BrattleboroCitizensBreakfast

February20,2015GibsonAikenCenter

CenterforWoundHealing
BrattleboroMemorialHospital
http://www.bmhvt.org/centerforwoundhealing
8022753674

Presenter:FrederickHarrison,ProgramDirector
fharrison@bmhvt.org
4136634237(mobile)

TheBMHCenterforWoundHealingprovidesspecializedtreatmentfornonhealing,chronic
woundsorwoundsthathavenotsignificantlyimprovedfromconventionaltreatments.

Fredprefacedhisremarksbynotingthatheservesinanadministrativerleandtherefore
cannotgivemedicaladvice.TheCenterisstaffedbyasdiversepanelofphysicians,Gregory
Gadowski(Surgery),WilliamVranos(Orthopedics),CarolynTaylorOlson(PCP),George
Idelkope,
AmyGadowski
(Hospitalist/PrimaryCare),FredLandes(ER)andRemeDamasco
(InternalMedicine).Thepanelfunctionsasateam,talkingwitheachother.

TheWoundCenterisnotanacutecaresite.Ifyou'vecutyourselfandneedimmediate
treatment,gototheEmergencyRoomtostabilizethewound.TheCenterdoesnottreat
woundsthatareselfhealing.Itaddressesnonhealingwounds,whicharedefined,asa
generalrule,asthosewoundsthatdonothealinthree(3)weeks.Ifthewoundisnothealing
inthattime,thereisanunderlyingcause.Thosearethepatientsthatneedtobeseenatthe
Center.Don'tignorethesymptoms.

Diabeticulcers
:

Thereare26millionType2diabetespatientsintheUS15%experience
diabeticulcers.Becauseofcardiovascularissues,theseulcerstonothealontheirown.Lack
ofbloodfloworoxygentothewoundistheprimaryreason.

Venousinsufficiency
:Thisisaconditioncausedbypoorcardiofunctioningresultingin
insufficientsupplyofbloodtotheextremitiesandthereforewoundsnothealing.

Pressurewounds
:Thesewoundsareduetoneuropathynervedamagethelackoffeeling
intheextremities.Normally,ifone'sfootisinjured,onelimps,favoringtheinjuredfoottoallow
healing.Ifthereisnosensationinthefoot,onewouldcontinuetowalkontheinjuredfoot.

TheCenterhasagoodrecordofhealing:a93%healingrate.Themediandaystohealis30
days.

ThethingsthattheCenterdoestoaddressthelackofbloodsupplytoawound:

Debridement
:Thisistheremovalofdebristoclearapathforcapillarygrowth.Thereis
surfacedebridementanddeeperlevels:excisionalandsurgical.

OffLoading
:Inthecaseofneuropathy,offloadingconsistsofusingvacuumcastsortotal
contactcaststoshiftthepressureawayfromtheinjuredarea.

Hyperbaricchamber
:Thistypeofoxygenchamberwasoriginallyusedtotreatthebends,to
getnitrogenoutoftheblood.Itisusedforabout2%ofwoundpatients.Oxygensaturatesthe
woundatoneatmosphereofpressure.Theuseofthechamberissometimesreferredtoas
divingthepatient,becauseinscubadiving,adiveof33istwoatmospheresofpressureand
66isthreeatmospheres.Theincreaseinoxygensaturationisabouttentimestheusual.The
patientisplacedonaslideandentersaglasstubeandstaysinthechamberforonehourfor
thetreatment,withadditionaltimeofabout15minutesforenteringandexiting.Thetreatment
isappliedfivetimesaweekfor30days.Thereare
specificindicationsandconditions
under
whichMedicaremayreimbursehyperbarictherapy.Thetherapyhasbeenthesubjectof
scientificresearch.1

ThedoctorsattheWoundCenterarespecificallytrainedandcertifiedinthisfieldandfollow
some136clinicalpracticeguidelinesderivedfromworkbythe
MayoClinic
,the
Cleveland
2
Clinic
and
JohnsHopkins
,amongotheracademicinstitutions.

Indiabetics,ulcerscanmetamorphosizeultimatelyresultinginamputations65,000to90,000
amputationsarebecauseofdiabetes.Therearealsoqualityoflifeissuespostamputation.
Themortalityratefordiabeticamputees5yearspostinitialamputationisapproximately65%.
Iftheulceriscaughtearlyenough,amputationcanbeprevented.

Ifthereisonetakeawayfromthispresentation,Fredsaid,itshouldbethatanonhealing
woundisasymptomofsomething,suchasdiabetesorsomeotherphysicalcondition,so
"pleasedon'tignoreit"ifanopenwoundisnothealing,itneedstobeaddressed.

HyperbaricoxygentherapyUSNationalLibraryofMedicine,NationalInstitutesofHealth,Oct24,1998
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114115/
HyperbaricoxygentherapyforchronicwoundsTheCochraneLibrary,Apr18,2012
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004123.pub3/abstract
HyperbaricoxygentherapyfortreatingacutesurgicalandtraumaticwoundsTheCochraneLibrary,Dec.
16,2013
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008059.pub3/abstract
cf::"Hyperbaricoxygentherapyinthemanagementofdiabeticlowerlimbwounds",
SingaporeMedJ
2008
49(2):105
http://www.ranri.org/Articles/4902a2.pdf
2
alsosee:Healogics:
http://www.healogics.com/WoundCareResourceCenter/patients