Wounds Supplements

Today's Wound Clinic
Spring Digital Edition

Supplements:

	Negative Pressure Wound Therapy Devices: A Clinical Review Contemporary Issues in Wound Infection: Managing the Risks, Treating the Problem Consensus Statement on Negative Pressure Wound Therapy for the Management of Diabetic Wounds
	All Supplements

Special Publication:
The following is a collection of publications from Healthpoint intended to facilitate expeditious, cost-effective wound care management. There will be nine publications total.

	December: Newly Funded Selective and Non-Selective Debridement CPT Codes: Impact on Hospital-Owned Outpatient Wound Care Departments November: Clinical Experience with Oasis® Wound Matrix for the Treatment of Venous and Diabetic Ulcers: A Series of Four Cases
	View All in this Series

Related Links:

Symposium on Advanced Wound Care (SAWC)

The Buck Stops Here

Association of Advanced Wound Care

Ostomy/Wound Management

Podiatry Today

Vascular Disease Management

Wound Healing Society

Article Submission:

All submissions for consideration should be submitted online using the Rapid Review Web-Based Review System at www.rapidreview.com. Authors should scroll down to HMP Communications and click on Author.

Negative Pressure Wound Therapy Devices: A Clinical Review

Ron Gasbarro

Supported through an educational grant from Medela

Evidence-Based Wound Care Standards in the Clinical Setting: Applying the Knowledge to Real-World Practice

Contemporary Issues in Wound Infection: Managing the Risks, Treating the Problem

Jose A. Vazquez, MD, FAC P, FIDSA and David H. Keast, MSc, MD, FC F P

Supported through an educational grant from Smith & Nephew's Global Wound Academy.

Consensus Statement on Negative Pressure Wound Therapy for the Management of Diabetic Wounds

George Andros, MD; David G. Armstrong, DPM, PhD; Christopher E. Attinger, MD; et al.

Supported by an educational grant by KCI.

The True Cost of Growth Factor Therapy in Diabetic Foot Ulcer Care

A CME/CE Supplement

This activity is targeted towards physicians, nurses, and podiatrists.

Clinical Experience with a New,Stable, Super-Oxidized Water in Wound Treatment

A look at the science and clinical results of a novel, super-oxidized antiseptic solution in the treatment of wounds

Wound Care Management

The following is a collection of publications from Healthpoint intended to facilitate expeditious, cost-effective wound care management. There will be nine publications total.

December: Newly Funded Selective and Non-Selective Debridement CPT Codes: Impact on Hospital-Owned Outpatient Wound Care Departments

Each year in the US, healthcare insurers (including Medicare) process more than five billion claims for payment. Standard codes have been devised to ensure these claims are processed in an orderly and consistent manner. As a reference for providers, the American Medical Association (AMA) publishes a monthly guide, the CPT Assistant, that includes the correct definitions of all Current Procedural Terminology (CPT®) Codes*.

November: Clinical Experience with Oasis® Wound Matrix for the Treatment of Venous and Diabetic Ulcers: A Series of Four Cases

Diabetic and venous ulcers are prevalent, costly, and can be frustrating to treat. These wounds are typically slow to heal and may develop into chronic wounds that are nonresponsive to therapy. Although standard care is effective for some of these wounds, a substantial portion fail to heal despite 3 or 4 months of diligent care.1 Evidence from a number of studies shows that wounds that do not progress adequately toward healing within the first 2 to 4 weeks of standard care are unlikely to heal given 3 or 4 months of care.2,3 These findings suggest that difficult-to-heal wounds should be re-evaluated after 4 weeks; if they have not progressed adequately toward closure, more aggressive treatment strategies should be initiated.2

October: Clinical Experience with Oasis® Wound Matrix for the Treatment of Venous and Diabetic Ulcers: A Series of Four Cases

Diabetic and venous ulcers are prevalent, costly, and can be frustrating to treat. These wounds are typically slow to heal and may develop into chronic wounds that are nonresponsive to therapy. Although standard care is effective for some of these wounds, a substantial portion fail to heal despite 3 or 4 months of diligent care. Evidence from a number of studies shows that wounds that do not progress adequately toward healing within the first 2 to 4 weeks of standard care are unlikely to heal given 3 or 4 months of care. These findings suggest that difficult-to-heal wounds should be re-evaluated after 4 weeks; if they have not progressed adequately toward closure, more aggressive treatment strategies should be initiated.

September: A Clinical and Coding Overview of OASIS® Wound Matrix and OASIS® Burn Matrix

OASIS® Wound Matrix is a natural extracellular matrix that has an intact three-dimensional structure that replaces the body’s missing or failing extracellular matrix. OASIS contains key components of the dermal extracellular matrix such as collagen, elastin, glycosaminoglycans, glycoproteins, and proteoglycans. It is derived from porcine small intestinal submucosa and retains the biological structure of extracellular molecules to provide the scaffolding to support cell proliferation and adherence.

August: Newly Funded Selective and Non-Selective Debridement CPT Codes: Impact on Hospital-Owned Outpatient Wound Care Departments

July: The Extracellular Matrix in Wound Healing

Clinician understanding of pathophysiological event processes in wound healing must include knowledge of normal structure and function. Such information enables appropriate application of replacement products or adjunctive therapies that assist in restoring the normal healing process. For example, a matrix is more than a construct of collagen that acts as a scaffold for tissue re-growth (the common, basic perception) — it is a complex, highly organized three-dimensional structure that serves not only as a scaffolding, but also as a signaling, binding, and activating substrate that interacts with the highly organized wound healing process. A matrix is important at all stages of wound repair from homeostasis to healing; it may promote communication between the keratinocyte and the fibroblast. In the past few years, technology has allowed a better understanding of the events of wound healing. Peer-reviewed clinical data are now available on matrix replacement options in chronic wounds. This article provides an overview of the extracellular matrix and its role in wound healing.

June: Advancing Standard of Care in Difficult-to-Heal Wounds: Rationale for OASIS® Wound Matrix as the Next Step in Therapy

Wounds that fail to heal in a timely fashion can be both a frustrating and costly experience. These wounds, most frequently venous, diabetic, or pressure ulcers, are time consuming for patients and clinicians and oftentimes interfere with patient quality of life. The direct financial costs of these wounds are staggering, totaling many billions of dollars annually in the United States. For instance, the cost of treating uninfected diabetic foot ulcers alone has been estimated at more than $6 billion annually. Wound complications such as infection and subsequent hospitalization are the largest contributors to costs.

May: New Developments in Enzymatic Debridement Therapies: “No-Touch” Application

Difficult-to-heal and chronic wounds such as diabetic, venous, and pressure ulcers are among the most challenging wounds to treat. Billions of dollars are spent on the management of these wounds annually. Beyond the burden to the healthcare system, the negative impact these wounds have on a patient’s quality of life make reducing time to closure an essential component of the treatment plan.

Wound Bed Preparation

Part 1: An Introduction to TIME

Patients referred to a wound care clinic must be prepared to heal. Despite innovative, new technologies such as growth factors, bio-engineered skin products, and vacuum-assisted closure, chronic wounds will not progress to healthy closure without consideration of a number of patient and wound factors. Clinicians must address key initial components of wound management — treat the cause of the chronic wound, appraise patient-centered concerns, determine wound chronicity/location/dimensions/condition, and assess pain — and ensure the wound bed is appropriately prepared. Only then can the maximum benefits from advanced wound care products be derived and wound healing achieved.

Part 2: TIME for Venous Ulcer Management

Chronic wounds present a unique set of challenges for wound care clinicians. Unlike acute wounds that progress through four phases to closure, chronic wounds become stuck in the intermediate phases and require intervention to remove the barriers to healing and to restart the healing process. Specific wound types, such as venous ulcers, require particular approaches within the realm of wound bed preparation to remove major obstacles to optimal closure of the chronic wound.

Part 3: The Role of Silver in Infection Control

Wound bed preparation is a new approach that integrates proven concepts to build a platform for the treatment of chronic wounds. It organizes currently approved medical procedures and products into a holistic approach that can be used to evaluate and remove barriers to the wound-healing process. Removal of such barriers allows for optimal wound repair and healing. To address these barriers, a systematic approach to the management of chronic wounds has been developed. The approach goes by the acronym TIME (tissue: non-viable or deficient; infection or inflammation; moisture imbalance; and edge of wound: non-advancing or undermined) — the goal is to establish a well-vascularized wound bed that facilitates the effectiveness of other therapeutic measures.

Part 4: Debridement and the Role of Enzymes

An important aspect of the TIME principle is the need to address nonviable or deficient tissue and restore the wound base and extracellular matrix proteins. In acute wounds, wound debridement is an effective way to remove necrotic tissues and bacteria so the wound can heal with relative ease. This is not the case for chronic wounds, where much more than debridement needs to be addressed for optimal results. Chronic wounds, such as venous ulcers, have a “necrotic burden” consisting of both necrotic tissue and exudate — as such, these wounds can be intensely inflammatory. They produce substantial amounts of exudate that interfere with healing and the effectiveness of therapeutic products such as growth factors and bioengineered skin. Therefore, in the context of wound bed preparation, clinicians need to remove not only eschar and frankly nonviable tissue, but also wound exudate.

Part 5: Moisture Imbalance and the Chronic Wound

Wound care has progressed rap idly during the last 20 years. If clinicians and their patients are to fully benefit from the sophisticated therapies currently available, as well as those currently under development, a greater understanding of the basis of proper wound care is essential. Unless the wound is properly prepared, neither conventional nor advanced therapies (eg, gene therapy, recombinant growth factors, or bioengineered skin grafts) will prove as effective as they can be.

Part 6: Infection and Inflammation

Wound infection delays wound closure. It prolongs the inflammatory phase of healing and often causes distress and discomfort for patients. Wound infections also have considerable financial implications due to increased length of hospital stay, the additional cost of antimicrobial therapy, and a higher incidence of related wound management complications.

Part 7: Protecting Skin from Breakdown

The prevalence of incontinence in the elderly increases this population’s risk for skin breakdown, particularly pressure ulcers. Moisture increases shear and friction on the skin, which affects skin permeability and barrier function. Enzymes present in urine and fecal matter exacerbate these negative effects; cleansing can be abrasive and further disrupt the skin’s natural chemical environment. Skin breakdown is costly. Treatment expensive and quality-of-life issues are challenging. Plus, because pressure ulcers awareness in both the public and judicial sectors has increased, the potential monetary and emotional expense of litigation must be considered.

Part 8: Burn Wound Care

Burn care is complex. It involves multisystem assessment, multidisciplinary care, and appropriate interventions. Only after the burn care professional is fairly certain the patient will survive the burn injury can treatment goals focus on burn wound closure. Inpatient hospital stays for burn patients range from a few days for small partial-thickness burns that heal on their own to several months for patients with large total body surface area burns and deep burns that often are exacerbated by other medical complications and require multiple surgeries to achieve wound closure.

Part 9: Incorporating a Dermal Substitute

During the normal process of wound healing, a series of molecular events prepare the wound for repair, deposition of new extracellular matrix, and eventually complete wound closure. This orderly process of cellular control is impaired in chronic wounds, delaying or interrupting the repair process.

Part 10: The Wound Bed Preparation Care Cycle

Wound bed preparation and the TIME principle facilitate evaluation and treatment of chronic wounds. Earlier articles in this series discussed the components of TIME and how this approach can be used to treat specific wound types such as venous ulcers and diabetic foot ulcers.

Part 11: A Concept for Pressure Ulcers

Pressure ulcers are a costly, often unpredictable challenge for clinicians. Although these wounds have been managed successfully for years, increased awareness among governing bodies and healthcare providers regarding the need for prompt, appropriate pressure ulcer management has sparked a renewed interest in improving care. The National Pressure Ulcer Advisory Panel (NPUAP) is currently revisiting its understanding of pressure ulcer physiology — the results of its considerations potentially will affect the way pressure ulcers are staged and treated. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) has increased scrutiny of pressure ulcer management in long-term care, introducing revisions to its pressure ulcer management guidelines; similar guideline implementation is anticipated for acute care. Pressure ulcers and their possible implication in substandard care litigation are fueling public awareness of the pressure ulcer conundrum. Obviously, diligent healthcare providers need to find the optimal balance between providing quality care and managing expenses.

Part 12: Benchmarking Outcomes

Attention to underlying wound etiology and factors that affect healing, combined with the TIME Principle for Wound Bed Preparation, can be a powerful model for healthcare providers who manage patients with chronic wounds. Wound bed preparation is an important part of the care process, as is the ability to evaluate and benchmark the effectiveness of individual treatment modalities and the overall quality of care provided within a facility. In addition, assessing performance can fuel a facility's outcomes-based quality improvement (OBQI) program and the ability to benchmark with others can help a facility achieve "best practice" status.