dermatology wound clinic jessica scanlon, md october 9, 2014

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Dermatology Wound Clinic Jessica Scanlon, MD October 9, 2014

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Dermatology Wound Clinic

Jessica Scanlon, MDOctober 9, 2014

Who We Are

• Physicians– Vince Li– Jessica Scanlon– Bill Tsiaras

• Jen Elliott, PA-C• Nursing staff– MAs: Koravee, Tina– Triage: Mary– Scheduling: Janelle Trotman (used to be DaLisa)

What We Do

• Management of chronic wounds– Wounds lasting longer than 6 weeks– Frequent wounds– Pts with a history of chronic wounds– Complex wounds

Conditions We Treat• The 3 big chronic wounds:

– Venous leg ulcers– Diabetic foot ulcers– Arterial ulcers

• Complex dermatologic conditions– Pyoderma gangrenosum– Morphea– Radiation dermatitis– Vasculitis– Infection– NLD– Calciphylaxis– Tumors– Etc…

What We See

Chronic Wounds

• Wound management is complex• Requires frequent wound and dressing

reassessment

How Do We Operate

• Team approach– Everyone has an important role in wound care

• Important team players– Patients: Age, comorbidities, ability to manage ADLs– Families, friends: Complicated and complicating– VNA, home health aides, hospice care– Other wound centers– PCPs, other specialties (vascular, plastics, ortho, onc)– Dermatology: Office manager, MAs, triage, PA, MDs

Managing Comorbidities• A chronic wound is a systemic disease – affected by a host of other factors

– Chronic disease– Venous and/or arterial insufficiency– Diabetes– Neurologic defects– Psychiatric disturbance– Immunodeficiency– Nutritional deficiency– Medications– Blood disorders, hypercoagulability– Advanced age– Allergy– Pressure, infection, edema– Smoking, alcohol, illicit drugs– Others…

Managing Pt Expectations

• Ulcers have a big impact on QOL– Pain– Activity level, mobility– Time of dressing changes– Pt’s rely more heavily on others– Showering, swimming

• Pt’s expect ulcers to heal quickly, painlessly, and with a minimum of trouble

Choosing Appropriate Wound Dressings

• Assessment of the wound/milieu– Moisture balance– Inflammation– Necrotic debris, crusting– Bacterial bioburden (odor, drainage)– Quality of the skin (ACD, xerosis, stasis, etc)

• Comorbid factors– Ease of dressing changes– Pain– Is the person changing the dressings making things worse?– Dressing availability, cost

Tools

• Dressings• Debridement– Sharp debridement, collagenase

• Compression• Topical agents– Regranex

• Bio-Engineered Grafts– OASIS, Apligraf, Dermagraft, EpiFix

• Antiseptic measures

Maintaining the Moisture BalanceTegaderm (film)

Duoderm (hydrocolloid)

Aquacel (hydrofiber)

Allevyn foam cavity dressing(foam)

Antiseptic Dressings

Compression

Wound Clinic

• Dressings taken down, wound cleaned with NS• EMLA – 15 minutes• Pt is evaluated, wound assessed– Measure the wound– Debridement– Cultures– Skin substitute if necessary– Wounds redressed

Wound Clinic

• Much of the work is done outside of clinic, by support staff– PA’s, communicating with pharmacies– Communicating with VNA or other wound care providers– Managing supplies, compression pumps– Ordering skin substitutes and obtaining them from the

blood bank– Providing OTC wound supply resources– Managing cultures, biopsy results, labs– Managing billing issues– Managing pt concerns and expectations

Care Coordination• VNA services• Medical supply ordering• HBOT• Medication/Dressing PAs

– Regranex, collagenase, grafts• Physical therapy services

– Lymphedema massage• Equipment

– Wound VAC– Compression boots

• Referrals– Vascular– Plastics– Renal, other medicine services

Logistics

• Scheduling– Urgent issues– All others go through our scheduler

• Days– Thursdays AM/PM, Vince monthly– Bill Wednesdays

• Location– 221 Longwood

• Inpatient consult service