CLINIC IN FOCUS - The Center for Reconstruction and Wound Healing
What are the most common indications treated at the clinic?
Late effects of radiation, diabetic lower-extremity ulcers, venous ulcers, arterial ulcers, pressure ulcers, skin cancers, surgical wounds (breast, colon, stomach), hand and wrist injuries, traumatic wounds, vasculitic wounds, foot and ankle conditions, complex reconstruction, decompression illness, compromised skin flaps and grafts, refractory osteomyelitis
Interesting success stories from clinic?
We treated a very pleasant gentleman who presented to us in 2016 due to multiple small nonhealing scalp ulcers in the range of 1.5 x 1.3 x 0.2 cms with bone at the base. His history was positive for a squamous cell excision by Mohs surgery in 2012, followed by a split-thickness skin graft from his shoulder, and then 3500 rads of radiation therapy.
Two years later, he was diagnosed with lymph-node cancer of the head and neck and was treated with another 3500 rads. He presented to us with the nonhealing scalp wounds secondary to his Mohs surgery and radiation therapy. His split-thickness skin graft had also failed, probably related to his radiation therapy. He received 30 treatments of hyperbaric oxygen therapy, and then we performed a CelluTome epithelial graft to the involved scalp area and followed this with a 10-treatment course of hyperbaric oxygen therapy due to his extensive history of radiation. By this time he only had a small area of exposed bone of 0.2 x 0.2 x 0.1, and we applied a dehydrated amniotic tissue graft each week for two weeks. His last exam following these applications demonstrated a healed postop surgical wound and healed small ulcers due to the late effects of radiation. The patient is extremely pleased to no longer have any open wounds after suffering for more than two years.
A second case demonstrating the advantages of having a multidisciplinary approach to a problematic wound was that of a 71-year-old woman who presented to the clinic in 2015 with a nonhealing surgical wound of the right lower leg. Her dermatologist had excised a squamous cell cancer, followed by a course of more than 6000 rads for definitive treatment. She was treated postradiation with several topical creams, but the surgical site failed to heal. After three months she was referred to the Center for Reconstruction and Wound Healing
After assessing that she had adequate arterial flow to the extremity, and ruling out infection, we gave her 40 hyperbaric oxygen treatments as well as intermittent debridements and collagen/oxidized regenerated cellulose (ORC) wound care. Posthyperbaric treatments, she had improved granulation, and the clinic’s plastic surgeon performed a split-thickness skin graft. Negative pressure was applied postoperatively.
Finally, she had several dehydrated amniotic tissue grafts applied to cover the small areas where the split-thickness skin graft had failed. By the teamwork of the wound physician and hyperbaric physician and finally the plastic surgeon, the patient had a completely healed wound and has become an advocate for the Center for Reconstruction and Wound Care.
The Center for Reconstruction and Wound Care received the Certificate of Distinction–Wound Care Program from the Joint Commission’s Disease-Specific Certification Program in July 2017.