Division of Vascular Surgery
Our Services
Wound Healing/Limb Preservation Center
The Wound Healing/Limb Preservation Center serves patients with wounds of the extremities. Founded in 1987, the clinic focuses on wounds caused most commonly by arterial insufficiency, diabetes, venous hypertension, or pressure. All patients are evaluated by a vascular surgeon with expertise in the healing of complex wounds. There is also a nurse practitioner trained in wound healing. An on-site non-invasive vascular laboratory is available to evaluate both arterial and venous circulation.
In general, all wounds are managed in accordance with the guidelines established by the Wound Healing Society. Arterial ischemia is treated with angiography and angioplasty/stenting or bypass surgery as is appropriate. Patients with ischemic ulcers who are not candidates for arterial reconstruction are referred to Hyperbaric Medicine for evaluation and treatment. Patients with venous hypertension as the cause of their wounds are healed with topical dressings and compression, or by ablation of the superficial veins if this is indicated. A complete evaluation of their venous system in the non-invasive laboratory is performed to assess for venous hypertention. Cases refractory to standard therapy may be treated with newer treatments such as living skin equivalents or matrix grafts. Diabetic wounds are perhaps the most challenging. These patients have ulcers caused by ischemia, neuropathy, or both. Diabetes is the most common cause of amputation in the United States. There are 80,000 amputations per year in patients with diabetes. These patients commonly require surgical debridement, topical ointments, antibiotics, and off-loading. Some require total contact casting. In difficult cases, patients are offered a clinical trial of experimental wound healing therapies. Patients with healed diabetic wounds are referred to a pedorthic center for off-loading diabetic footwear. Amputation can be avoided in most patients.
In some cases, homebound patients can be managed with a visiting nurse using a telemedicine approach. Wounds are evaluated using digital photography with wound assessment performed remotely. This approach provides physician and nurse expertise in the patient’s home.
Dr. David Steed was the founder of the Wound Healing Center in 1987 and is still the principle practitioner. Dr. Steed’s practice is devoted full-time to wound healing and he has been part of many national trials to test new compounds for wound healing efficacy.