Please join Robert J. Klein, DPM, FACFAS, CWS for this mini on-demand video utilizing mechanical disposable negative pressure in the management of a dehisced foot wound.
I'm Dr Robert Klein, and I practice won't care full time in Greenville, South Carolina. I'm a clinical assistant professor at the University of South Carolina School of Medicine in Greenville. Also surveys division chair for wound care for prison health upstate in South Carolina. And I'm also the medical director at the Vascular Health Alliance Moon telling a hot Burke center in Greenville, South Carolina, today we're gonna be talking about to snap therapy system on also have a case presentation for you. This is just a important information slide for disclosure. I'm a consultant for Casey now, part of three M. We see a lot of diabetic patients in our wound care centers and in our offices, even though these may not be diabetic related wounds. I wanted to talk about diabetes and the cost of the system, uh, with respect to one care, Uh, in 2018, which is the latest data that I have. There were roughly 10.5% of Americans that were diagnosed with diabetes. That equals roughly 34.2 million Americans in the US with diabetes. Andi, uh, this is a group that is just increasing in size. We know that African American patients have a high incidence diabetes, Asian Americans and Hispanics do. Also, Patients that live a sedentary lifestyle are increased risk for diabetes, and we just see this number going up. A zey years progress With respect to cost to the system, diabetic related foot disease is staggering. In 2000 and 18, there was $237 billion that was spent in total cost of care for diabetes. If you break that down on a more granular level, with respect to diabetic foot alterations, the health care system spent somewhere between nine and $13 billion just in the treatment for diabetic foot alterations. So it's a very costly, um, conditioned to our health care system and something that we see regularly within our room care centers. So I just wanted to talk about diabetes and prevalence and costs for just a few moments before we go into snap therapy system. Dr. Armstrong just recently published an article on the five year mortality rate from diabetic foot complications and comparison Thio cancer. We all know that diabetic related foot disease carries a high five year mortality rate with respect to major amputation, that being a below knee amputation. What was interesting in this article that he recently published was that diabetic related foot disease has a higher five year mortality rate than breast cancer and is equal to most cancers. With the exception of lung cancer. He in this article he got more granular, and he looked at shark related foot disease, diabetic foot alterations, minor and major amputation. And what he found was patients that had diabetic foot alterations had a 30% 5 year mortality rate basically similar to all cancers, with the exception of lung cancer. When you get into an amputation, minor amputation, toe amputation, ray amputation, transmitted partial amputation, uh, the mortality rate jumped up to 46.2% in five years, and then with major amputation, it was 56%. So this is not a benign type of condition. It's just not a hole in the skin. This is something that has a huge impact on the patient's life and their longevity. Major amputations, what we're trying to avoid when we're treating or a diabetic foot alterations snap therapy system has many indications on its similar indications to what we use for negative pressure wound therapy. We want to manage, educate infectious material in tissue debris. Eso for me when I think about snap therapy system. Uh, the indications that I consider for snap therapy system include diabetic foot ulceration is Venus, leg alterations and pressure alterations. We also can use a snap therapy system in wounded distance, which I use pretty regularly. That's my case presentation. Today. We can apply the snap therapy system over surgically closed incisions, flaps crafts on. We can use it in traumatic wounds as well. So basically anything that we want to use with negative pressure. Boone Therapy Management of excessive exit date removal of infectious material on getting rid of tissue debris The snap therapy system is very effective. Things that I would suggest when considering a snap therapy system is a small to medium sized wound with mild to moderate exit date. The case presentation that I have today is a 46 year old female with the chronic diabetic alteration underneath your second metatarsal head. You can see on the photo on the right that she's had a previous first rate amputation as well. A second Tony amputation. She developed an alteration of the second metatarsal ahead, and that's no surprise. She has more pressure underneath. The second metatarsal had now more friction. More sheer, unfortunately, she developed the wound. The co morbid problems that this patient had is no different from what you typically see either at your book, your centers or in your offices. Um, she's a diabetic. She has peripheral neuropathy. She has heart disease. She has lifted problems. Uh, this patient also is morbidly obese and have poorly controlled diabetes. Um, what necessitated her first ring amputation and her second toe amputation was osteomyelitis. Unfortunately, as I shared, she developed a transfer alteration underneath the second metatarsal head. The patient field. Traditional conservative care, aggressive debridement, advanced wound care dressings, aggressive offloading on. We decided to do a second metatarsal had resection for this patient. This is her pre op photo on the left. Once again, she has a wound that has depth. We can actually palpate the second metatarsal head through the graduation tissue. So I took the patient to the operating room into the second metatarsal. Every section the slide on the right is the patient. Three days post up. We're moving along just fine. The incision is well approximated. Ah, Patients scheduled to see me two weeks later for suit removal. Unfortunately, two weeks later, the patient begins to develop some wounded hastens, uh, initially, I treated this patient with traditional wound therapy, uh, on advancement, hairdressing to manage exit date and promotes, um, graduation tissue. Did some compression, did some debridement, but unfortunately, her wounded, not progressive, in fact, got larger. You can see on the slide on the right. She has a new increase in size and increase in depth. She has some, uh, tissue debris that needs to be removed on. I made a decision to use three snap therapy system on this patient on. This is just before the snap therapy system was applied. The slide on the left is five days after using a snap therapy system. You can see it. A lot of that tissue debris eyes no longer there. We have decreased the size and the depth of the wound. And she now has begin to develop some robust graduation tissue just five days after the snap therapy system. So it's a very effective two, or modality for us to use for wounded. Hastens the slide on the right. Just basically depicts the snap therapy system applied to the patient's leg. This is a mechanical negative pressure wound therapy system, so it doesn't require power source. So the patient eyes very portable, they could go to work. Uh, it's a very small device so they can hide it underneath their pant leg or underneath the skirts that nobody knows that they have it. Um, so it's a very useful system with respect to the patient, not being tethered to a power cord, on being able to go back to work and resume a pretty normal life with a snap therapy system. This is a patient. 10 days after instituting the snap therapy system, we can see that deregulation tissues now level with skin line. The tissue debris that we saw beforehand is no longer there. She has very robust regulation tissue. One of the interesting things that we see with respect to this wound is the oedema that we saw previously is no longer there. There's been a reduction in oedema. We have nice, robust graduation tissue. Uh, at this point, I decided to discontinue the snap therapy system and switched over to advance. Wouldn't care dressing program, prison matrix Uh, and the slide on the right depicts 17 days after snap therapy system and just seven days with program prisoner matrix. There's been a significant decrease in the size of the wound, and her wound is almost closed. This is the patient. 34 days after developing wounded distance and instituting the snap therapy system, her wound is closed. And, as you may recall, we did the surgery initially for a diabetic foot ulceration on the planet aspect of your foot. Underneath that second metatarsal head, that second metatarsal head is no longer there, and her wound disclosed on the bottom of her foot as well. Some tips and trips with respect to snap therapy system. The snap therapy system comes with a secure ring a Hodja Corley ring on. You wanna put that at least one centimeter from the wound edge? One of the tricks that I use in my, uh, moon care centers, I warm the securing in my hand for about a minute or so. It makes the securing much more pliable and easy to manipulate to get it where it's one centimeter around the wound. You want to cut the phone to the size of the moon, and you want to make sure that the foam extends above the wound margin when applying the drape you want appeal with center released liner. First put the track pad over the phone and then secure the rest of the dressing down by removing the side liners. And then, lastly, you wanna have it least one centimeter Rentech skin. Uh, to help maintain that seal on the don't side. The Don's air equally is important. You don't wanna place that securing next to the wound. You can remember that these wounds are being used to treat exit date. Also, to remove infectious material and debris. But agitate eyes one of the things that we want thio remove with snap therapy system and I find it. If you put the secure ring close to the moon edge, you can have a problem with exotic management. Any other things that you want to do is you don't want to use a snap therapy system and highly executive wounds. The indications for the snap therapy system is small to medium sized moons, with mild to moderate exit date. You don't want to use an untreated osteomyelitis. We don't place the snap therapy system over Escarre. And lastly, you don't want to throw away the key. I want to thank you for taking time out to listen to my presentation today with respect to snap therapy system. I hope this was informative for you on once again. Thank you very much for your time.