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A collaborative approach to wound care and lymphedema therapy: Part 1

By Erin Fazzari, MPT, CLT, CWS, DWC

Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema and wound care. (more…)

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Role of rehab in wound care

 By Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DCCT

How many times have you heard someone say, “I didn’t know PTs did wound care”? Statements like this aren’t uncommon. The role of physical therapists (PTs), occupational therapists, and speech therapists in wound care is commonly misunderstood by and even a mystery to many clinicians. Sometimes the therapists themselves are confused about reimbursement or what their role on the wound care team can be. (more…)

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Clinical Notes : Diabetes, medical honey, silver dressings, clostridium

Guidelines for optimal off-loading to prevent diabetic foot ulcers 

The management of diabetic foot ulcers through optimal off-loading,” published in the Journal of the American Podiatric Medical Association, presents consensus guidelines and states the “evidence is clear” that off-loading increases healing of diabetic foot ulcers.

The article calls for increased use of off-loading and notes that “current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities.” The authors reviewed about 90 studies. (more…)

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Clinical Notes

Diabetes carries high economic burden

According to a study published in Diabetes Care, the economic burden associated with diagnosed diabetes (all ages) and undiagnosed diabetes, gestational diabetes, and prediabetes (adults) exceeded $322 billion in 2012, amounting to an economic burden exceeding $1,000 for each American. (more…)

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Clinical Notes: Aspirin, Skin Infections, NPWT surgical incisions

Aspirin inhibits wound healing

A study in the Journal of Experimental Medicine describes how aspirin inhibits wound healing and paves the way for the development of new drugs to promote healing.

The authors of “12-hydroxyheptadecatrienoic (12-HHT) acid promotes epidermal wound healing by accelerating keratinocyte migration via the BLT2 receptor” report that aspirin reduced 12-HHT production, which resulted in delayed wound closure in mice. However, a synthetic leukotriene B4 receptor 2 (BLT2) agonist increased the speed of wound closure in cultured cells and in diabetic mice. (more…)

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Clinical Notes: Pressure Injury Prevention, Diabetes, LIV

Incidence density best measure of pressure-ulcer prevention program

According to the National Pressure Ulcer Advisory Panel (NPUAP), incidence density is the best quality measure of pressure-ulcer prevention programs. Pressure-ulcer incidence density is calculated by dividing the number of inpatients who develop a new pressure ulcer by 1,000 patient days. Using the larger denominator of patient days allows fair comparisons between institutions of all sizes. (more…)

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Clinician Resources: Intl Ostomy Assoc., Substance Use Disorder

Take a few minutes to check out this potpourri of resources.

International Ostomy Association

The International Ostomy Association is an association of regional ostomy associations that is committed to improving the lives of ostomates. Resources on the association’s website include:

  • a variety of discussion groups
  • information for patients
  • list of helpful links.

The site also provides contact information for the regional associations. (more…)

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Clinical Notes: Low BMD, CKD, hypoglycemia, HBOT

Low BMD common after ostomy

Low bone mineral density (BMD) is common in patients with inflammatory bowel disease who have a stoma placed, according to “Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory bowel diseases,” published in Inflammatory Bowel Diseases. (more…)

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Clinical Notes: diabetic foot osteomyelitis, BIA, footwear

Antibiotics and conservative surgery yield similar outcomes in patients with diabetic foot osteomyelitis

A study in Diabetes Care finds that anti­biotics and surgery have similar outcomes related to rate of healing, time of healing, and short-term complications in patients who have neuropathic forefoot ulcers and osteomyelitis, but no ischemia or necrotizing soft-tissue infections.

Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis. A randomized comparative trial” compared two groups: an antibiotics group and a surgery group. Patients in the antibiotics group received antibiotics for 90 days, and patients in the surgery group received conservative surgery with postoperative antibiotics for 10 days. (more…)

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Clinical Notes: Pressure-Ulcer Data, Diabetic Foot Ulcers, IFG & HbA1c

Hospital pressure-ulcer comparison data not accurate

Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine.

Hospital report cards for hospital-acquired pressure ulcers: How good are the grades?,” funded by the Agency for Healthcare Research and Quality, analyzed 2 million all-payer administrative records from 448 California hospitals and quarterly hospital surveillance data from 213 hospitals from the Collaborative Alliance for Nursing Outcomes. (more…)

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