Wound Care and Limb Salvage

St. Luke’s – Roosevelt Hospital St. Luke’s – Roosevelt Hospital Center Center

Goals

Retain limbsRetain limbs Minimally invasive and invasive therapyMinimally invasive and invasive therapy

Aggressive treatment of wounds Aggressive treatment of wounds Wound care team algorithmsWound care team algorithms Clinical trial accessClinical trial access Cutting edge therapeutic interventionsCutting edge therapeutic interventions Aggressive rehabilitation servicesAggressive rehabilitation services

How we achieve these goals?

Aggressive attempts at limb salvageAggressive attempts at limb salvage Using a combination of techniquesUsing a combination of techniques

When a wound is inevitableWhen a wound is inevitable Inpatient wound care teamInpatient wound care team Outpatient wound care teamOutpatient wound care team Standardized formularyStandardized formulary Individualized plan for each patientIndividualized plan for each patient

Invasive surgical options

Minimally invasive techniques

Outcomes of Aggressive intervention 5 year 1° patency – 5 year 1° patency –

65 to 70 %65 to 70 % 5 year 2° patency – 5 year 2° patency –

80 to 85 %80 to 85 % 5 year limb salvage – 5 year limb salvage –

85 to 90%85 to 90%

Wound care team

Speeds time to recoverySpeeds time to recovery Integrates different experienceIntegrates different experience Integrates different perspectivesIntegrates different perspectives Provides increased continuityProvides increased continuity Decreases contradictory treatment Decreases contradictory treatment

applicationapplication

Wound care team

Allows for better development and Allows for better development and application of algorithmsapplication of algorithms Aids in patient and caregiver educationAids in patient and caregiver education Provides for equal voice from various Provides for equal voice from various

care backgroundscare backgrounds Much easier to implement preventive Much easier to implement preventive

strategiesstrategies

Application of the Team Concept/ Standardized Formulary

Further sub-specializationFurther sub-specialization Diabetic foot teamDiabetic foot team Amputation teamAmputation team Decubitus teamDecubitus team

• Stoma teamStoma team

Standardized Formulary

Allows for less caregiver and patient Allows for less caregiver and patient confusionconfusion

Decreases costDecreases cost Decreases lapses in therapy once initiatedDecreases lapses in therapy once initiated Improves time to recovery ?Improves time to recovery ?

Specific team requirements

Diabetic footDiabetic foot Diabetologist- Inpatient and OutpatientDiabetologist- Inpatient and Outpatient Nurse specialist - VNS liasonNurse specialist - VNS liason NutritionistNutritionist Physical therapist - Outpatient liasonPhysical therapist - Outpatient liason Podiatrist Podiatrist ProsthetistProsthetist Social workerSocial worker Vascular surgeon (Team leader)Vascular surgeon (Team leader)

Specific team requirements

Amputation TeamAmputation Team Nurse specialist - VNS liasonNurse specialist - VNS liason NutritionistNutritionist Physical therapist - Outpatient liasonPhysical therapist - Outpatient liason PodiatristPodiatrist ProsthetistProsthetist Vascular / Orthopedic surgeonVascular / Orthopedic surgeon Social worker Social worker PsychologistPsychologist

Novel approaches and clinical trials Growth factor studiesGrowth factor studies Vacuum Assisted Closure Device studiesVacuum Assisted Closure Device studies Drug eluting stent trialsDrug eluting stent trials

At present seven active clinical trials At present seven active clinical trials focused at these problemsfocused at these problems

Multidisciplinary plan of careMultidisciplinary plan of care