WOUND CARE: NUTS AND BOLTS

Kevin Broder, MDTelemedicine & Wound Director, San Diego GWEPTelehealth Director, Department of SurgerySection of Plastic SurgeryVA Medical Center – San Diego, CA

December 4, 2016

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ADJUNCTS TO WOUND HEALING

• Negative Pressure Wound Therapy• Acellular and Cellular Based Wound Therapies

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPY

• Advantages– Occlusive – maintains

moist wound environment– Increase blood flow– Decrease edema– Decrease bacterial

contamination– Promote wound contraction– Less dressing changes– Less pain

• Contraindications– Fresh blood vessel repair– Malignancy– Untreated osteomyelitis

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPY

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPY

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPY

• A 57-year-old paraplegic woman

• Right hip trochanteric Stage IV pressure ulcer down to the level of exposed bone

• I&D with flap reconstruction

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPY

• Delayed Wound Healing

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 9 Weeks

ACELLULAR-BASED THERAPY

• Acellular Matrices

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

Porcine Small Intestinal Submucosa

Dermal Regeneration Matrix - Meshed acellular bovine collagen, glycosaminoglycan, silicone

Human Dermal Allograft

• A 66-year-old male with T5 ASIA C paraplegia• Stage 4 left ischial pressure ulcer• Type 2 diabetes• Active smoking• Malnutrition• Lives at home with attendant care• Skin defect dimensions of 8x8 cm• Wound depth 5 cm to the level of exposed bone• Refused Flap Reconstruction

ACELLULAR-BASED THERAPY

ACELLULAR-BASED THERAPYINITIAL PRESENTATION

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

• Smoking Cessation• Nutrition Optimization• Pressure Relief• Glucose Control• Debride• Bone biopsy• Antibiotics• Negative Pressure3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYFAILED TO HEAL

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 2

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYPORCINE URINARY BLADDER MATRIX

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYMATRIX AND NEGATIVE PRESSURE WOUND

THERAPY SPONGE

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 3

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 4

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 5

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 6

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 7

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

ACELLULAR-BASED THERAPYWEEK 8

CELLULAR-BASED THERAPY

• Allogenic– Cryopreserved– Stimulate senescent wounds– Faster wound healing

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

Bilayered: Neonatal fibroblasts and keratinocytes on bovine collagen

Monolayer: neonatal dermal fibrogblasts on bioresorbable polyglactin

Split thickness cadaveric skin

• Placental Membranes– Used for 100’s of years– No painful donor site– Stem cell recruitment

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

Human amnion/chorion membrane

CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION

MEMBRANE

CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION

MEMBRANE• A 63-year-old male

paraplegic with chronic stage IV sacral and left ischial pressure ulcers

• Underwent I&D with flap reconstruction of sacral ulcer

• While awaiting staged reconstruction of ischial wound, underwent dHACM application

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION

MEMBRANE

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

8 Weeks

• Adipocyte Derived Regenerative Cells– NCT02375802; Phase 1; Adipose-Derived Stromal Cells (ASC’s) and Pressure

Ulcers; Pressure Ulcers– NCT02092870; Phase 2;Adipose-derived Regenerative Cellular Therapy of

Chronic Wounds; DFU, chronic wounds

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

CELLULAR-BASED THERAPYSTEM CELLS

WOUND CARE: NUTS AND BOLTS

Thank YouKevin Broder, MD

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium

Torrey Pines Golf Course