Cath Lab Digest

   As Dr. Fife notes, the key to caring for heel pressure ulcers is knowing the patient’s vascular status. If patients have adequate vascular status, she says they are candidates for any aggressive interventions in your armamentarium. In her clinical experience, Dr. Fife has found negative pressure wound therapy effective when one uses it after the debridement of heel pressure ulcers.

   If patients do not have adequate vascular status, “then all your interventions are doomed to fail,” emphasizes Dr. Fife.

    “You might end up just prolonging the inevitable (an amputation), creating unrealistic expectations for the family and increasing the likelihood of the development of osteomyelitis.”

   She adds that heel pressure ulcers represent a significant litigation risk for wound care clinicians because they can result in amputation.

   Dr. Fife emphasizes that one must assess vascular status early on in the evaluation of the patient. She says the patient and the family should have a clear understanding of the vascular situation and the likely outcome of the ulcer from the first visit.

   When it comes to patients with heel ulcers, Dr. Brietstein’s philosophy consists of directing treatment conservatively unless the patient is well perfused, has osteomyelitis or advanced soft tissue infection, which could lead to sepsis.

Dr. Brietstein is a Clinical Professor in the Department of Geriatrics at Nova Southeastern College of Osteopathic Medicine in Davie, Fla. He is the Clinical Director of the University Hospital Wound Healing Center in Tamarac, Fla. He is a member of the Editorial Advisory Boards of WOUNDS and Ostomy/Wound Management.
Dr. Fife is an Associate Professor in the Department of Medicine, Division of Cardiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.
Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.