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2016: Wound Care: Nuts and Bolts - Broder
- 1. WOUND CARE: NUTS AND BOLTS Kevin Broder, MD Telemedicine & Wound Director, San Diego GWEP Telehealth Director, Department of Surgery Section of Plastic Surgery VA Medical Center – San Diego, CA December 4, 2016 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 2. ADJUNCTS TO WOUND HEALING • Negative Pressure Wound Therapy • Acellular and Cellular Based Wound Therapies 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 3. 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
- 4. NEGATIVE PRESSURE WOUND THERAPY 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 5. NEGATIVE PRESSURE WOUND THERAPY 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 6. 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
- 7. NEGATIVE PRESSURE WOUND THERAPY • Delayed Wound Healing 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 8. NEGATIVE PRESSURE WOUND THERAPY WITH INSTILLATION 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 9. NEGATIVE PRESSURE WOUND THERAPY WITH INSTILLATION 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 9 Weeks
- 10. 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
- 11. • 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
- 12. ACELLULAR-BASED THERAPY INITIAL PRESENTATION 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 13. • Smoking Cessation • Nutrition Optimization • Pressure Relief • Glucose Control • Debride • Bone biopsy • Antibiotics • Negative Pressure 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY FAILED TO HEAL
- 14. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 2
- 15. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY PORCINE URINARY BLADDER MATRIX
- 16. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY MATRIX AND NEGATIVE PRESSURE WOUND THERAPY SPONGE
- 17. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 3
- 18. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 4
- 19. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 5
- 20. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 6
- 21. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 7
- 22. 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium ACELLULAR-BASED THERAPY WEEK 8
- 23. 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
- 24. • 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 THERAPY DEHYDRATED HUMAN AMNION/CHORION MEMBRANE
- 25. CELLULAR-BASED THERAPY DEHYDRATED 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 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium
- 26. CELLULAR-BASED THERAPY DEHYDRATED HUMAN AMNION/CHORION MEMBRANE 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 8 Weeks
- 27. • 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 THERAPY STEM CELLS
- 28. WOUND CARE: NUTS AND BOLTS Thank You Kevin Broder, MD 3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium Torrey Pines Golf Course