Sometimes, a wound is as simple as a paper cut or a scraped knee. This type of wound is usually minor and may be able to clear up on its own without needing more than a bandage or a little antiseptic cream.
However, there are some wounds that require more specialized treatment from a team of experts in wound care. That’s where the Stormont Vail Wound Center steps in.
The Wound Care Center offers patients access to top-notch outpatient wound care as well as hyperbaric medicine. We specialize in advanced wound care using clinical treatments, therapies and support services to treat chronic wounds.
Our approach to care is physician-driven and involves providers from multiple specialties. This ensures that our treatments have high success rates and that patients can heal quickly and effectively.
Conditions We Treat
Diabetic UlcersPeople with diabetes are at an increased risk of developing sores called foot ulcers.
While these ulcers are usually painless, it is important to have a physician look at them right away — ulcers that do not heal can cause severe damage to bones or tissues, and may even require amputation (surgical removal) of your foot, toe or part of your leg. In fact, 80% of amputations begin with foot ulcers.
The good news is ulcers can often be treated without amputation.
Three common ways to treat foot ulcers include:
- Debridement: Removing dead skin and tissue. This allows your provider to clearly see and evaluate the ulcer. It can also reduce the rate of infection, and make it easier for the ulcer to heal.
- Relieving pressure: Since foot ulcers are partially caused by pressure on the foot, it’s important to put as little pressure as possible on your foot. If you have an ulcer, your provider may have you wear a brace, cast or special shoes. In some cases, you may need to use crutches or a wheelchair until the ulcer has healed. These devices take pressure off your foot, speeding the healing process.
- Keeping the wound clean: Daily cleaning and wound dressing can help your ulcer heal. One of the most commonly used methods is wet-to-dry cleaning. This involves putting a wet dressing on the ulcer, which absorbs part of the wound as it dries. Then, when you remove the dressing, some of the damaged tissue will come off with it.
In addition, it’s important to pay extra special attention to diabetes management. Keeping your blood sugar and blood pressure levels under control can lower your risk of needing an amputation.
Neuropathic and Ischemic UlcersIschemic ulcers are wounds that occur when you do not get enough blood flow to your legs. This causes tissue damage. Generally, these ulcers occur on the legs and feet, and can be slow to heal.
The most common cause of ischemic ulcers is clogged arteries (blood vessels in the heart). The heart cannot send enough blood throughout the body, and cannot provide enough oxygen or nutrients to the legs. Ischemic ulcers can also be caused by conditions that cause inflammation (swelling) in the skin, or when there is a buildup of fluid in the legs.
Neuropathic ulcers are caused by neuropathy (nerve damage or disease), and tend to occur in the feet or toes. Many people with neuropathy experience numbness, so they can’t feel when they injure their foot. They might not even notice the wound until it becomes infected.
These types of ulcers are usually found in people with diabetes. However, they can occur in anyone who has problems with sensation in their feet.
Ulcers can often be treated with simple wound care: keeping the ulcer clean, bandaging the wound to prevent infection, keeping the dressing and surrounding skin dry, and not putting too much pressure on the ulcer. If you have an ischemic ulcer, you may need medicine or surgery to restore blood flow to your legs.
Pressure Ulcers (Bedsores)Pressure ulcers are areas of damaged skin that are caused by lack of blood flow because of pressure. The pressure occurs when people stay in the same position for too long, and there is pressure on the skin from a bed, cast, splint, wheelchair or poorly fitting prosthetic device.
People who are bedridden, confined to wheelchairs, cannot reposition themselves, or have a lengthy stay at a hospital or nursing home, are at risk for developing pressure sores. They are most common in older people.
If left untreated, pressure sores can be life-threatening. Fortunately, with early treatment the sores can usually heal.
Treatments include relieving pressure on the area, managing pain (e.g. with pain medication), controlling infections, and eating a nutritious diet. If you have a large sore that cannot heal, you may need surgery to close the sore.
Wound cleaning and dressing are essential for healing. It is vital to keep the sores clean, apply dressings and remove dead skin (debridement). Since the tissue is dead, and you cannot feel pain in dead tissue, debridement is generally a painless process.
Dressings protect sores and help them heal. The type of dressing your provider recommends is based on the condition and location of the sore, as well as the amount of drainage (pus or fluid) that oozes from the sore.
Venous InsufficiencyNormally, your veins move blood from your legs to your heart. In order for the veins to work, the surrounding muscles and valves prevent blood from flowing backward, and going back into the legs. If these muscles and valves weaken or fail, the veins can’t return blood to the heart. Blood begins to collect and stay in the affected vein.
Venous insufficiency can cause symptoms and wounds including:
- Skin ulcers
- Blood clots
- Skin that becomes cracked or irritated if you scratch it
- Varicose veins (twisted, swollen, and enlarged veins that are visible under the skin)
- Superficial thrombophlebitis (the veins in your legs that are closest to the skin become swollen and tender)
- Lipodermatosclerosis (skin on the legs and ankles become thick and hard)
- Stasis dermatitis (red, swollen, crusty skin)
Many times, changing your lifestyle (e.g. losing weight, not standing or sitting for long periods of time) and caring for your wound (e.g. dressings, cleaning) are enough to treat venous insufficiency. If these changes do not improve your symptoms, or if you are experiencing severe pain, you may need another type of treatment.
Treatment options include:
- Endovenous thermal ablation: Radiofrequency heats and seals off the affected vein. We use ultrasound technology to see the vein and do the procedure, without performing open surgery.
- Sclerotherapy: We inject a solution right into your vein. This causes it to shrink until it eventually disappears. If the vein is large, we also inject foam, which closes and seals the vein. This treatment is minimally invasive, meaning you will not need major surgery.
- Phlebectomy (vein stripping): We use a needle or small scalpel to remove varicose veins on the surface of the leg. This is done through tiny cuts on the skin, and does not require major surgery.
- Vein stripping surgery: This is a surgical procedure where we remove the entire superficial vein (vein closest to the skin). The surgery is done under general anesthesia, meaning you will be unconscious during the procedure. Since there are several effective, non-surgical treatments available, vein stripping surgery is not performed often.
Surgical and Traumatic WoundsSurgical wounds occur when an incision (cut) that was made during surgery breaks open. Traumatic wounds are non-surgical tears, scrapes, or punctures. They may be the result of scraping your skin against something that contains debris (e.g. sand, gravel), force (e.g. body parts are crushed, as in a car accident), or animal bites.
Some wounds, such as shallow cuts not caused by bites, are not serious and can heal on their own. However, others can become infected causing further injury or severe consequences such as severe blood loss.
For both surgical and traumatic wounds, our goal is to make sure your wound heals fully. We remove dirt and debris that has gotten into the wound and stitch broken skin back together to prevent infection.
The next step is making sure that the wound is properly dressed and clean. Your provider will determine which type of dressing you need and how often you need to change it based on the type and location of your wound.
In addition, we commonly treat burns and other chronic, non-healing wounds.
Hyperbaric Oxygen Therapy (HBOT)
In order to function correctly, your body’s tissues require an adequate oxygen supply. Wounded or damaged tissue needs even more oxygen.
Hyperbaric oxygen therapy helps your wounded tissues function more efficiently by increasing the amount of oxygen that can be carried through your blood, and delivering about 15 to 20 times more than the normal amount of oxygen to your tissues. This helps you heal, and also prevents infection.
During HBOT, you will lay down in an enclosed chamber and breathe in pure oxygen. The air pressure in the chamber is increased to three times higher than normal, allowing your lungs to gather more oxygen than they would normally be able to at regular air pressure.
If you have any of these conditions, your provider may recommend HBOT:
- Diabetic ulcers (sores) in the feet or legs
- Non-healing wounds
- Skin or bone infection
- Skin grafts or flaps that are at risk for tissue death
- Soft tissue radionecrosis (tissue breakdown from radiation therapy) or osteoradionecrosis (bone death from radiation therapy)
- Chronic refractory osteomyelitis (recurring bacterial infection in the bone or bone marrow)
- Actinomycosis (long-lasting infection caused by the Actinomyces israelii bacteria, that usually affects the neck and face)
- Crushing injury (force or pressure put on the body)
- Arterial gas embolisms (air-filled bubbles instead of your blood vessels)
- Gangrene (death of body tissue due to a serious bacterial infection or lack of blood flow to the tissue)
Common dressings include:
- Clear films or gels protect pressure sores in the earliest stages, when they do not have much drainage. These dressings are changed every three to seven days.
- Hydrocolloid patches are placed on sores to keep in oxygen and moisture. They protect sores with light or moderate drainage. These patches are changed every three days, but may need to be changed more often if they become too full of fluid.
- Alginates are pads, ribbons and ropes made from seaweed. They are used on pressure sores that have a lot of drainage. These dressings are changed every seven days, but must be changed earlier if they become too fluid-filled.
- Foam dressings are used on sores with any amount of drainage. There are waterproof versions, which protect pressure sores from sweat, urine and feces. These must be changed every three to four days.