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
Unna’s 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
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 für Phlebologie, der Deutschen J Vasc Surg Gesellschaft für Gefäßchirurgie, des Berufsverbandes der Phlebologen e.V. und der Arbeitsgemeinschaft der niedergelassenen Gefäßchirurgen 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 für 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.
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.
Multicenter study
In Italy ¾ of the patients can’t afford the costs of woundcare!
A SPECIAL THANK TO . . .
Community nursing center (Coord. F. Daprà, Dr. G.Gröber)
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)
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