Wound Debridement

Debridement is a medical procedure to remove dead, damaged, or infected tissue from wounds. Wound debridement is the foundation for swift and successful wound healing in both acute and chronic wounds. Appropriate and timely wound debridement facilitates infection control by removing the biofilm created by bacteria over wound surfaces.

Various clinical studies suggest that weekly wound debridement results in a higher rate of wound closure (Reference: Steed D, Plastic Recon Surg. 2006 and Cardinal et al. Wound Rep Regen. 2009)

Prior to any surgical debridement, we use 2% topical lidocaine and/or injectable lidocaine to anesthetize and minimize the pain that may come from the debridement procedures.

Skin substitutes ("Artificial" skin grafts)

Skin grafting is a process that removes a thin layer of skin from one part of your body and applies it to cover another wounded area. Even though it is a highly effective method in closing a large wound, it creates another "wound" in the skin graft "donor" site where the skin was harvested, usually on your outer thigh area. The procedure is painful and involves recovery time. Fortunately, biotechnology advances have produced "artificial" skin grafts composed mostly of collagen. These "skin substitutes" contain various growth factors that chronic wounds need to begin healing. As your comfort is important to us, we often use these synthetic skin to spare the pain involved in traditional skin grafting. For more information, please visit www.dermagraft.com and www.oasiswoundmatrix.com

Sensilase® Skin Perfusion Pressure (SPP) Monitor by Vasamed Inc.

One of the biggest hurdles in successful wound healing is the lack of perfusion (or blood flow) to the extremities. Peripheral Arterial Disease (PAD), a condition characterized by poor blood flow to the legs, is under-diagnosed and under-treated. You are at high risk for PAD, if you are older than 70 years old or if you are 50 years or older with any other risk factors including: diabetes, smoking, or a history of heart diseases (Reference: American College of Cardiology/American Heart Associations PAD Guideline 2005).

Sensilase is the latest laser-Doppler device that measures the blood flow (Pulse Volume Recordings) and blood pressure of the skin (Skin Perfusion Pressure). Compared to older technologies, such as ABI (Ankle Brachial Index) or TCOM (Trans-Cutaneous Oximetry), the SPP monitor is known to have the highest accuracy in detecting blood flow and predicting wound healing probability.

For more information visit www.vasamed.org.

Nutritional Counseling

"You are what you eat" -- is good advice for wound healing. Skin and muscle are made of protein, and it has been proven clinically that wound patients require much higher protein intake than the general population. NPUAP (National Pressure Ulcer Advisory Panel) recommends that wound patients consume "high-protein nutritional supplements" in addition to their usual diet (Strength of Evidence: level A). Although the recommended daily allowance (RDA) calls for roughly 0.4 grams (0.8 g/kg) protein per pound body weight per day, it is recommended that wound patients consume 0.7 to 0.9 grams / pound of protein per day (1.5-2 g/kg), meaning over 100 grams of protein per day for a 150 pound person. Our doctors can recommend the appropriate dietary supplementation for you.

We also work with the Cedars-Sinai Weight-Loss Center, for obese patients who may be interested in nutritional counseling and bariatric surgery.

For more information, please visit www.juven.com and www.cedars-sinai.edu/Patients/Programs-and-Services/Weight-Loss-Center/

Compression Therapy

Leg edema (swelling), commonly seen in lower legs, can impede wound healing drastically. We offer various methods of lower extremity compression therapy that can be very effective for reducing edema. Multi-layer compression wraps (pictured) can squeeze excess fluid out of the legs to facilitate wound healing. Once the leg wound heals, your doctor may prescribe medical-grade compression stockings based on your needs. Patients who cannot tolerate conventional compression stockings may be given a prescription for custom stockings, a lymphedema pump for home use, and/or a referral to physical therapist and lymphedema specialist.

Hyperbaric Oxygen Therapy (HBOT)

HBOT is a well-established medical treatment where a patient is placed within a sturdy chamber filled with 100% oxygen above atmospheric pressure. During this treatment, a large amount of oxygen is delivered to the blood and tissues throughout the body, including the wounds and the surrounding tissues. Most wounds requiring HBOT therapy are treated for 20 sessions on consecutive days, Monday through Friday. Although time-intensive, HBOT has been proven to be highly effective in healing the most difficult wounds and bone infections, especially for severe diabetic foot wounds. Medicare and most insurance companies will reimburse the costs of HBO if treatment indications are met. For more information visit
www.uhms.org
A Guide To Hyperbaric Oxygen Therapy For
Diabetic Foot Wounds 2007
Indications for Hyperbaric Oxygen Therapy

How V.A.C. Therapy Works

KCI has advanced wound care with the development of negative pressure wound therapy. V.A.C. therapy removes fluids and infectious materials, helps protect the wound environment, helps promote perfusion and a moist healing environment and helps draw together the wound edges. For more information, please visit www.kci1.com/KCI1/home

Quostic® Ultrasound Debridement Device

"Debridement" is the process of cleaning out the dead skin and tissues from a wound. Debridement is the foundation of swift and successful wound healing and helps prevent infections. The Quostic wound therapy system is the latest low-frequency ultrasound system that combines the sharp debridement with continuous saline irrigation, while delivering focused therapeutic ultrasound to the wound bed. This ultrasound therapy has various positive effects in tissue restoration and wound healing by killing the bacteria, fragmenting and loosening the non-viable tissues, and increasing blood flow to the wound bed. Ultrasound wound therapy is known to heal wounds faster than conventional treatment, according to the Mayo Clinic's latest study (References: Karvos et al. 2008, Suzuki et al 2009).

For more information visit www.arobellamedical.com.