2016: wound care: nuts and bolts - broder
TRANSCRIPT
WOUND CARE: NUTS AND BOLTS
Kevin Broder, MDTelemedicine & Wound Director, San Diego GWEPTelehealth Director, Department of SurgerySection of Plastic SurgeryVA Medical Center – San Diego, CA
December 4, 2016
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ADJUNCTS TO WOUND HEALING
• Negative Pressure Wound Therapy• Acellular and Cellular Based Wound Therapies
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPY
• Advantages– Occlusive – maintains
moist wound environment– Increase blood flow– Decrease edema– Decrease bacterial
contamination– Promote wound contraction– Less dressing changes– Less pain
• Contraindications– Fresh blood vessel repair– Malignancy– Untreated osteomyelitis
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPY
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPY
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPY
• A 57-year-old paraplegic woman
• Right hip trochanteric Stage IV pressure ulcer down to the level of exposed bone
• I&D with flap reconstruction
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPY
• Delayed Wound Healing
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 9 Weeks
ACELLULAR-BASED THERAPY
• Acellular Matrices
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Porcine Small Intestinal Submucosa
Dermal Regeneration Matrix - Meshed acellular bovine collagen, glycosaminoglycan, silicone
Human Dermal Allograft
• A 66-year-old male with T5 ASIA C paraplegia• Stage 4 left ischial pressure ulcer• Type 2 diabetes• Active smoking• Malnutrition• Lives at home with attendant care• Skin defect dimensions of 8x8 cm• Wound depth 5 cm to the level of exposed bone• Refused Flap Reconstruction
ACELLULAR-BASED THERAPY
ACELLULAR-BASED THERAPYINITIAL PRESENTATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
• Smoking Cessation• Nutrition Optimization• Pressure Relief• Glucose Control• Debride• Bone biopsy• Antibiotics• Negative Pressure3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYFAILED TO HEAL
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 2
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYPORCINE URINARY BLADDER MATRIX
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYMATRIX AND NEGATIVE PRESSURE WOUND
THERAPY SPONGE
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 3
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 4
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 5
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 6
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 7
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 8
CELLULAR-BASED THERAPY
• Allogenic– Cryopreserved– Stimulate senescent wounds– Faster wound healing
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Bilayered: Neonatal fibroblasts and keratinocytes on bovine collagen
Monolayer: neonatal dermal fibrogblasts on bioresorbable polyglactin
Split thickness cadaveric skin
• Placental Membranes– Used for 100’s of years– No painful donor site– Stem cell recruitment
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Human amnion/chorion membrane
CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE
CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE• A 63-year-old male
paraplegic with chronic stage IV sacral and left ischial pressure ulcers
• Underwent I&D with flap reconstruction of sacral ulcer
• While awaiting staged reconstruction of ischial wound, underwent dHACM application
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
8 Weeks
• Adipocyte Derived Regenerative Cells– NCT02375802; Phase 1; Adipose-Derived Stromal Cells (ASC’s) and Pressure
Ulcers; Pressure Ulcers– NCT02092870; Phase 2;Adipose-derived Regenerative Cellular Therapy of
Chronic Wounds; DFU, chronic wounds
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CELLULAR-BASED THERAPYSTEM CELLS
WOUND CARE: NUTS AND BOLTS
Thank YouKevin Broder, MD
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Torrey Pines Golf Course