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Wound Care and Limb Salvage

Wound Care and Limb Salvage. St. Luke’s – Roosevelt Hospital Center . Goals. Retain limbs Minimally invasive and invasive therapy Aggressive treatment of wounds Wound care team algorithms Clinical trial access Cutting edge therapeutic interventions Aggressive rehabilitation services.

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Wound Care and Limb Salvage

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  1. Wound Care and Limb Salvage St. Luke’s – Roosevelt Hospital Center

  2. Goals • Retain limbs • Minimally invasive and invasive therapy • Aggressive treatment of wounds • Wound care team algorithms • Clinical trial access • Cutting edge therapeutic interventions • Aggressive rehabilitation services

  3. How we achieve these goals? • Aggressive attempts at limb salvage • Using a combination of techniques • When a wound is inevitable • Inpatient wound care team • Outpatient wound care team • Standardized formulary • Individualized plan for each patient

  4. Invasive surgical options

  5. Minimally invasive techniques

  6. Outcomes of Aggressive intervention • 5 year 1° patency – 65 to 70 % • 5 year 2° patency – 80 to 85 % • 5 year limb salvage – 85 to 90%

  7. Wound care team • Speeds time to recovery • Integrates different experience • Integrates different perspectives • Provides increased continuity • Decreases contradictory treatment application

  8. Wound care team • Allows for better development and application of algorithms • Aids in patient and caregiver education • Provides for equal voice from various care backgrounds • Much easier to implement preventive strategies

  9. Application of the Team Concept/ Standardized Formulary • Further sub-specialization • Diabetic foot team • Amputation team • Decubitus team • Stoma team

  10. Standardized Formulary • Allows for less caregiver and patient confusion • Decreases cost • Decreases lapses in therapy once initiated • Improves time to recovery ?

  11. Specific team requirements • Diabetic foot • Diabetologist- Inpatient and Outpatient • Nurse specialist - VNS liason • Nutritionist • Physical therapist - Outpatient liason • Podiatrist • Prosthetist • Social worker • Vascular surgeon (Team leader)

  12. Specific team requirements • Amputation Team • Nurse specialist - VNS liason • Nutritionist • Physical therapist - Outpatient liason • Podiatrist • Prosthetist • Vascular / Orthopedic surgeon • Social worker • Psychologist

  13. Novel approaches and clinical trials • Growth factor studies • Vacuum Assisted Closure Device studies • Drug eluting stent trials • At present seven active clinical trials focused at these problems • Multidisciplinary plan of care

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