Beyond Wet to Dry

8/2/2019 Beyond Wet to Dry

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Wound Care: Beyond

the Wet to Dry dressingGabriel Urrea-Botero, MD

Fellowship in Wound Care


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The Problem Cost

In 1999, the average cost per patientfor 2 years of treatment of a diabeticulcer in the United States of America

(USA) was an estimated $27,987

Kruse I, Edelman S. Evaluation andtreatment of diabetic foot ulcers.

Clin Diabet 2006;24:91-3.


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More recently, the cost for the treatment ofa single ulcer has increased to $8000, andthe cost of an infected ulcer has increased

to approximately $17,000 per year.

The Problem Cost

Barone EJ, Yager DR, Pozez AL, et al.

Interleukin-1 alpha and collagenase

activity are elevated in chronic wounds.

Plast Reconstr

Surg 1998;102:1023-7.


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In 1980 synthetic wound dressings wererarely sold, whereas in 1987 it wasestimated that $350 million was spent on

these dressings.

The Problem Cost

Eaglstein WH, Mertz PM, Falanga V. Clinicaland experimental approaches to dermal and

epidermal repair: Normal and chronic

wounds.

New York: Wiley-L% 1991: 257- 65.


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The likelihood of a diabetic being dead five years after a amputationis nearly 68%. This is more than double the chance of death fromprostate or breast cancer

Health Impact


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Wound Care at GMG

Conventional / Gold Standard Treatments

Non Conventional / The Cutting EdgeApproach

Infections

Skin Surgery

Topical Treatments


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Wound Care at GMG

Infections

Cultures

Abscess

Osteomyelitis


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Wound Cultures

A swab culture of the surface of a DFU usuallyreveals at least 1 potential pathogen; suchsurface cultures can be difficult to use in guidingtreatment because they do not distinguish acolonized ulcer from an infected one.

Swab cultures of the surface of an infected DFU

often fail to represent the underlying pathogen.When deep DFIs are suspected, deep culturesare most suitable for guiding antibiotic therapy.


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Wound Cultures

Ideally, deep cultures should be obtainedwithout traversing the wound bed, to avoidthe potential contamination of deep tissue

with surface colonizing flora. Afterremoving overlying necrotic debris,specimens should be obtained from the

wound base or deeper tissues


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Wound Cultures

In most cases, cultures of DFI should beobtained before the start of treatment (althougha recent study found a striking lack ofassociation between receipt of prior antibioticsand bone culture positivity) 1. Arag on-S anchez FJ, Cabrera-Galv an JJ,

Quintana-Marrero Y, et al. Outcomes of surgicaltreatment of diabetic foot osteomyelitis: a series of

185 patients with histopathological confirmation ofbone involvement.

Diabetologia 2008;51(11): 196270


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Intralesional antibiotic injection ofantibiotics


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Most series report amputation as the only possiblesurgical treatment

1. Karchmer AW, Gibbons GW (1994) Foot infections in diabetes.Evaluation and management.

Curr Clin Top Infect Dis 14:122

2. Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, MorganCB, Lavery LA (1997) The natural history of great toe amputations.J Foot Ankle Surg 36:204208

3. Nehler MR, Whitehill TA, Bowers SP et al (1999) Intermediate-term outcome of primary digit amputations in patients with diabetesmellitus who have forefoot sepsis requiring hospitalisation andpresumed adequate circulatory status. J Vasc Surg 30:509517

Osteomyelitis


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Others have also suggested that antibiotic therapycombined with debridement of the infected bone cancure most cases of diabetic foot osteomyelitis.

1. Grayson ML, Gibbons GW, Habershaw GM et al (1994) Useof ampicillin/sulbactam versus imipenem/cilastatin in thetreatment of limb-threatening infections in diabetic patients.Clin Infect Dis 18:683693

2. Venkatesan P, Lawn S, Macfarlane RM, Fletcher EM, Finch

RG, Jeffcoate WJ (1997) Conservative management ofosteomyelitis in the feet of diabetic patients.Diabet Med 14:487490

Osteomyelitis


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Wound Care at GMG

Skin Surgery

Woundectomy

Late Closure of wounds

Lattice Stitch Technique


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Lattice Stitch Techinque:Early Suture Removal


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2nd Degree Burns


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2nd Degree Burns


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Late wound closure


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Late wound closure


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Woundectomy


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Unna boot in the hands


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Interesting cases


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Interesting cases


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Interesting cases


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Interesting cases


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Thanks!

Time is over

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