2016: wound care: nuts and bolts - broder
TRANSCRIPT
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WOUND CARE: NUTS AND BOLTS
Kevin Broder, MDTelemedicine & Wound Director, San Diego GWEPTelehealth Director, Department of SurgerySection of Plastic SurgeryVA Medical Center – San Diego, CA
December 4, 2016
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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ADJUNCTS TO WOUND HEALING
• Negative Pressure Wound Therapy• Acellular and Cellular Based Wound Therapies
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPY
• Advantages– Occlusive – maintains
moist wound environment– Increase blood flow– Decrease edema– Decrease bacterial
contamination– Promote wound contraction– Less dressing changes– Less pain
• Contraindications– Fresh blood vessel repair– Malignancy– Untreated osteomyelitis
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPY
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPY
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPY
• A 57-year-old paraplegic woman
• Right hip trochanteric Stage IV pressure ulcer down to the level of exposed bone
• I&D with flap reconstruction
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPY
• Delayed Wound Healing
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 9 Weeks
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ACELLULAR-BASED THERAPY
• Acellular Matrices
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Porcine Small Intestinal Submucosa
Dermal Regeneration Matrix - Meshed acellular bovine collagen, glycosaminoglycan, silicone
Human Dermal Allograft
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• A 66-year-old male with T5 ASIA C paraplegia• Stage 4 left ischial pressure ulcer• Type 2 diabetes• Active smoking• Malnutrition• Lives at home with attendant care• Skin defect dimensions of 8x8 cm• Wound depth 5 cm to the level of exposed bone• Refused Flap Reconstruction
ACELLULAR-BASED THERAPY
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ACELLULAR-BASED THERAPYINITIAL PRESENTATION
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
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• Smoking Cessation• Nutrition Optimization• Pressure Relief• Glucose Control• Debride• Bone biopsy• Antibiotics• Negative Pressure3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYFAILED TO HEAL
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 2
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYPORCINE URINARY BLADDER MATRIX
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYMATRIX AND NEGATIVE PRESSURE WOUND
THERAPY SPONGE
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 3
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 4
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 5
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 6
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 7
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3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
ACELLULAR-BASED THERAPYWEEK 8
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CELLULAR-BASED THERAPY
• Allogenic– Cryopreserved– Stimulate senescent wounds– Faster wound healing
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Bilayered: Neonatal fibroblasts and keratinocytes on bovine collagen
Monolayer: neonatal dermal fibrogblasts on bioresorbable polyglactin
Split thickness cadaveric skin
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• Placental Membranes– Used for 100’s of years– No painful donor site– Stem cell recruitment
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Human amnion/chorion membrane
CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE
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CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE• A 63-year-old male
paraplegic with chronic stage IV sacral and left ischial pressure ulcers
• Underwent I&D with flap reconstruction of sacral ulcer
• While awaiting staged reconstruction of ischial wound, underwent dHACM application
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CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION
MEMBRANE
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
8 Weeks
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• Adipocyte Derived Regenerative Cells– NCT02375802; Phase 1; Adipose-Derived Stromal Cells (ASC’s) and Pressure
Ulcers; Pressure Ulcers– NCT02092870; Phase 2;Adipose-derived Regenerative Cellular Therapy of
Chronic Wounds; DFU, chronic wounds
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
CELLULAR-BASED THERAPYSTEM CELLS
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WOUND CARE: NUTS AND BOLTS
Thank YouKevin Broder, MD
3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
Torrey Pines Golf Course