Advanced Wound Care Treatments Lecture: Introduction (04:18)
M. Dolores Farrer describes her podiatry and VA background. She will discuss chronic wounds, such as pressure, diabetic, venous and arterial ulcers.
Cellular Wound Healing Process (11:11)
Farrer explains hemostasis and inflammation; diabetic patients get "stuck" in the inflammation stage. Open wounds risk infection; most have polymicrobial biofilm. Learn about removing senescent cells and decreasing rogue matrix metalloproteinases (MMPs).
Basic Wound Care (05:19)
Infection control is the first priority, including bone removal. Sharp debridement involves removing senescent cells, rogue MMPs, and foreign bodies. Farrer discusses the importance of nutrition, patient education and compliance.
Debridement Types and Methods (21:26)
Learn about autolytic debridement, including using hypochlorous solution to decrease pH level for applying collagenase to remove fibrin. Wound cleanser deactivates collagenase. Farrer discusses using medical honey, gentian violet, methylene blue, mechanical debridement, ultrasound, negative pressure, maggots, and tissue nippers.
Farrer explains how antibiotic resistant colonies form a matrix over planktonic bacteria in a wound, promote anaerobic bacteria, and prevent fibroblasts and keratinocytes from entering. Learn about debriding friable granulation tissue, applying hypochlorous solution and cadexomer iodine, and prescribing oral antibiotics.
Diabetic Foot Ulcers (17:28)
Farrer discusses medical and lifestyle expenses of amputations; 50% pf patients die within five years due to inadequate treatment. Hear DFU risk factors and clinical presentations. Learn about the 5.07 monofilament test and filing down calluses.
Neuropathy and Assessment (14:47)
Farrer explains how loss of sensation affects diabetic feet. Learn about taking weight bearing x-rays, the dorsalis pedis pulse, and using the capillary field test and Wagner Grading System. Farrer describes a necrotic bone case study and discusses patient offloading education.
DFU Offloading Options (28:33)
Farrer explains why whirlpools are no longer used for DFUs. Patients should not use betadine or alcohol to clean wounds. Learn about knee rollers, total contact casts, football dressings, customized shoes, and cam walkers.
Total Contact Cast, Padding, and Football Dressing (21:18)
Farrer explains how pressure is distributed up the calf, allowing DFUs to heal, and discusses ways to increase patient compliance. Peel and stick pads can be placed around the wound. Farrer discusses football dressings and using TALs to heal plantar wounds.
Charcot Foot (27:07)
Learn about the neuropathic hyperemia condition causing a fallen arch and a "rocker bottom" foot shape. Immobilization is the main treatment; other options include custom shoes, bracing, orthotics, and CROW walkers. Learn about foot care prevention measures.
Football Dressing Demonstration (19:31)
Farrer shows how to place a football dressing to relieve foot ulcer pressure.
Venous Leg Ulcers (21:14)
Hear how ulcers occur in the superficial vein system. Treatment includes compression stockings and vein ablation. Farrer discusses clinical presentation, varicosity, cancer risk, pyoderma gangrenosum (pg), and DVT.
VLU Symptoms and Treatment (17:25)
Farrer covers irregular borders, bony prominence occurrence, drainage, hemosiderin staining, dermatitis, and edema patterns. Learn about mechanical debridement with negative pressure, debridement with microfiber pads, topical dressings, leg elevation, and medications. Surgical options include skin grafts and vein ablation.
VLU Compression Wrap Options (15:35)
Compression reduces edema, improves venous reflux, and reduces swelling and pain. Check for DVT before putting on a tight dressing. Farrer discusses inelastic Unna boots and elastic long stretch bandages.
VLU Alternatives to Compression Wraps (21:00)
Ferrer discusses adjustable fabric material with Velcro, compression leg pumps, leg elevation, and negative pressure. Hear about the importance of patient education in preventing reoccurring ulcers.
Advanced Tissues: Skin Grafting (32:09)
If wounds do not heal after four weeks, adjunctive therapies like cellular tissues, skin grafts, hyperbaric oxygen therapy, ultrasonic therapy, negative pressure, continuous oxygen, and e-stimulation are recommended. Farrer explains different types of skin grafts and discusses reimbursement strategies.
Other Adjunctive Wound Therapies (15:11)
Farrer discusses using mechanical negative pressure and hyperbaric and topical oxygen therapy, including their advantages and disadvantages. Hyperbaric oxygen therapy is not always covered by insurance.
Stress and Wound Care (08:37)
Stress is the body's physical or emotional reaction to injury and pain. Farrer talks about how stress affects the immune system and healing process. Breathing techniques, exercise, pain medication, and social activity help reduce stress. Hear ways to gain patient trust.
Involving Patients in Wound Care (12:54)
Farrer discusses gaining patient trust, being courteous, and empowering patients to advocate for their health.
Patient Compliance vs. Adherence (08:31)
Farrer talks about patients refusing to follow instructions and patients agreeing to instructions but being unable to follow them. Healthcare professionals should involve them in wound care decisions and educate them about the disease process.
Arterial Ulcers (13:27)
AUs are caused by poor perfusion. Clinical presentation includes weak pulses, extremity hair loss, and calf pain. Farrer covers vascular testing, toe systolic pressure, vessel calcification, TCOM, skin perfusion, and arterial wounds on diabetic feet.
Arterial Ulcer Treatment (05:13)
Use betadine on eschar wounds and offload them, but do not debride them until revascularization. Farrer discusses dry and wet gangrene, pain control, and arterial pumps.
Wound Dressings (11:15)
Farrer provides an overview of types of medical dressings, including collagen, alginate, anti-bacterial gauzes, foam, and hydrocolloid. Silver resistance is developing. Farrer recommends getting discounts from product representatives.
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