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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

Wound Care and Limb Salvage

St. Luke’s – Roosevelt Hospital Center

goals
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
how we achieve these goals
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
outcomes of aggressive intervention
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%
wound care team
Wound care team
  • Speeds time to recovery
    • Integrates different experience
    • Integrates different perspectives
    • Provides increased continuity
    • Decreases contradictory treatment application
wound care team8
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
application of the team concept standardized formulary
Application of the Team Concept/ Standardized Formulary
  • Further sub-specialization
    • Diabetic foot team
    • Amputation team
    • Decubitus team
        • Stoma team
standardized formulary
Standardized Formulary
  • Allows for less caregiver and patient confusion
  • Decreases cost
  • Decreases lapses in therapy once initiated
  • Improves time to recovery ?
specific team requirements
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)
specific team requirements12
Specific team requirements
  • Amputation Team
    • Nurse specialist - VNS liason
    • Nutritionist
    • Physical therapist - Outpatient liason
    • Podiatrist
    • Prosthetist
    • Vascular / Orthopedic surgeon
    • Social worker
    • Psychologist
novel approaches and clinical trials
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