many faces of wound care limb salvage.pdf · 2017-09-05 · spectrum -539 pt. empirical antibiotic...
TRANSCRIPT
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
770-484-9599