Limb Salvage

By Dr. Mark Hinkes, DPM Twenty first century technology is helping people with diabetes to heal foot ulcers. An Australian colleague, for example, is developing an application that reminds people with diabetes to control their blood sugars with prompts and instructions, and allows them to upload a picture of their wound for their podiatrist to evaluate.

By Aletha Tippett MD In considering this question as to whether amputation can be palliative, let’s keep clear that these are two separate subjects that sometimes interact. It is key to always keep our goals in mind. What is the goal in palliative care? The goals are to provide comfort, relieve pain, prevent infection, and improve or maintain quality of life. These goals are always to be in concert with the desires and wishes of the individual patient.

By Aletha Tippett MD There has been a very interesting and disheartening development in the past two years. My practice has always had a small private wound care clinic, and we have always been busy with referrals from local physicians. But lately those referrals have evaporated, the reason being that the local physicians have become part of larger hospital-based systems. So now if they have a wound they refer it to the hospital wound center that is a part of their system.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Diabetic foot ulceration can lead to significant morbidity and mortality and is probably one of the most-feared complications of diabetes. Loss of limb (amputation) is a frequent outcome of diabetic foot ulceration.

Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic lower-limb amputations in the US. Although already high, the rate of amputation is increasing.

By the WoundSource Editors A vast percentage of wounds become chronically stalled because of mixed etiology and other underlying comorbid medical conditions. This means the wound is multifactorial, and using a singular approach won’t be enough. Lower extremity wounds, for example, can have diabetes, venous and arterial issues, and pressure all as factors playing into the same wound.

By Christine Miller, DPM, DMM, PhD, FACCWS One of the gratifying aspects of being a wound care physician is the ability to develop such rich relationships with our patients. The frequent and consistent contact with the same provider lays a strong foundation of open communication and trust. I work in an urban safety net hospital’s ambulatory care center, which sees a high volume of high-acuity patients. It is not uncommon for me to see patients with venous leg ulcerations with concomitant uncontrolled hypertension or diabetic foot ulcerations secondary to uncontrolled blood glucose levels. Patient education is a vital part of my clinical encounters, particularly focusing on the systemic nature of wound healing. I always emphasize that while we are treating your wound, it is the full body well-being that is needed for ultimate success.

By Lydia Corum RN MSN CWCN The times are changing in the world of wound care. There used to be a time when there were no problems with reimbursements, as long as the doctor wrote the order. Today, the Centers for Medicare & Medicaid Services (CMS) regulations confuse clinicians and make the world of healing wounds much more difficult. The changes are in the area of denials with not enough information given for choosing dressings, use of negative pressure therapy and hyperbaric oxygen therapy. Are all these changes needed? Why are these changes happening? What can hospitals and wound clinics do to make things better?

By Aletha Tippett MD I have written about so many things over the past years… Maybe now is a good time to announce that I am writing a book called Hear Our Cry, an autobiographical story about 20 years of wound care and limb salvage. The process has had quite an impact on me, reviewing all the pictures and notes from my wound patients from the past two decades.