2005 Symposium on Advanced Wound Care | |
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Case Study
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Safe operative treatment of chronic wounds Andrew Hanflik, BS, Columbia Wound Healing Program, Columbia University Medical Center, New York, NY; Lucille Torres, BS, Columbia Wound Healing Program, Columbia University Medical Center, New York, NY; Harold Brem, MD, Director Wound Healing Program, Columbia University College of Physicians and Surgeons, New York, NY; G.O. Armond, RN, MA, Nursing Director Wound Healing Center: The Wound Center at Columbia, New York, NY Introduction. Over a six month period in 2004, we evaluated the comorbidities of 120 consecutive patients who presented to the wound center and were electively brought to the operating room for surgical debridement. Our hypothesis was, that by standardizing the preoperative evaluation and strictly adhering to published wound protocols, comobidities could be optimally managed preoperatively, anesthesia optimized and outcomes improved.1-4 Methods. Using a standard query of our Wound Electronic Medical Record database we examined the history of 120 consecutive patients who underwent procedures in the operating room directly related to their wounds. Results. Cardiac pathology included severe aortic stenosis of 0.8 cm, recent cardiac ischemia, arrhythmias and ejection fraction of below 30%. Pulmonary impairments included chronic obstructive pulmonary disease and Sarcoidosis. Psychological/Psychiatric conditions were also represented, including bi-polar disorder, schizophrenia, dementia and anxiety. Alzheimer’s, Parkinson’s disease, peripheral neuropathy and epilepsy were also present, representing neurological impairments. A variety of states of paralysis in patients ranging from (C4-T12) presented. 100 consecutive patients received anesthesia without any major complications. The length of stay of all 100 patients was significantly less than the external benchmark. Conclusion. Most complications in patients with chronic wounds can be avoided by case management with the primary medical physician, collaboration with the anesthesiologist and strict adherence to published protocols. References Brem H, Lyder C. Protocol for the successful treatment of pressure ulcers. Am J Surg. 2004;188:9–17. Brem H, Kirsner RS, Falanga V. Protocol for the successful treatment of venous ulcers. Am J Surg. 2004;188:1–8. Brem H, Sheehan P, Boulton AJM. Protocol for treatment of diabetic foot ulcers. Am J Surg. 2004;187:S1–S10. Brem H, Jacobs T, Vileikyte L, et al. Wound-healing protocols for diabetic foot and pressure ulcers. Surg Technol Int. |
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