June 2013

Danielle Chicano, Editorial Associate

DPM Recalls The Terror At The Boston Marathon

By Danielle Chicano, Editorial Associate

“Just as we were peaking, when the bulk of the runners were coming in (the medical tent), that’s when all hell broke loose,” explains Howard Palamarchuk, DPM, as he recalls the moments surrounding the first blast at this year’s Boston Marathon.

   Having attended the Boston Marathon as a medical volunteer for the past 28 years, Dr. Palamarchuk expected to see your run-of-the-mill, sports medicine injuries at this year’s marathon.

   “(I expected) a lot of blisters — draining blisters — different skin injuries to the feet, sock abrasions, plantar fasciitis and possible stress fractures,” notes Dr. Palamarchuk, the Director of Sports Medicine at Temple University’s School of Podiatric Medicine.

   However, at 2:50 pm, the unexpected occurred.

   When the first bomb went off near the finish line, Dr. Palamarchuk assumed a propane tank had exploded or that it was a howitzer blast “like they fire at Army-Navy games.”

   “It had that kind of boom but it was a lot louder. You could feel the concussion, you could feel the shake—the ripple effect,” recalls Dr. Palamarchuk. “Shortly after, you heard the second (blast). Then you knew, ‘Oh my God, this is something bad.’”

   Dr. Palamarchuk and 10 students from Temple University’s Sports Medicine Club had been inside the medical tent approximately 30 yards from the finish line during the blasts. Through monitors inside the tent, Dr. Palamarchuk and his students saw the finish line “area torn up with people on the ground and the crowd barriers knocked down into the course.

   “First, you fear for your own safety,” he recalls. “You don’t know if you’re under attack or not. Is the next one coming? Will there be a third bomb?”

   Despite the fear and uncertainty, emergency responders, medical professionals and volunteers sprung to action offering help in any way they could, explains Dr. Palamarchuk.

   Doctors, emergency medical personnel and trauma nurses rushed to the finish line to triage those wounded while Dr. Palamarchuk and his students remained in the tent tending to the “walking wounded,” those who were transported in wheelchairs or carried to the medical tent, and those who were allowed to walk to the treatment tables nearby.

   The supply cart near the podiatric section of the tent was vital to their wound care efforts as most of what Dr. Palamarchuk and his students encountered were shrapnel wounds.

   “We would do a quick cleaning and assessment. A lot of it was assessment to see if (the injured) were wounded anywhere else,” explains Dr. Palamarchuk. “The idea was that we were able to assist while the critically wounded were loaded (onto ambulances).”

   Dr. Palamarchuk notes EMS personnel promptly brought the most critically wounded through the medical tent and to the ICU area for transport to the hospital while police and SWAT teams surrounded the tent.

   “What you saw in photos is what we saw in person,” Dr. Palamarchuk explains, recalling some of the more serious and traumatic injuries. “You’re wondering how that person could still be conscious. There was no crying, no hysterics, just complete shock.”

   Dr. Palamarchuk notes he and his students worked for 30 to 40 minutes before police evacuated the area. He is proud of the students. “We assisted the EMS (personnel). My students were all involved. Nobody stood around. Everyone was involved,” recalls Dr. Palamarchuk.

   Following the evacuation of the area, he recalls a very somber and surreal mood. Once a day of pride and elation, there was an aura of fear and distress for those involved with the marathon.

   “No one can ever tell you who won the race or what their time was,” says Dr. Palamarchuk. “That will all be forgotten. The joy of the race was lost.”

   Despite the tragic events at this year’s marathon, Dr. Palamarchuk maintains that he will be in attendance next year to continue the tradition.

   “It’s a duty. We’ve done it all these years,” he adds. “You know the race will go on.”

Study Finds Favorable Results With Apligraf For Venous Ulcers

By Brian McCurdy, Senior Editor

A recent oral presentation gives high marks to a living cell-based treatment for the treatment of venous leg ulcers.

   Organogenesis presented the study on its Apligraf product at the Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) meeting. The retrospective analysis focused on 1,489 patients with venous leg ulcers treated over a three-year period. Study authors note that 1,187 patients with 1,451 ulcers received Apligraf while 302 patients with 350 ulcers received a non-interactive collagen wound dressing.

   At 36 weeks, Apligraf healed 61 percent of wounds in comparison to 46 percent of wounds that had the dressing, according to the study. The study also notes that Apligraf healed wounds 44 percent faster and over a three-year period, wounds treated with Apligraf demonstrated an increased probability of healing of 29 percent.

   Paul Kim, DPM, MS, uses Apligraf regularly and has used it specifically for venous ulcers. He emphasizes that the keys to the success of any biologic product are proper wound bed preparation and addressing the underlying cause of the wound. Dr. Kim has seen a positive response when using Apligraf to treat diabetic and venous ulcers.
Dr. Kim questions the study’s comparison of Apligraf to a dressing.

   “Dressings do not heal wounds,” says Dr. Kim, an Associate Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. “They facilitate the removal of detritus and exudate, and form a barrier to the external environment. Therefore, you cannot compare the function of Apligraf to that of wound dressings.”

   Still, Dr. Kim calls the study results “very interesting,” saying retrospective studies such as this “are more clinically relevant (than randomized controlled trials) because they are inclusive of the kinds of patients and wounds we actually treat.”

In Brief

Shire Regenerative Medicine recently announced at the SAWC Spring/WHS that it is providing the Association for the Advancement of Wound Care (AAWC) with an unrestricted grant for fellowships that will advance the science of wound care.

   The $100,000 grant will be split to sponsor two individual fellowships for the 2014-2015 academic year, according to Shire Regenerative Medicine. The AAWC will administer the fellow selection process and the company notes each fellowship will be open to DPM, MD and DO candidates throughout the United States. Shire Regenerative Medicine adds that the grant will support a post-residency or fellowship program that focuses on multidisciplinary wound healing and tissue preservation. The AAWC will accept applications for the fellowship grants through 2013 and the selections of fellows and their programs will occur by March 2014.

A recent study found elevated protease activity in nearly half of the wounds (43 percent) that had skin graft failure.

   According to Systagenix, the findings from the 30-patient study, which was presented at the European Wound Management Association conference in Copenhagen, Denmark, revealed that three out of four split thickness skin grafts failed in wounds that tested positive for elevated protease activity immediately prior to clinicians performing the graft procedure.

   Systagenix says these findings confirm that elevated protease activity is a highly predictive marker that could help surgeons target skin graft procedures more effectively and also support the use of the company’s Woundchek Protease Status product. Systagenix notes this product is not currently approved by the FDA in the United States.

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