Archive for the ‘Debridement’ Category

Maggot debridement therapy and leech therapy are viable options

Wednesday, May 13th, 2020
maggot debridement therapy

Using maggots and leeches in the healthcare setting can make many people cringe, including seasoned wound care clinicians.

But the age-old treatments of maggot debridement therapy and leech therapy are relatively inexpensive and fairly effective.

“Maggot therapy can save a limb in approximately 40% to 60% of patients scheduled for amputation,” said Ronald Sherman, MD, MSc, DTM&H, director at BioTherapuetics, Education & Research (BTER) Foundation, co-founder.

Sherman also works as the laboratory director at Monarch Labs and a practicing physician in Orange County, Calif.

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What’s all the fuss about wound dressing change frequency?

Wednesday, December 4th, 2019
A clinician maintains a patient's wound dressing change frequency.

Let’s take a one question wound care quiz.

What is more important for wound dressing change frequency?

  1. Expert application of a dressing
  2. Frequency of the dressing change

The correct answer is the frequency. Now let’s talk about why.

I do not want to take away from the importance of properly applying dressings because that certainly has its own merits. But when it comes down to it, the frequency wins hands down. 

As we teach in class, wound healing is a dynamic process. As the wound progresses through the phases of healing, all kinds of cellular activity is happening.

From the neutrophils and macrophages to the growth factors and fibroblasts, each phase has a job to do for the wound to move to the next phase and ultimately close.

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Retained surgical bodies can lead to serious wounds

Tuesday, November 19th, 2019
A surgeon checks a wound for retained surgical bodies.

Retained surgical bodies in a patient postop is not an unfamiliar occurrence.

One literature review indicated that with more than 28 million operations in the U.S. nationwide, 1,500 estimated cases per year of retained surgical bodies left in patients take place.

In the 2016 case of Thompson v. Mangham Home Care, Inc., who left gauze in a patient’s surgical wound was at issue.

The patient saw her primary care physician for boils/sores on both of her buttocks in 2008.

The primary doctor prescribed antibiotics without success, and the patient was referred to a general surgeon who treated the condition with antibiotics and warm soaks.

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Sharp debridement: Cutting through the confusion

Wednesday, November 13th, 2019
Tools to perform sharp debridement rest on a surgical tray.

I have been training wound care clinicians in sharp debridement for more than 16 years, yet questions and confusion still abound about this practice.

Many clinicians have either received no education or incorrect education regarding sharp debridement and its use in wound care. 

This often leads to infrequent use of sharp debridement or worse, the inappropriate use of the practice. This is a skilled procedure and one should be properly trained before engaging in it.

My hope is to cut through the confusion and offer a solid explanation of this highly effective treatment for managing wounds.

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How to treat diabetic foot ulcers with a total contact cast

Thursday, October 10th, 2019
A man sits with his total contact cast elevated on a chair.

There are times when clinicians and patients have done all they can to prevent diabetic foot ulcers, and they still develop.

“The patients who develop a diabetic foot ulcer are the ones who fell through the cracks,” said Don Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery.

Wollheim has 25 years of experience in general/vascular surgery and 13 years as a wound care specialist and educator. He also is a medical-legal consultant, college science instructor and clinical instructor for the Wound Care Education Institute.

“Once a diabetic foot ulcer develops, it’s essential it is treated aggressively with proven, standardized methods, as 85% of the amputations performed on diabetic patients began as a diabetic foot ulcer,” Wollheim said.

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The truth about wound infection and treatment

Monday, October 7th, 2019
wound infection

Does it seem like clinicians are quick to assume infection in a wound requiring systemic treatment?   

The tragic part is the wound infection diagnosis is often made with a lack of proper cultures or symptoms. 

Is it because clinicians are fearful? Is it their lack of knowledge of what confirms a wound infection? 

I would say it is likely a combination of both. Instead of looking at the evidence, clinicians fall into a “we have always done it this way” approach and the patient is the one who ultimately suffers.

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WCEI instructor finds his niche in physical therapy wound care

Thursday, June 13th, 2019

physical therapy wound care

Many alumni of the Wound Care Education Institute (WCEI) will tell you they enjoyed their training — so much so they view the WCEI staff and fellow students as another type of family.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

Part of what gives the institute that warm, welcoming feeling is the dedication to students and energetic style of teaching of one of its instructors: Bill Richlen, PT, WCC, DWC.

He is a clinical instructor with the Wound Care Education Institute (WCEI) and owner of Santa Claus, Ind.-based Infinitus LLC — a wound care instruction and consulting company.

Richlen began his extensive career as a licensed physical therapist 25 years ago and, almost simultaneously, found his work in physical therapy also involved caring for patients with a wide variety of wounds. He first discovered his attraction to wound care while still in his clinical practicum in physical therapy school.

“I did a six-week internship at a VA hospital,” Richlen said. “My first wound care patient was a paraplegic veteran with a stage 4 pressure injury. This was my first exposure to this type of wound. I had to help with his treatment in the whirlpool, submerging much of his entire body for his sacral wound. I soon realized they did not teach us how to care for wounds in PT school.”

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What happened to practicing wound care basics?

Tuesday, April 30th, 2019

wound care basics

Having been involved in wound care for about 25 years, I have seen many changes in our understanding of wound healing, research evidence and technology.

wound care

By Bill Richlen, PT, WCC, DWC

As I hear my students describe common practices today and the many myths of wound care, I’m led to wonder, “What happened to starting with wound care basics for healing?”

A colleague of mine once stated there are basically two fundamentals to healing wounds: a healthy patient and a healthy wound environment. Once those are accomplished, topical treatments will not make that big of a difference.

However, clinicians often cling to some “holy grail” treatment in the form of a dressing or adjunctive modality that will somehow overcome the need to practice solid, evidence-based wound care.

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Disappointed by Debridement

Friday, March 3rd, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Plaintiffs often express shock and disbelief after eschar is removed, which often leaves a wound larger than the original size of the eschar.

Disappointed by Debridement

Wound photo: “Stage 4 decubitus displaying the Gluteus medius muscle attached to the crest of the ilium” by Bobjgalindo is licensed under CC BY 2.0

“We were in shock and couldn’t believe our eyes. It was like half her foot was gone.”

“My husband and I were horrified when we saw what they did.”

“My sister and I looked at each other, and I just kept asking why?”

“I had to leave the room and go the bathroom to cry when I saw what they did to my mother.”

You might think these quotes are from people who have witnessed a shocking crime or some sort of violence, but they are not. These are quotes from family members, now plaintiffs, who are suing for poor medical care related to a chronic wound. Their shock all had one thing in common—it came after seeing a wound that was surgically debrided.

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Wet-to-Dry Dressings: Why Not?

Friday, February 10th, 2017

What should wound care professionals do when a physician orders wet-to-dry dressings? Be prepared and know the facts.

Wet-to-Dry Dressings: Why Not?

Pictured: Trauma caused by wet-to-dry dressing.

 

Those of us in wound care know that wet-to-dry dressings are considered substandard care. Some physicians, however, commonly order wet-to-dry dressings for patients, often leaving clinicians in a tricky situation. Do you feel conflicted as to how you should respond? It can be intimidating, but with a little preparation, it doesn’t have to be. By knowing the facts about wet-to-dry dressings, as well as effective and cost-efficient alternatives, you can handle such situations with confidence. Not sure where to start? We’re here to help.

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