Current Perspectives On Dressings, Tunneling Wounds And Infected Ulcers

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Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

Offering insights on dressing dispensing and obtaining a level of debridement with dressings, these panelists also share their thoughts on wounds ranging from deep tunneling wounds to infected ulcerations in the lower extremity.

Q:

Do you use mail order delivery or dispense dressings from your office to your patients?

A:

Kazu Suzuki, DPM, CWS, uses Byram Healthcare, a medical supply company that supplies wound dressings by billing Medicare and co-insurances. He adds that other companies provide similar delivery services. Dr. Suzuki says this is an option for patients who do not want home health services and prefer to change their dressing themselves. He does not dispense dressings in the office, calling it “bothersome to take inventory and keep records for the sales tax purpose.”

   John Steinberg, DPM, says mail order delivery services “provide great flexibility” in getting patients their dressing materials. He notes the medical assistants do most of the administrative work in ordering and then he signs off on the home delivery orders. “For the most part, these have been efficient and well received,” he notes.

   Desmond Bell, DPM, does not dispense durable medical equipment (DME) products directly. His practice had obtained a DME provider license a number of years ago but in running a small solo practice at the time, he decided not to dispense products. The main reason for this decision was the administrative time he needed to process the paperwork and other regulatory issues. Dr. Bell began using several DME companies to supply his patients with dressings. “The home delivery works well and it has been a ‘win-win’ for us,” he comments.

Q:

What do you use when you want to achieve debridement function with dressings?

A:

The majority of Dr. Steinberg’s debridement is with sharp instrumentation at the time of the visit and he generally repeats this every week or two.

   Throughout his career, Dr. Bell has used enzymatic agents as an adjunctive to surgical debridement of devitalized tissue. He notes any moisture retaining dressing should provide the additional benefit of autolytic debridement when one uses it properly. The autolytic debridement benefit crosses over categories of dressings so he says products including hydrogels, alginates and hydrocolloids can assist in the debridement process. If additional debridement is needed between visits or if the site is too painful for sharp debridement, Dr. Steinberg uses enzymatic debridement, applying collagenase topically with a dry dressing daily.

   Dr. Suzuki has been using a lot of medical honey dressing (TheraHoney Gel, Medline), which comes in gel and impregnated gauze, for topical debridement of wounds. He used to use a lot of Santyl collagenase ointment but notes the company increased its price this year. For a cheaper alternative, Dr. Suzuki suggests applying a hydrogel or hydrocolloid to the wound and creating an occlusive environment. He notes the human body naturally produces proteases and collagenase, which “debrides” the wound naturally and slowly.

Q:

What do you use when you see a deep tunneling wound?

A:

In some instances, Dr. Bell says negative pressure wound therapy (NPWT) is highly effective for deep tunneling. Dr. Suzuki also considers NPWT first for deep tunneling wounds.

   Dr. Suzuki uses VAC Therapy (KCI), SNaP (Spiracur) and Pico (Smith & Nephew) devices, saying each product has strengths and weaknesses. He will pick what is most appropriate for the particular wound. For example, Dr. Suzuki notes the disposable NPWT devices, such as SNaP and Pico, are definitely lighter than VAC therapy, and may be more appropriate if his patient is a frail person with a fall risk.

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