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On Topic Transcript: Non-Healing Wounds & Limb Preservation

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Dr. Dane Wukich, Director, UPMC Wound Healing Services at UPMC Mercy

The kinds of wounds that we’ll treat range from diabetic foot wounds, to people with bed sores, to people with venous insufficiency wounds of their lower extremity from chronic varicose veins, and also patients who have wounds from surgery that don’t heal and follow the normal healing process.

Non-Healing Wounds

Patients should be concerned about the progression of wound healing when a wound doesn’t heal by 50 percent in four weeks. For example, if a patient has a wound on the bottom of their foot that measures the size of a quarter, if in four weeks it’s not the size of a nickel, you should be concerned about that.

Patient Assessment

Patients who come with a wound that’s not healing properly undergo an assessment which includes a detailed history and a thorough physical exam. One of the most important things in your history is to try and figure out if there’s anything that may be compromised their wound healing. Do they have extenuating circumstances like diabetes; do they have rheumatoid arthritis; are they taking medicines like cortisone which can impair the normal healing process?

Reducing Risks

The risk of having an unattended wound really is infection. Wounds that are open for more than 30 days are much more likely to become infected, and once you develop an infection your risk of amputation goes much higher. To mitigate those risks, we actually will go in there and surgically remove the dead tissue. That’s called debridement. We’ll actually put wound gels on there to try and promote healing; and finally, we want to remove pressure on these wounds, which we call offloading. That can be done using crutches, a wheelchair, a walking boot, a cane, or even specialized shoes.

Diabetic Foot Wounds

Education of patients, particularly with diabetic foot wounds, is absolutely critical because we get these healed but about 70 percent of the time a wound can recur. So what can we do to prevent a recurrence of an ulcer? Number one is they need good shoe wear. Number two is they need to examine their feet every day, and some of these people have arthritis so they can’t look at the bottom of their feet. They need somebody in their family to do it or a special mirror so that they can look at it. I also advocate that people with neuropathy who don’t have good feeling in their feet, have numbness and tingling, wear white socks because when they take their socks off they might see a little bit of blood from a blister. They may not feel it but they can see that.

Team of Experts

At UPMC Mercy we created a multidisciplinary team to take care of problems with the wound. And that team is comprised of orthopaedic surgeons, vascular surgeons, podiatrists as well as plastic surgeons. And the point is that we can take care of the entire problem when somebody comes in, whether it be doing a bypass or a skin graft. And we even have a medical doctor on board to take care of the medical issues as well.