Name: Caf # CM# VON ID #: District CCAC ID # Address Telephone Home: Work: Date of Birth Y/M/D:
More informationDisclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview
Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott
More informationRole of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
More informationLarry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
More informationGlobal Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care
Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care Michael S. Conte MD Professor and Chief, Division of Vascular and Endovascular
More informationNon- invasive vascular testing. Pros and Cons of ABIs and Alternative Physiologic Assessments
Non- invasive vascular testing Pros and Cons of ABIs and Alternative Physiologic Assessments Non- Invasive Physiologic Arterial Studies Segmental Systolic Pressure Measurements ABIs, TBIs, and full segmentals
More informationGLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE
GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE Michael S. Conte MD Professor and Chief, Vascular and Endovascular Surgery Co-Director, Center for Limb Preservation Co-Director, Heart and Vascular
More informationDiabetic Foot Ulcers. Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C. Advanced Practice Nurse / Adult Clinical Nurse Specialist
Diabetic Foot Ulcers Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist Organization of Wound Care Nurses www.woundcarenurses.org Objectives Identify Diabetic/Neuropathic
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abscess, with diabetic foot ulcers, 472 Achilles tendon, in calcanectomy, for osteomyelitis, 473, 483 in calcaneus anatomy, 477 478 in Syme
More informationLeg ulcer assessment and management
Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or
More informationJohn E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
More informationAngiosome concept myth or truth? Does it make a real difference in real world cases?
Angiosome concept myth or truth? Does it make a real difference in real world cases? Osamu Iida, MD, FACC Kansai Rosai Hospital Amagasaki, Hyogo, Japan Disclosure Speaker name:... I have the following
More informationClinical Approach to CLI and Related Diagnostics: What You Need to Know
Clinical Approach to CLI and Related Diagnostics: What You Need to Know Ido Weinberg, MD Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital None Disclosures Critical
More informationVersatility of Reverse Sural Artery Flap for Heel Reconstruction
ORIGINAL ARTICLE Introduction: The heel has two parts, weight bearing and non-weight bearing part. Soft tissue heel reconstruction has been a challenge due to its complex nature of anatomy, weight bearing
More informationAcknowledgements. No tengo conflictos de interés que revelar. I have no conflicts of interest to disclose. Michael S. Conte. David G.
No tengo conflictos de interés que revelar I have no conflicts of interest to disclose. Critical Limb Ischemia : The Need for a New System to Define Disease Burden and Stratify Amputation Risk and Need
More informationObjective assessment of CLI patients Hemodynamic parameters
Objective assessment of CLI patients Hemodynamic parameters Worth anything in end stage patients? Marianne Brodmann Angiology, Medical University Graz, Austria Disclosure Speaker name: Marianne Brodmann
More informationPerson s Name: ID Number: Date:
South West Regional Wound Care Program Person s Name: ID Number: Interdisciplinary Diabetic/Neuropathic Foot Assessment Form MEDICAL HISTORY: Question Year diabetes diagnosed: Characteristics of onset
More informationClasificación WIFI: Finalmente hablaremos el mismo idioma! WIfI: Wound, Ischemia, foot Infection The SVS Threatened Limb Classification
Clasificación WIFI: Finalmente hablaremos el mismo idioma! WIfI: Wound, Ischemia, foot Infection The SVS Threatened Limb Classification Joseph L. Mills, Sr., M.D. Professor of Surgery, Chief, Vascular
More informationWound Assessment Report
Wound Assessment Report Single Assessment, Single Wound Mary Taylor Assessment Patient ID MT4367147 Date of Birth 1939-4-18 Left Foot, Sole: Wound A Image taken 16-45-43 Area 1.7cm2 Perimeter 48mm Maximum
More informationAngiosome revascularization strategies in real world practice: how much difference does it make?
Angiosome revascularization strategies in real world practice: how much difference does it make? Peter A. Schneider, MD Kaiser Foundation Hospital Honolulu, Hawaii Disclosure Peter A. Schneider... I have
More informationTHERE IS NO PROOF FOR THE ANGIOSOME CONCEPT
THERE IS NO PROOF FOR THE ANGIOSOME CONCEPT Peter Huppert Professor of Radiology and Neuroradiology Department of Radiology, Neuroradiology and Nuclear Medicine Klinikum Darmstadt Academic Teaching Hospital
More informationDefinitions and criteria
Several disciplines are involved in the management of diabetic foot disease and having a common vocabulary is essential for clear communication. Thus, based on a review of the literature, the IWGDF has
More informationResident Teaching Conference 3/12/2010
Resident Teaching Conference 3/12/2010 Goals Definition and Classification of Acute Limb Ischemia Clinical Assessment of the Vascular Patient History and Physical Diagnostic Modalities Management of Acute
More informationPeripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
More informationTransmetatarsal amputation in an at-risk diabetic population: a retrospective study
The Journal of Diabetic Foot Complications Transmetatarsal amputation in an at-risk diabetic population: a retrospective study Authors: Merribeth Bruntz, DPM, MS* 1,2, Heather Young, MD 3,4, Robert W.
More informationVASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT
VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order
More informationUSWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
USWR 23: Outcome Measure: Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential MEASURE STEWARD: The US Wound Registry [Note: This measure
More informationRole of free tissue transfer in management of chronic venous ulcer
Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address
More informationMy Diabetic Patient Has No Pulses; What Should I Do?
Emily Malgor, MD Assistant Professor of Surgery University of Oklahoma, Oklahoma City My Diabetic Patient Has No Pulses; What Should I Do? There are no disclosures. Background Diabetes affects 387 million
More informationULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years
Jay Christensen D.P.M Advanced Foot and Ankle of Wisconsin 2-4% of the population at any given time will have ulcers 0.06-0.20% of the total population Average age of patients 70 years increased as more
More informationAddress: Left Leg. other: Nails: thick yellow brittle fungus abnormal thick yellow brittle fungus abnormal
South West Regional Wound Care Toolkit: Interdisciplinary Lower Leg Assessment Form Instructions for use: Competent/ Proficient/ Expert level HCP to complete if lower leg ulcer present or risk of ulcer
More informationThis presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Introduction Compartment Syndromes of the Leg Related to Athletic Activity Mark M. Casillas, M.D. Consequences of a misdiagnosis persistence of a performance limitation loss of function/compartment loss
More informationLower Extremity Peripheral Arterial Disease: Less is Sometimes More. Spence M Taylor, M.D.
Lower Extremity Peripheral Arterial Disease: Less is Sometimes More Spence M Taylor, M.D. President, Greenville Health System Clinical University Senior Associate Dean for Academic Affairs and Diversity
More informationApproach to the Patient with (suspected) Arterial Insufficiency Related Ulceration
Approach to the Patient with (suspected) Arterial Insufficiency Related Ulceration Elisa C. Taffe, MD, CWSP Vascular Medicine Medical Director Allegheny General Advanced Wound Healing and Lymphedema Center
More informationWound Classification. Overview
Overview Jeffrey A. Niezgoda, MD FACHM, MAPWCA, CHWS Review of Initial Wound Care Consultation Rational for Classification Wound Appearance Wound Etiology Management Algorithms Initial Wound Care Consult
More informationThe relation of 2D perfusion angiography after BTK intervention and wound healing in patient with CLI - Single center prospective study -
The relation of 2D perfusion angiography after BTK intervention and wound healing in patient with CLI - Single center prospective study - Shinya Sasaki, MD. Saka General Hospital Miyagi, JAPAN Disclosure
More informationIntroduction to Peripheral Arterial Disease. Stacey Clegg, MD Interventional Cardiology August
Introduction to Peripheral Arterial Disease Stacey Clegg, MD Interventional Cardiology August 20 2014 Outline (and for the ABIM board exam * ** ***) Prevalence* Definitions Lower Extremity: Aorta*** Claudication***
More information6/6/2016. Pedal Loop Reconstruction: A Crash Course in 60 minutes. Pedal-Plantar Anatomy. Anand Prasad, MD, FACC, FSCAI, RPVI.
6/6/2016 Pedal Loop Reconstruction: A Crash Course in 60 minutes Pedal-Plantar Anatomy Anand Prasad, MD, FACC, FSCAI, RPVI Associate Professor of Medicine Freeman Heart Association Endowed Professor in
More informationLIMB SALVAGE IN THE DIABETIC PATIENT
LIMB SALVAGE IN THE DIABETIC PATIENT WHO? HOW? BEST? DISCLOSURES Educational grant from Cook Inc OBJECTIVES Review risk stratification and staging schemes for the threatened limb Discuss current concepts
More informationLimb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017
Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene
More informationWound Jeopardy: Name That Wound Session 142 Saturday, September 10 th 2011
Initial Wound Care Consult History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed History and Physical (wound)
More informationFOR THE 18 MILLION INDIVIDUALS with diabetes mellitus in
11 Evaluation and Management of Peripheral Arterial Disease Joseph L. Mills, Sr., MD FOR THE 18 MILLION INDIVIDUALS with diabetes mellitus in the United States, foot problems ulceration, infection, and
More informationForget about the angiosome theories. Yann Gouëffic, MD, PhD Department of vascular surgery, institut du thorax, Nantes, France
Forget about the angiosome theories Yann Gouëffic, MD, PhD Department of vascular surgery, institut du thorax, Nantes, France Disclosure of Interest Research grants /Consulting/Honoraria for - Abbott -
More informationGuidelines for Management of Peripheral Arterial Disease
Guidelines for Management of Peripheral Arterial Disease Subhash Banerjee, MD, FACC, FSCAI Professor of Medicine, Univ. of Texas Southwestern Medical Center Chief, Division of Cardiology, VA North Texas
More informationLearning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship
Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with
More informationThe Risk. Background / Bias. Integrating Wound Care into a Limb Preservation Initiative 4/24/2009
Stimulating Wound Granulation: Advances in NPWT and other Measures (Wound Bed Preparation) Charles Andersen MD, FACS, FAPWCA Clinical Prof of Surgery UW, USUHS Chief Vascular/Endovascular/ Limb Preservation
More informationHigh Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC
High Risk Podiatry in a Vascular Setting; A new paradigm in Diabetic Foot Disease? Ereena Torpey Senior Podiatrist - FMC A new paradigm? Foot ulceration 101 Assessing Perfusion a new challenge Pressure
More informationFrancisco Acín, César Varela, Ignacio López de Maturana, Joaquín de Haro, Silvia Bleda, and Javier Rodriguez-Padilla
International Journal of Vascular Medicine, Article ID 27539, 13 pages http://dx.doi.org/1.1155/214/27539 Clinical Study Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients
More informationI have no financial interests to disclose in regards to this lecture.
Evaluation and Treatment of Diabetic Foot Ulcerations John M. Giurini, D.P.M. Associate Professor in Surgery Harvard Medical School Disclosure Statement I have no financial interests to disclose in regards
More informationASSESSING FOOT PERFUSION AFTER BTK REVASCULARIZATION
ASSESSING FOOT PERFUSION AFTER BTK REVASCULARIZATION Miguel Montero-Bakerr Associate Professor of Vascular Surgery Baylor College of Medicine Houston, TX, USA TRANSPORT BTK disease DISTRIBUTION BTA disease
More informationEnd Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema. Original Policy Date
MP 2.02.12 End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date
More informationStratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI?
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Peter F. Lawrence, M.D. Gonda Vascular Center Division of Vascular Surgery
More informationLower Extremity Peripheral Arterial Disease: Its All About the Pulse. Spence M Taylor, M.D.
Lower Extremity Peripheral Arterial Disease: Its All About the Pulse Spence M Taylor, M.D. President, Greenville Health System Clinical University Senior Associate Dean for Academic Affairs and Diversity
More informationHow to manage leg ulcers in the elderly
How to manage leg ulcers in the elderly David Riding Clinical Research Fellow / Specialty Registrar in Vascular Surgery University of Manchester / MFT British Geriatric Society Trainees Meeting 2018 Objectives
More informationASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES
ASSESSING THE VASCULAR STATUS OF THE FEET FOR PATIENTS WITH DIABETES Caroline McIntosh is Senior Lecturer in Podiatry, University of Huddersfield, Yorkshire A reduced blood supply to the lower limb, due
More informationLower Extremity Artery: Physiologic Testing
Master Title Ultrasound for Initial Evaluation of Lower Extremity Arterial Occlusive Disease: WHY? Gregory L. Moneta MD Professor and Chief Knight Cardiovascular Institute Division of Vascular Surgery
More informationNanogen Aktiv. Naz Wahab MD, FAAFP, FAPWCA Nexderma
Nanogen Aktiv Naz Wahab MD, FAAFP, FAPWCA Nexderma Patient BM 75 y.o female with a history of Type 2 Diabetes, HTN, Hypercholesterolemia, Renal insufficiency, Chronic back Pain, who had undergone a L3-L4
More informationPedal Bypass With Deep Venous Arterialization:
Pedal Bypass With Deep Venous Arterialization: Long Term Result For Critical Limb Ischemia With Unreconstructable Distal Arteries Pramook Mutirangura Professor of Vascular Surgery Faculty of Medicine Siriraj
More informationCase study: A targeted approach to healing complex wounds using the geko device.
Case study: A targeted approach to healing complex wounds using the geko device. Authors: Mr Sameh Dimitri Consultant Vascular and Endovascular Surgeon MSc FRCS (Eng Edin) Nikki Pavey Physiotherapist at
More informationInterventional Treatment First for CLI
Interventional Treatment First for CLI Patrick Alexander, MD, FACC, FSCAI Interventional Cardiology Medical Director, Critical Limb Clinic Providence Heart Institute, Southfield MI 48075 Disclosures Consultant
More informationSAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS
SAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS LIBBY WATCH, MD MIAMI VASCULAR SPECIALISTS MIAMI CARDIAC & VASCULAR INSTITUTE FINANCIAL DISCLOSURES None 2
More informationArthroplasty after previous surgery: previous vascular problems
Arthroplasty after previous surgery: previous vascular problems Jacques Menetrey & Victoria B. Duthon Centre de médecine de l appareil locomoteur et du sport Swiss Olympic medical Center Unité d Orthopédie
More informationSurgical Options for revascularisation P E T E R S U B R A M A N I A M
Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation
More informationHyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction
Original Article Plastic and Aesthetic Research Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction Pradeoth Mukundan
More informationValidation and Clinical Utility of the SVS WIfI Threatened Limb Classification
Validation and Clinical Utility of the SVS WIfI Threatened Limb Classification PRESENTED BY: 11 th Houston Aortic Symposium 15 February 2018 Joseph L. Mills, Sr., M.D. Reid Endowed Professor of Surgery
More informationInjuries to the Hands and Feet
Injuries to the Hands and Feet Chapter 26 Injuries to the Hands and Feet Introduction Combat injuries to the hands and feet differ from those of the arms and legs in terms of mortality and morbidity. Death
More informationMaximally Invasive Vascular Surgery for the Treatment of Critical Limb Ischemia
Maximally Invasive Vascular Surgery for the Treatment of Critical Limb Ischemia Traci A. Kimball, MD Department of Surgery Grand Rounds Septemember 13, 2010 Overview Defining Critical Limb Ischemia Epidemiology
More informationDiabetic Foot Complications
Diabetic Foot Complications Podiatry Specialty Clinic YKHC Bethel, Alaska August 1-3, 2017 Charles C. Edwards, DPM Alaska Native Tribal Health Consortium Peripheral Neuropathy Diabetic Peripheral Neuropathy
More informationClinical Examination of VASCULAR PATIENTS. Stephanie Hirst & Alexander Sunde
Clinical Examination of VASCULAR PATIENTS Stephanie Hirst & Alexander Sunde Goals of Medical History To record the patient s symptoms at time of presentation. To organize the events which have lead to
More informationPeripheral Arterial Disease
UFS Peripheral Arterial Disease A problem of supply and demand Larry Rhoads, Associate Chief Underwriter November 8, 2011 PAD Two categories of these circulation disorders: Functional peripheral vascular
More informationBritish Columbia Provincial Nursing Skin and Wound Committee
Developed by the BC Provincial Nursing Skin and Wound Care Committee in collaboration with Wound Clinicians from: / Education Module Ankle Brachial Index(ABI) Procedure in Adults for Handheld Doppler &
More informationAnkle Brachial Index and Transcutaneous Partial Pressure of Oxygen as predictors of wound healing in diabetic foot ulcers
The Journal of Diabetic Foot Complications Ankle Brachial Index and Transcutaneous Partial Pressure of Oxygen as predictors of wound healing in diabetic foot ulcers Authors: Lalithambika CV 1, Nisha B
More informationAmputation as a Last Resort A Multidisciplinary Approach to Limb Salvage
Amputation as a Last Resort A Multidisciplinary Approach to Limb Salvage George L. Adams, MD, MHS, MBA, FACC, FSCAI Clinical Associate Professor of Medicine University of North Carolina Health System Director
More informationEnd-Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema
End-Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary,
More informationNon-invasive examination
Non-invasive examination Segmental pressure and Ankle-Brachial Index (ABI) The segmental blood pressure (SBP) examination is a simple, noninvasive method for diagnosing and localizing arterial disease.
More informationCombat Extremity Vascular Trauma
Combat Extremity Vascular Trauma Training teams to be a TEAM Chatt A. Johnson LTC, MC, USA 08 March 2010 US Army Trauma Training Center Core Discussion Series Outline: Combat Vascular Injury Physiologic
More informationDetection of peripheral vascular disease in patients with type-2 DM using Ankle Brachial Index (ABI)
Original article: Detection of peripheral vascular disease in patients with type-2 DM using Ankle Brachial Index (ABI) 1DR Anu N Gaikwad, 2 Dr Vikrant V Rasal, 3 Dr S A Kanitkar, 4 Dr Meenakshi Kalyan
More informationDiagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC
Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton,
More informationVenous. Arterial. Neuropathic (e.g. diabetic foot ulcer) Describe Wound Types & Stages of. Pressure Ulcers. Identify Phases of Healing & Wound Care
A dressing the situation at hand Describe Wound Types & Stages of Pressure Ulcers Identify Phases of Healing & Wound Care Goals Clarify Referral Protocol Lacerations- The goal is nearest to complete approximation
More informationSplit Hemianterior Tibialis Turndown Muscle Flap for Coverage of Distal Leg Wounds With Preservation of Function
Split Hemianterior Tibialis Turndown Muscle Flap for Coverage of Distal Leg Wounds With Preservation of Function Vinay Gundlapalli, MD, a John W. Gillespie III, MD, b and Chris D. Tzarnas, MD, FACS c a
More informationAnatomy MCQs Week 13
Anatomy MCQs Week 13 1. Posterior to the medial malleolus of the ankle: The neurovascular bundle lies between Tibialis Posterior and Flexor Digitorum Longus The tendon of Tibialis Posterior inserts into
More information