many faces of wound care limb salvage.pdf · 2017-09-05 · spectrum -539 pt. empirical antibiotic...

Many Faces of Wound CareBridging Antibiotics, Biologics, and Surgical

Reconstruction

Dr. Javan S. Bass, FACFAS

Metro Foot & Ankle Centers, PC

Georgia Podiatric Association Board of Directors

No disclosures

Stakes are high

BKA Complications

Wound Dehiscence

Stump Neuroma

Phantom Limb Pain

Prosthetic Complication

Guidelines

UK Hospital – multidisciplinary approach

- reduced total amputation 40%

- reduced major amputation 62% over 11yr

Lost Financial Support = amputation rates

rose

Regained Support = amputation rates fell

Krishnan et al Diabetes Care 2008

Biologics

Antibiotic Surgery

Antibiotics

Resistance

????????

-Spectrum

-Course

-Diagnosis

Spectrum

-539 pt. Empirical antibiotic therapy inadequate 22% (121)

-168 pt. Adjusted, antibiotic therapy inadequate 27% (46)

-Main Reason, broad spectrum (24% of original, 52% of

adjusted)

Metler et al BMC ID 2007

Course

-Uncomplicated cellulitis, 5 day as effective as 10

day course Levofloxacin

-Composite scores for cellulitis, subjective pain, and

swelling comparable between 5 day vs. 10 day course

Hepburn MJ et al Arch Intern Med 2004

Diagnosis

-69 pt., poor concordance between wound culture

swabs and percutaneous bone biopsies (22.5%)

Senneville et al CID 2006

Biologics

Antibiotic Surgery

Biologics

Amniox

-Cryopreserved Human

Umbilical Cord and Amniotic

Membrane

Grafix-Cryopreserved placental

membrane comprised of an

extracellular matrix (ECM)

1st Clinic Visit

42 Y/O

Diabetic

PVD

HTN

Staph Infection

BKA

Recommendation

2 Applications 7 Weeks

Limited

Debridement

2 Applications 8.5Weeks

Non-Compliance

3 Applications 11 Weeks

4 Applications 15 Weeks

Non-Compliance

4 Applications 17 Weeks

20 Weeks

After HBO for 8 weeks

29 Y/O

Paraplegic

Smoker

BKA

Recommendation

2cnd Application Week 6

3rd Application Week 9

Pressure Kills

3rd Application Week 30

Week 33

When Possible

don’t touch!!

Week 36

Recap

Deep Sub Q -- Skin

Resist the urge!!!

Pressure Kills!!!!!

Biologics

Antibiotic Surgery

Pressure and Charcot

30 Y/O AA Female

Uncontrolled DM

Wound > 1 year

Staph Infection

BKA

Recommendation

Surgical Recon

Treating Pt. vs X-ray

Goals

Stave off infx

Heal the wound

Clear the pt.

Keep the leg

Send patient

Metro Foot and Ankle Centers, P.C

Metrofootanklepc.com

Info@metrofootanklepc.com

Javanbass@yahoo.com

770-484-9599