Raelina S. Howell

Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue.

Background: Venous leg ulcers (VLUs) represent the most common ulcers of the lower extremity. VLUs are notorious for delayed and prolonged healing with high rates of recurrence. Most patients with VLUs also have significant comorbidities that interfere with primary wound healing. Thus, caring for patients with VLUs requires an interdisciplinary approach that addresses the abnormal venous anatomy and the downstream effects that lead to inflammation, ulceration, and a hostile wound microenvironment. Methods: The current literature regarding venous ulcer treatment with an emphasis on compression, surgical options, and use of bioengineered tissue was reviewed. A combination of society guidelines, Cochrane reviews, and over 80 primary articles with high-level evidence were utilized to develop this summary and algorithm for an integrated approach to treating patients with venous ulcers. Details regarding compression modalities and venous diagnostic imaging are presented to help the clinician understand the rationale for using these technologies. Results: The comprehensive approach to the patient with chronic venous insufficiency (CVI) includes advances in compression, diagnostics, minimally invasive surgical treatment of venous disease, wound bed preparation, and bioengineered skin and soft tissue substitutes. An algorithm that incorporates early treatment of the ulcer and the venous disease leading to healing with prevention of recurrence is presented. Conclusions: Utilizing guidelines that incorporate evidence-based modalities will lead to the highest quality outcomes with the most appropriate resource utilization. A proactive approach to treating venous disease will alleviate suffering and prevent the long-term sequelae of CVI.

Hyperbaric Oxygen Therapy: Indications, Contraindications, and Use at a Tertiary Care Center

The indications for the use of hyperbaric oxygen therapy have expanded greatly in the last 200 years. This article provides a brief history of hyperbaric oxygen, reviews the indications and contraindications for its use, and presents an overview of the hyperbaric oxygen program at a tertiary care facility. We describe three common indications for hyperbaric oxygen therapy: osteomyelitis, delayed radiation injury, and graft or flap compromise. We also discuss therapeutic protocols for treatment with hyperbaric oxygen at our facility. Patients with a wide range of diagnoses have access to hyperbaric oxygen therapy 24 hours per day and seven days per week at our facility, in addition to a wellqualified team of health care providers who strive to deliver optimal patient care.

A Perioperative Approach to Increase Limb Salvage When Treating Foot Ulcers in Patients With Diabetes

Foot ulceration in patients with diabetes increases the risk of lower extremity amputation. Major amputations produce substantial adverse consequences, increase length of hospital stay, diminish quality of life, and increase mortality. In this article, we describe approaches that decrease amputations and improve the quality of life for patients with diabetes and foot ulcers. We highlight the role of the perioperative nurse, who is essential to providing optimal patient care in the perioperative period. Perioperative care of patients with diabetes involves providing optimal surveillance for a break in the skin of the foot, screening for neuropathy, following guidelines for foot ulcer infections, preparing for pathophysiology-based debridement, using adjuvant therapies, and offloading the patients affected foot. Nurses should understand the disease process and pathophysiology and how to use these approaches in the perioperative setting to assist in curtailing the morbidity and mortality associated with foot ulcers in patients with diabetes.

The Future of Data‐Driven Wound Care

Care for patients with chronic wounds can be complex, and the chances of poor outcomes are high if wound care is not optimized through evidence-based protocols. Tracking and managing every variable and comorbidity in patients with wounds is difficult despite the increasing use of wound-specific electronic medical records. Harnessing the power of big data analytics to help nurses and physicians provide optimized care based on the care provided to millions of patients can result in better outcomes. Numerous applications of machine learning toward workflow improvements, inpatient monitoring, outpatient communication, and hospital operations can improve overall efficiency and efficacy of care delivery in and out of the hospital, while reducing adverse events and complications. This article provides an overview of the application of big data analytics and machine learning in health care, highlights important recent advances, and discusses how these technologies may revolutionize advanced wound care.

Wound Care Center of Excellence: Guide to Operative Technique for Chronic Wounds

Wound surgery is a well-established modality for the treatment of chronic wounds. Surgical debridement is an essential, integral part of wound care management and the wound service is often an appendage of other departments, such as surgery, nursing, or geriatrics. However, the specifics of surgical management of chronic wounds are often not well-defined. To have a full-time practice of 4 wound surgeons, we found it necessary for the sake of continuity of care to use agreed-on techniques for goal-directed therapy. We have built a dedicated wound surgery service and, in this article, we discuss the operative techniques used by 4 specialized wound physicians in 3,717 consecutive operations from 2012 to 2016 for the management of chronic wounds at a tertiary care facility. Table 1 is a summary of our wound practice.

An unusual presentation of Merkel cell carcinoma: a case report

Abstract Merkel cell carcinoma (MCC) is a rare, aggressive carcinoma that usually arises in sun-exposed regions. MCC is a primary neuroendocrine tumor that arises in the skin. This report describes an unusual case of MCC on the buttocks that was treated with excision, radiation and chemotherapy. Physicians should consider MCC as a differential diagnosis when encountering a rapidly growing, painless lesion. Early diagnosis and treatment may improve patient survival rates.