JA Ebner, H Ebner - circ- ?· PATHWAY FOR LEG ULCERS SPECIALIST. Family physician ... Diagnostik und…

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JA Ebner, H Ebner

QUESTIONS

WHO treats leg ulcers in South Tyrol?

HOW MANY leg ulcers we have in South Tyrol?

HOW do we manage leg ulcers in South Tyrol?

WHO treats leg ulcers in South Tyrol?

PUBLIC HEALTHCARE

834 beds

Ca 29.600 hospitalizations

Ca 1 Million outpatient treatments

550 bedsCa 18.900 hospitalizationsCa 560.000 outpatient

treatments

322 bedsCa 12.700 hospitalizationsCa 400.000 outpatient

treatments

346 bedsCa 12.500 hospitalizationsCa 370.000 outpatient

treatments

PUBLIC HEALTHCARE

DermatologyVascular SurgeryDiabetes Center(Internal Medicine)

DermatologyGeneral Surgery

DermatologyGeneral Surgery

DermatologyGeneral Surgery

Dermatology(GS) Vascular Surgery

Dermatology(GS) 1Vascular SurgeonDermatology

General Surgery

PUBLIC HEALTHCARE

Community nursing service (19)Center of support (14)

Family physician (122)Community Nursing Service (Diagnosis)

Woundcare

WoundcareEducationPrevention

PUBLIC HEALTHCAREPATHWAY FOR LEG ULCERS

SPECIALIST

Family physician (122)Community Nursing Service (Diagnosis)

Woundcare

WoundcareEducationPrevention

Vascular and thoracic sugery

OUPATIENT WOUNDCARE DEP.

INTERPROFESSIONAL TEAMWORK

(Diabetes center, Dermatology)

PATHWAY FOR LEG ULCERS

How many leg ulcers?

1990: ca. 1.000.000 people2000: 1.400.000 people2009 : 2.000.000 people

in Italy?

in South Tyrol?

NUMBER OF SERVICES 2015- COMPRESSION THERAPY- WOUNDCARE- ..

4.252

14.314

1085

n 19.651

COMPRESSION THERAPY

COMPRESSION THERAPY

Service (number) Dermatology General Surgey Vascular Surgery

Compression therapy 13.587 1.609 603

Unnas boot 3.708 144 /

Total 17.295 1.753 603

General Surgery212

Vascular Surgery107

General Surgery54

General Surgery111

General Surgery65

General Surgery150

General Surgery95

VEIN SURGERY (CVI)

VEIN SURGERY AND VENOUS LEG ULCER

General Surgery27

(+other dep. 2)

Vascular Surgery110

(+other dep. 34)

General Surgery2

(+other dep 2)

General Surgery13

(+other dep. 6)

General Surgery34

(+other dep. 32)

General Surgery1

General Surgery2

Number (n) of hospitalizations for ARTERIAL LEG ULCERS

Dermatology218

Dermatology1229

Dermatology56

Vascular Surgery2239

Dermatology2945

General Surgery180

Total: 2401

Dermatology1859

WOUNDCARE

General Surgery4115

General Surgery307

General Surgery24

Dermatology828

14.070

Dermatology55Dermatology

5

Vascular Surgery116

Dermatology3

Negative Pressure Wound Therapy

General Surgery18

n 3

n 3

n 49

n 12n 1

Number of Hospitalizations (n)

DIABETIC FOOT ULCERDiabetes Type 2:Prevalence 4,1%Mean age: 69,4 years

www.provincia.bz.it Osservatorio epidemiologico, relazione salute 2015

http://www.provincia.bz.it

DiabeticCenter

Service Number

Podiatric treatmentsWoundcare

4562

Vasc and Thorc Surg Service Number

MeasurementTcpO2

484

ECD 2685

OUTPATIENT TREATMENT

DIABETIC FOOT ULCER

Compression Therapy and WoundcareCOMUNITY NURSING SERVICE

Advanced Woundcareand/or Compression

therapyn 13.819

Community nursing service (19)Center of support (14)

Compression therapy and Woundcare

NURSING SERVICE AT HOME

Advanced Woundcareand/or Compression

therapyn 27.973

Community nursing service (19)Center of support (14)

HOW do we manage leg ulcersin South Tyrol?

Woundcare - Outpatient department

2015

VENOUS ULCERS 21 (14,5%)

ATERIAL ULCERA 54 (37,7%)

MIXED 16 (11,2%)

DIABETIC FOOT 52 (36,6%)

Ischemic 12

Neuropathic 10

Mixed 30

Total 143

LEG ULCER ETIOLOGY

VENOUS (70%)

ARTERIAL (10%)

MIXED (10%)

OTHER (10%)

06/10/2010

25/10/2010

9,43 cm2

0,24 cm2

Society for Vascular Surgery and The American Venous Forum,

Gloviczki P., Comerota A.J., Dalsing M.C. et al, J Vasc Surg Volume 53, Issue 5, Supp ,

Pages 2-48, 2011

Management of venous leg ulcers: Clinical practice guideliens of the SVS and the

American Venous Forum Suppl. Aug 2014

Deutschen Gesellschaft fr Phlebologie, der Deutschen J Vasc Surg Gesellschaft fr Gefchirurgie, des Berufsverbandes der Phlebologen e.V. und der Arbeitsgemeinschaft der niedergelassenen Gefchirurgen Deutschlands e.V.*, H.G. Kluessa . ,T.

Noppeney . ,F.X.Breu et al, Phlebologie (641), Gefaesschirurgie (657) 2009

Linee guida flebo-linfologiche SIF SICVE Minerva Cardioangiol. Aug 2016

Diagnostik und Therapie des Ulcus cruris venosum, DGP AWMF 2008

SIGN Scottish Intercollegiate Guidelines Network . Managament of chronic

venous leg ulcers. A national clinical guideline. 2010

Cochrane Collaboration Library. Systematic reviews topic Wounds:Venous

ulcer Heart&Circulation:Varicose veins 2004-2014

Deutsche Gesellschaft fr Phlebologie, Leitlinie

2004; American Society fpr plastic Surgeons.

Evidence based clinical practice guideline 2007

Guidelines for management of wounds in patients

with lower-extremity arterial disease, WOCN 2008

Diabetic foot disorders:a clinical preactice guideline.

American College of foot and ankle surgeons 2006

Deutsches Institut fuer Wundheilung. 2007

Linee guida SIF SICVE 2016

16.08.2011Compression therapy

Antibacterial dressing

30.08.2011

Hydrofiber + Silver

8.09.2011

Stockings (II)

Antibiotics

Hydrofiber + Silver

8.11.2011

HEALED

20.09.2011

4.10.2011

+ HA with collagenase

Patient and ulcer oriented management plan

Chir Ital. 2008 Jul-Aug;60(4):563-6.Leg ulcer: proposal of a new method for comparing different wound dressingsEbner H1, Zaraca F, Ebner JA, Stringari C.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Ebner%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Zaraca%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Ebner%20JA%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Stringari%20C%5BAuthor%5D&cauthor=true&cauthor_uid=18837258

Group A

mm2

Group B

mm2P

1 size 704 778 779 912 0,379

After 35 days 209 210 168 199 0,06

After 50 days 118 174 56 112 0,17

Chir Ital. 2008 Jul-Aug;60(4):563-6.Leg ulcer: proposal of a new method for comparing different wound dressingsEbner H1, Zaraca F, Ebner JA, Stringari C.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Ebner%20H%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Zaraca%20F%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Ebner%20JA%5BAuthor%5D&cauthor=true&cauthor_uid=18837258http://www.ncbi.nlm.nih.gov/pubmed/?term=Stringari%20C%5BAuthor%5D&cauthor=true&cauthor_uid=18837258

Multicenter study

In Italy of the patients cant afford the costs of woundcare!

A SPECIAL THANK TO . . .

Community nursing center (Coord. F. Dapr, Dr. G.Grber)

Controlling center of the Hospital of Bruneck (Dr. J.Zingerle)

Controlling center of the Hospital Meran (Dr. M.Pfitscher)

Departement of Dermatology Bozen (Prof. DDr. K.Eisendle)

Department of Dermatology Bruneck-Brixen-Sterzing-Innichen (Dr.ssa C.Nobile)

Department of Dermatology Meran (Dr. P.Zampieri)

Department of General Surgery Meran (Dr. Gruber)

Epidemiologic observatory Province of Bozen (Dr.ssa C.Melani, Dr. R.Picus)