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SUMMARY
“A wound is a disruption of normal anatomic structure and function. Acute wounds normally proceed through an orderly and timely reparative process that results in sustained restoration of anatomic and functional integrity.
Chronic wounds have failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result.” **
This presentation will compare and contrast wounds that heal normally to chronic wounds such as pressure, diabetic and venous stasis ulcers. Particular focus will be on the cellular and biochemical components.
** (Lazarus, GS, et al., Arch Dermatol. 1994; 130:489-493)
SUMMARY
In this presentation, I will start by giving a brief review of how bacterial biofilms develop increased tolerance to immune cells antibiotics and many antiseptics, which leads to biofilms stimulating chronic inflammation with highly elevated levels of proteases and ROS that degrade proteins that are essential for healing. I will then shift to review the “step down then step up” principle of biofilm based wound care that emphasizes early and effective debridement of wound biofilms and describe the new technique that selectively locates biofilms in chronic wound beds, describe new debridement treatments, and emphasize the importance of following debridement with several topical therapies that prevent reformation of biofilms and kill any residual biofilm bacteria. I will conclude by describing how to move to the “step up” phase of wound treatment by utilizing new treatments like topical oxygen therapy, advanced cell and tissue products and topical growth factors.
SUMMARY
The talk will explore new methods, particularly imaging methods, for diagnosis of biofilm infections. Methods of combating biofilms will also be discussed.
SUMMARY
Although Biofilm is ubiquitous in nature, it could have extremely detrimental effects on healing of chronic wounds. This is particularly germane in patients with diabetes, who may have as much as 100% Biofilm present within an ulceration. This bacteria is heterogeneous and protected by a thick polysaccharide glycocalyx, which makes it impervious to topical and systemic therapies. Additionally, Biofilm, bacteria are senescent, and therefore resistant to systemic antibiotics. One treatment option is a step down approach where aggressive therapy, and PCR culturing is followed by standard care over a period of several weeks. This lecture elucidate the problem and offers some treatment alternatives and solutions.
SUMMARY
Wounds that do not respond to standard of appropriate care, including offloading, present a conundrum to the treating physician. Some skin disease and tumors can masquerade as wounds in wound prone patients with diabetes, arterial and venous disease, neuropathy, immunodeficiency, etc. In these cases, a wound biopsy should be considered to make sure we are treating what we think we are treating. Although it is a relatively small number of instances where this occurs, failure to biopsy a stalled wound can be implicated in a delayed diagnosis of cancer, as well as other diseases where a completely different treatment plan is required.
SUMMARY
This talk will delve into the aspects of why wounds fail to progress and what can be done to improve outcomes. Fluorescent imaging and how proper hygiene can be obtained will be discussed.
SUMMARY
People with diabetes comprise a population with at-risk skin. This session will review the work of the Coalition for At-Risk Skin (CARS) and its recently released 21 Consensus Statements on At-Risk Skin (November 2022).
After a brief review of how the Coalition came to be, strategies for prevention and recommendations for the selection and use of moisturizers for routine skin care will be presented. CARS encourages patients, families and caregivers to be involved in the process of managing at-risk skin.
SUMMARY
Point of service wound assessment tools are so important for every wound care provider as it provides real time information that can help to manage wounds better. Dr. Shah will review all traditional and innovative wound assessment techniques which will help you better manage your wound patients.
SUMMARY
Hyperbaric Oxygen is a treatment in which the patient breaths 100% oxygen under pressure. This has a number of therapeutic effects including promoting angiogenesis, increasing circulating stem cells and improved neutrophil activity. This presentation will focus on a review of the literature supporting the role of hyperbaric oxygen therapy and limb salvage.
SUMMARY
This two part lecture session will introduce the attendee to Ischemia reperfusion injury (IRI) and the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of IRI. Oxygen free radicals are defined and the basic chemistry surrounding reactive oxygen species (ROS) will be discussed. Detailed analysis of the inflammatory phase of wound healing and the role of oxygen free radicals in inflammation are presented. The theory of wound chronicity related to prolonged inflammation due to excessive or uncontrolled ROS production is discussed. The concepts of ROS binding and the anti-oxidant role of hyperbaric oxygen to control IRI and ROS in various inflammatory conditions will be highlighted.
Mitigation of IRI using HBOT will be presented as the common mechanism of action for HBOT, with special emphasis on IRI in brain injury, especially concussion and mild traumatic brain injury.
Learning Objectives:
1. Know the definition of oxygen free radicals, reactive oxygen species (ROS) and ischemia reperfusion injury (IRI).
3. Define the mechanism of cellular damage from IRI and ROS.
4. State the potential adverse impact on wound healing from uncontrolled or excessive oxygen free radical production.
5. Describe the mechanism of action of hyperbaric oxygen in the management of chronic wounds and other inflammatory conditions.
6. Understand the role of HBOT in the treatment of patients with conditions related to brain IRI, i.e. concussion and mile traumatic brain injury.
SUMMARY
This two part lecture session will introduce the attendee to Ischemia reperfusion injury (IRI) and the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of IRI. Oxygen free radicals are defined and the basic chemistry surrounding reactive oxygen species (ROS) will be discussed. Detailed analysis of the inflammatory phase of wound healing and the role of oxygen free radicals in inflammation are presented. The theory of wound chronicity related to prolonged inflammation due to excessive or uncontrolled ROS production is discussed. The concepts of ROS binding and the anti-oxidant role of hyperbaric oxygen to control IRI and ROS in various inflammatory conditions will be highlighted.
Mitigation of IRI using HBOT will be presented as the common mechanism of action for HBOT, with special emphasis on IRI in brain injury, especially concussion and mild traumatic brain injury.
Learning Objectives:
1. Know the definition of oxygen free radicals, reactive oxygen species (ROS) and ischemia reperfusion injury (IRI).
3. Define the mechanism of cellular damage from IRI and ROS.
4. State the potential adverse impact on wound healing from uncontrolled or excessive oxygen free radical production.
5. Describe the mechanism of action of hyperbaric oxygen in the management of chronic wounds and other inflammatory conditions.
6. Understand the role of HBOT in the treatment of patients with conditions related to brain IRI, i.e. concussion and mile traumatic brain injury.
SUMMARY
Diabetic foot ulcers are the leading cause of lower extremity amputations in diabetics. Recent studies show an increasing rate of amputation and increased risk for post-amputation morbidity and mortality. Total contact casting can reduce the risk of lower extremity amputation and is underutilized in the US even though considered to be the ‘gold standard’ for treating DFU’s. A brief video demonstrating the application of a total contact cast will be presented followed by a discussion of the history, physics and methods of offloading and casting.
SUMMARY
The decision on level of amputation is usually decided upon by the condition that the patient is presenting to the surgeon. However, different amputations pose unique problems for rehabilitation and gait after reconstructive surgery. This presentation will address different levels of amputation and their mechanical considerations to help prevent further ulceration, infection, and amputation.
SUMMARY
The COVID-19 pandemic exposes our health care system’s weaknesses. For instance, this outbreak shows that traditional healthcare delivery models for managing chronic illness like diabetes are not at scale to handle situations like the global COVID-19 crisis. Because people with diabetes represents a fragile population, they were recommended to avoid unnecessary diabetes-related hospital admissions to reduce the risk of COVID-19 exposure in the hospital. This is disrupting the best practices for preventing diabetes-related complications including diabetic foot ulcer (DFU). In response, many healthcare providers are re-engineering their pathways of care to promote alternatives and deliver care remotely. The speaker will discuss the latest innovations to remotely triage high-risk patients with diabetic foot syndrome and will discuss hurdles and obstacles for scaling up the use of these technologies in the decentralized healthcare delivery model.
SUMMARY
Objectives:
SUMMARY
Healthcare providers help navigate the often-treacherous journey of their patient’s Diabetic disease. As in most complex chronic conditions, outcomes are improved when the patient is an active participant and manager of their condition. Imparting knowledge to the patient with Diabetes and their care circle is often not enough to induce engagement in their own management.
This session will review factors that impede engagement and share strategies to assess patient engagement levels and examine unintentional provider behaviors that inhibit successful interactions.
