Wound Care and Limb Salvage
St. Luke’s – Roosevelt Hospital
Center
Goals
Retain limbs
 Minimally invasive and invasive therapy
 Aggressive treatment of wounds
 Wound care team algorithms
 Clinical trial access
 Cutting edge therapeutic interventions
 Aggressive rehabilitation services

How we achieve these goals?
Aggressive attempts at limb salvage
 Using a combination of techniques
 When a wound is inevitable
 Inpatient wound care team
 Outpatient wound care team
 Standardized formulary
 Individualized plan for each patient

Invasive surgical options
Minimally invasive techniques
Outcomes of Aggressive
intervention



5 year 1° patency –
65 to 70 %
5 year 2° patency –
80 to 85 %
5 year limb salvage –
85 to 90%
Wound care team

Speeds time to recovery
 Integrates different experience
 Integrates different perspectives
 Provides increased continuity
 Decreases contradictory treatment
application
Wound care team

Allows for better development and
application of algorithms
 Aids in patient and caregiver education
 Provides for equal voice from various
care backgrounds
 Much easier to implement preventive
strategies
Application of the Team Concept/
Standardized Formulary

Further sub-specialization
 Diabetic foot team
 Amputation team
 Decubitus team
• Stoma team
Standardized Formulary
Allows for less caregiver and patient
confusion
 Decreases cost
 Decreases lapses in therapy once initiated
 Improves time to recovery ?

Specific team requirements

Diabetic foot
 Diabetologist- Inpatient and Outpatient
 Nurse specialist - VNS liason
 Nutritionist
 Physical therapist - Outpatient liason
 Podiatrist
 Prosthetist
 Social worker
 Vascular surgeon (Team leader)
Specific team requirements

Amputation Team
 Nurse specialist - VNS liason
 Nutritionist
 Physical therapist - Outpatient liason
 Podiatrist
 Prosthetist
 Vascular / Orthopedic surgeon
 Social worker
 Psychologist
Novel approaches and clinical
trials
Growth factor studies
 Vacuum Assisted Closure Device studies
 Drug eluting stent trials
 At present seven active clinical trials
focused at these problems
 Multidisciplinary plan of care
