Please join Robert J. Klein, DPM, FACFAS, CWS to hear his experience with negative pressure wound therapy in the out-patient setting and see NPWT in action through his case studies.
I'm Dr Robert Kline and I practiced wound care and limb preservation full time in Greenville, South Carolina. I serve as the medical director at our winter and hyperbaric center at our institution. I'm also a clinical professor of surgery at the University of South Carolina in Greenville, South Carolina, and serve as the division chair for wound care in the upstate region of South Carolina. Today, we're gonna be talking about continue with negative pressure wound therapy and the out of hospital setting. This is just a basic slide that I just need to go over just to make sure that you all, uh, check the instructions of use prior to using the technology that we're talking about in this lecture. If not, consult with your case guy with a camera for full disclosure. I am a consultant for Casey. I now part of three m. We deal with a lot of wounds, uh, in the wound care setting and in the office setting. Some of the common wounds that we do see include diabetic foot alterations. Venous leg ulceration is pressure alterations, traumatic wounds, arterial wounds, wounds that result from infection, surgical wounds. Um, so in short, we see a lot of different wounds. Uh, and a lot of these wounds, our wounds that can benefit from negative pressure wound therapy. And that's we're going to talk about tonight, especially the outpatient setting I started wound care about 28 years ago. That was when I was in my residency, Uh, and it wasn't uncommon back in those days to order what to dry dressings twice a day. And then we around on these patients several times a week and hope that these rules are graduating. The wound care has changed a lot in 28 years. Unfortunately, we have negative pressure wound therapy that's available to treat our heart to heal wounds both in the hospital setting and for this book in the outpatient setting out of the hospital setting. I'm going to talk about that. Decide today. Benefits of negative pressure wound therapy are a lot, um, they created an environment that helps promote wound healing. It helps to decrease the Diemer around the wound. It helps promote graduation tissue. It increases tissue perfusion to the wound. At the same time, it gets rid of excessive vegetate from the wound and also removes infectious. The briefing wound. So negative pressure wound therapy has a lot of benefits with respect to our wounds and just create an optimal environment to promote wound healing. There's a lot of articles within the literature that talked about negative pressure wound therapy, both in the inpatient settings, certain in the outpatient setting. I was looking at my journalist today that were on my desk, and I saw at least four articles that were in. The journals were just talking about negative pressure therapy in 2000 and eight. Caroline five Function article about safety and benefits of using a negative pressure wound therapy on diabetic foot ulceration, the operation setting. This was published in international journals in 2012. They often did a literature review on the cost effectiveness of the efficacy and the impact on quality of life for patients using negative pressure therapy, the management of chronic wounds in the UK What these articles talked about is that there's tremendous benefit to get these wounds to heal in the outpatient setting. And it's something that I utilize a lot within my practice for my heart to heal. Wounds and wounds that are difficult and challenging have a lot of experience using negative pressure wound therapy. And I want to share some of the types of wounds that I use. Negative pressure wound therapy and certainly surgical wounds. I have patients that I think you are, perhaps to a first rate resection, maybe a transmitted partial application. Ah, and I leave them open. Uh, at some point of these patients gonna be discharged from the hospital. And I certainly want to take advantage of negative factors. More therapy in these patients, surgical wounds are ones that I use moved back quite commonly wounded since both once that unfortunately, I've created the ones that have been referred to at the daycare center. Negative pressure. One therapy is an excellent modality. It helps treat wounded. Since diabetic foot ulceration, these wounds have sometimes a lot of energy date. They have infectious debris. They have depth through wounds. So diabetic foot alterations in the outpatient setting benefit from negative pressure therapy. I use negative pressure, one of therapy a lot with my cellular tissue products. I found that it helps get those wounds to wrangle it in and feeling quite quickly with the TTP dramatic ones again, anyone that really has exit date infectious debris. I use negative pressure on what we're talking about one here during the pandemic. Certainly the pandemic has affected a lot of hard facts, both in this region and nationwide. And I wanted to share with you my experience of what happened with the pandemic. Here in South Carolina. Certainly, we have a shortage of medical and surgical hospital. We have the best of those patients at the President's Fund, which limits our ability to put patients in the hospital. The length of cases have been put on hold in many instances, and we're just gearing up now. After this last surge that we had to start doing to let the cases again, length of stays for the patients that we have in the hospital decrease. We have to get our patients out relatively quickly that we can still the heads up with covid patients that have tested positive in our community and within our region. Placement issues have been huge. Uh, it's very hard to get patients in the long term acute care hospital at the present time as well skilled nursing facilities, because they're filled over the patient and then, lastly, home health home health agencies are not accepting new patients because they're overrun taking care of the current patients that they have. So this has been some of the challenges that I've had in South Carolina, and I'm sure that they mirror the challenges that you've had in your region as well as nationally. I have some cases on micro present today with respect to using no to pressure wound up in the official setting. In the first case I want to talk about is a 64 year old white male was diabetic at this high potential heart disease and chronic arthritis with no fun so vicious deposits, uh, in the hip joint of his great toe. You can see in the photo on the right that he has a large wound. It's draining wound, then straining with to fight. He was referred to the wound care center because his surgeon had recommended an amputation. The patient wanted to avoid an amputation, so my train approached. This patient was that he had a lot of, uh, huddling any of them depth to his wound and a lot of so fine. So I d roof the wound and you can see his love to find the slide on the left, and we agreed that at the care center and this slide on the right is the photo of him post agreement. But society is negative. Pressure wound therapy on this patient ordered the wound back, and this is the back side. One week later, the slide on the right, you can see that there's been increased regulations issued decrease in depth of the wound, and this is the one that's not ready to use in advance from hairdressing closure at this time. I instituted program Matrix to take this one out closure, and three weeks after we use program matrix, the patient spoon is almost completely closed, so the patient averted an amputation of his toe. The rapacious depositors are bound and the patients who disclosed very good outcome for this particular patient. The second patient I want to talk about is a 53 year old female that was admitted through our residents clinic at our institution where I practice. She was a diabetic patient on insulin. She has a neuropathy, liver disease, hypertension, fibromyalgia and depression. She was admitted to the hospital with sepsis. She had a horrible limb threatening wound and infection in her foot and the fellow took her to the O. R. That evening and did a nine D. And I was consulted to see the patient the following day. There really wasn't much that I could offer this patient other than a first very amputation. She had an MRI. Findings of bone infection. She has exposed tending. She has exposed bone here. So the patient was taken to the operating room to get a first ray amputation while in the hospital. I did use that beautiful for three days prior to her discharge and she was discharged on an active back on the photo on the left. You can see this is post op day 10. The wounds still has some size. It still has some depth. It still has some exit eight. So we'll continue with the active act at this particular time. The slide on the right is pit This patient seven days later at Post updates 17. She still has some death. She still has some anti date. The moon still needs to granulated. So we're continuing with the active action. This is the patient post op. Day 31 on the photo on the left her graduation tissue has now come to the skin line. She has no depth whatsoever. She has minimum of any exit date. So I transitions are over to program matrix and you can see on the photo on the right at post op Day 60 the patient is closed in this chapter of life. Fortune was closed as well, and she inverted an amputation. The third case that I have is a 64 year old diabetic meal with diabetes, neuropathy, salaries, and he had a chronic diabetic ulcer at the base of the fifth metatarsal. MRI findings revealed osteomyelitis that it ended up throughout the whole fifth metatarsal, and he was admitted to the hospital with a sending cellulitis, and I took him to the O. R for his fifth Ray amputation. This is the patient Inter operatively you can see. The fifth metatarsal was completely exposed. The fifth metatarsal bone was completely excised in the fifth Bone was disarticulated. I curated the Q Boyd exposed cartilage, and the patient was given negative pressure to moon therapy while in the hospital. The photo on the left, his patients seven days post op. He still has exposed deeper structures. Some tendon and muscle, and he still has every day from his wound. So we're continuing with the active at this time. The photo on the right is the patient that post op Day 14. You can see that there has been a decrease in size and depth of the wound, but he still has some infectious debris, some exit date and some graduation tissue in death that we need to fill in so we'll continue with the active act. Still, this is the patient. 30 days post op. The patient has had active act for 30 days. The wound has filled in quite nicely. There's no more depth. There is minimal accident and his wound care was transitioned to programme prisoner matrix. The photo on the right is 40 days post op, so the patient has had 12 days of programmed Prisma matrix, and you can see that the wound has decreased in size and depth even further. And we'll take this patient on the closure using that advanced wound care dressing. Thank you very much for taking time out to listen to my last year today, utilizing negative pressure Winthrop in the outpatient setting negative pressure. One therapy is excellent modality for diabetic foot alterations of surgical wounds. Wounded has since traumatic ones. And I hope that you will consider using this therapy for your challenge. You moves in your practice.
