In any chronic wound, one of the first evaluations to be performed is to determine if there is enough blood flow for the wound to heal. We examine the blood flow of the extremity by one of two techniques. The first is the use of the hand-held Doppler with a print out. This method detects blood flow through the arteries of the lower leg and toot, printing out the flow waves to evaluate. By carefully listening to the Dopple sounds over each artery, and examining the flow waves, a good determination of the adequacy of blood flow is performed. By additionally measuring the blood pressure over the ankle and foot arteries, and the blood pressure in the arm, an Ankle-Brachial-Index (ABI) can be determined, which gives the physician an objective number to determine whether the wound has adequate flow for healing, or may need a vascular surgery consultation.
We also make use of a Laser-Doppler Monitor, which is an even more sensitive method of determining blood flow. This makes use of Laser technology on the lower leg, foot, or toe, to determine the blood pressure when the first red blood cells flow by the laser when a blood cuff is slowly released. Again this helps determine whether to expect wound healing, or to consult with our vascular surgeons.
Advanced Wound Care and Dressings
Many patients with skin ulcers, burns and other types of wounds face difficulty with the healing process for these troubling wounds, especially if the patient is diabetic. There are several different treatment options available for wounds resistant to conventional therapies. Some of these may include creams, ointments, synthetic skin grafts and other therapies that promote natural healing within the skin to avoid wound complications.
At our center, we are proud to offer patients many advanced solutions to their wound healing problems. It is important for wounds to remain clean and free of debris and bacteria in order to properly heal and prevent infection, so proper dressings that are changed on a regular basis are essential. We provide a clean, moist environment that is conducive to healing for most wounds and helps lead toward a quick and efficient recovery.
Apligraf is a skin repair therapy that uses natural ingredients found in healthy human skin to heal difficult wounds such as diabetic foot and venous leg ulcers that have been unresponsive to traditional healing therapies after three to four weeks. Unlike wound therapies that are administered as a cream or traditional dressing, Apligraf wound therapy looks like a thin piece of real skin and is placed directly over the wound to stimulate the skin to repair and heal itself by delivering growth factors, cells, nutrients and proteins directly into the wound.
The Apligraf treatment contains an outer layer of protective skin cells and an inner layer of cells, just like your natural skin. Once applied to the wound, the Apligraf substance is covered with a non-adhesive dressing and then wrapped with other dressing to keep Apligraf in place and promote healing in a clean and moist environment. Apligraf offers patients effective results with no major side effects because of its natural consistency.
Dermagraft is a dermal substitute used to treat diabetic foot ulcers that extend through the dermis and have not healed in over six weeks. Made of human fibroblast cells derived from newborn foreskin tissue, these cells are then applied to a mesh scaffold and filled in with human dermal collagen, growth factors and other living cells. The Dermagraft substitute is distributed in a frozen form to preserve the living cells that act as a dermal substitute for the targeted wound.
When combined with traditional therapies, Dermagraft heals more chronic ulcers than with traditional therapy alone, and is effective for ulcers located anywhere on the foot. It helps to effectively restore the dermal bed and promote proper healing of the wound. After being applied to the wound, the Dermagraft substitute is protected with traditional dressings and applied on a weekly basis until the ulcer is healed.
An example of other advanced wound care products includes skin grafts processed from human placental tissue (Epifix), a dressing derived from porcine urinary bladder which has been demonstrated to act as both an extracellular matrix and also attract stem cells to the wound, many dressings derived from bovine collagen, many dressings which incorporate various substances intended to kill bacteria or to inhibit their growth.
Debridement In Office
Debridement removes dead tissue from ulcers, burns and other wounds to promote the healing process and reduce the risk of infection. When dead tissue on a wound is exposed to air, it forms a hard crust called an eschar that can hinder healing and lead to bacteria, infection and abscesses. While debridement seems beneficial to the healing process, not all wounds need this procedure. Some wounds can benefit from a hardened, stable crust of dead tissue, while others may have an insufficient blood flow if debridement is performed.
Debridement can be performed through surgical, mechanical, chemical or autolytic methods, depending on the health and severity of the wound. Surgical debridement is the quickest and most efficient type of procedure, which involves the use of a scalpel, scissors or other instrument to cut dead tissue from a wound. Other methods may include applying chemicals or special dressings to the wound for a certain period of time to allow dead tissue to be removed.
We have recently added an Ultrasonic Debridement System to our armamentarium. The system converts standard wall voltage to a 22.5 KHz electrical signal. The handpiece, using highly efficient piezoelectric crystals, converts the electrical signal to mechanical vibrations. The probe amplifies the mechanical vibration and transfers the acoustic energy into the tissue, via direct contact. The resulting cavitation, mechanical and hydrodynamic effects produce tissue disruption, fragmentation and emulsion in the wound bed, and bacterial destruction as well.