2016: Wound Care: Nuts and Bolts - Broder

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


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



• 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



• Delayed Wound Healing


NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION


NEGATIVE PRESSURE WOUND THERAPYWITH INSTILLATION

3rd Annual UCSD Clinical Geriatrics Interprofessional Symposium 9 Weeks

ACELLULAR-BASED THERAPY

• Acellular Matrices


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


• 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


ACELLULAR-BASED THERAPYWEEK 2


ACELLULAR-BASED THERAPYPORCINE URINARY BLADDER MATRIX


ACELLULAR-BASED THERAPYMATRIX AND NEGATIVE PRESSURE WOUND

THERAPY SPONGE

CELLULAR-BASED THERAPY

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


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


Human amnion/chorion membrane

CELLULAR-BASED THERAPYDEHYDRATED HUMAN AMNION/CHORION

MEMBRANE


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



MEMBRANE


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


CELLULAR-BASED THERAPYSTEM CELLS

WOUND CARE: NUTS AND BOLTS

Thank YouKevin Broder, MD


Torrey Pines Golf Course

2016: Wound Care: Nuts and Bolts - Broder

Healthcare

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