Wound Care Q&A
Heel pressure ulcers can be particularly challenging for podiatric physicians, given the risk of complications, offloading challenges and the compromised vascular status of high-risk patients. Accordingly, our expert panelists share their perspectives in providing wound care for these patients.
Q: How do you dispense offloading devices for pressure ulcers of... Read More.
Having effective and thorough documentation methods can enhance outcomes, improve efficiency and help reduce hurdles to timely reimbursement. These panelists draw on their experience to discuss exactly what one needs to document in charts and how to use technology to make documentation easier.
Q: What are the recommended methods for the wound care documentation?
A: In addition... Read More.
Establishing a wound care clinic can be a rewarding part of practice. These panelists draw on their wound care experience to discuss the essential clinical tools you need and also emphasize the importance of developing strong referral sources to help facilitate optimal outcomes for patients.
Q: What are the basic and bare minimum treatment modalities and tools you use daily in... Read More.
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Many leading researchers and wound care practitioners have shown that one of the most important elements in treating wounds is performing regular debridement of tissue (such as eschar) which interferes with wound healing. Timothy Shea, DPM, says the standard approach is to initially debride eschar (and other non-viable tissue) until you get down to good viable tissue and do subsequent debridement... Read More.
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The array of wound care products can be quite astounding. Choosing the right product(s) for your patient can be difficult. With this in mind, our panelists, strongly emphasizing case-by-case management, share their experiences, success stories and caveats with certain wound care products. Read on for what five expert panelists had to say about treating neuropathic ulcers, when to use growth... Read More.
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Many patients with non-healing ulcers are already in significant pain prior to surgery. Many of these patients will require escalating doses of pain medications following surgical debridement and grafting. Some will already have developed tolerances to pain medications. So, what do we prescribe to control their pain? More importantly, what can we prescribe and still maintain a level of comfort... Read More.
Even if a wound appears to be benign, one must obviously be vigilant against the possibility of malignancy. These expert panelists discuss identifying malignant wounds, taking biopsies and when one might consider an amputation.
Q: What clinical insights lead you to suspect that a lower extremity wound may have an underlying malignancy?
A: M. Joel Morse, DPM, suspects malignancy if a wound does... Read More.
Patients with venous ulcers can face daunting complications. Accordingly, our expert panelists provide pertinent pearls on diagnosis, compression therapy, debridement and how their patients have fared with vascular surgery procedures.
Q: How do you approach/work up the patient with a chronic venous ankle ulcer? Is there any need for venous ultrasound studies?
A: Kazu Suzuki, DPM, CWS, says many... Read More.
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While there is not an overwhelming amount of literature on hyperbaric oxygen therapy (HBO), the recent decision by the Centers for Medicare and Medicaid Services (CMS) to cover the use of HBO in treating diabetic foot wounds has fueled new discussions on the potential efficacy of the modality. With this in mind, our panelists discuss their experiences in using HBO, the current literature on the... Read More.
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Plastic and reconstructive surgery techniques can be a significant adjunct for podiatric surgeons in managing diabetic foot wounds and tissue loss. With this in mind, the panelists discuss a variety of techniques (including split-thickness skin grafting and muscle flaps) and indications for chronic ulcers, the neuropathic foot and pressure-induced heel ulcerations.
Q: When do you consider... Read More.
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Neuropathic ulcers can be extremely problematic for diabetes patients and podiatrists alike. Exploring the ins and outs of surgical treatment, our expert panelists take a closer look at specific ulcers, helpful techniques, the merits of preoperative vascular testing and postoperative protocols.
Q: Do you perform prophylactic diabetic foot surgery? If yes, what are the common types of situations... Read More.
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As Aristidis Veves, MD and Thanh Dinh, DPM, point out, it is well-known that the chronic diabetic foot ulcer is stuck in the inflammation phase of the wound healing cycle. Research studies have shown that non-healing wounds may have specific biochemical imbalances, notes Liza Ovington, PhD. In particular, non-healing wounds have been shown to have excessively high levels of proteolytic enzymes... Read More.
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