The Wound Care and Hyperbaric Treatment Program at Manatee Memorial Hospital provides specialized treatment for chronic or non-healing wounds, which are defined as sores or wounds that have not significantly improved from conventional treatments. Associated with inadequate circulation, poorly functioning veins, and immobility, non-healing wounds lead to lower quality of life and may lead to amputations.
In this segment, Maura Buete, MD, Medical Director, The Wound Care & Hyperbaric Treatment Center at Manatee Memorial Hospital, discusses when wounds persist, a specialized approach is required for healing. If you have a sore or wound that has not begun to heal in a month, or has not healed entirely in two months, contact Manatee Memorial's Wound Care department by calling 941.745.7251.
Selected Podcast
Manatee Memorial Hospital Wound Care and Hyperbaric Treatment Program – Why Wounds Won’t Heal
Featured Speaker:
Maura Buete, MD
Maura Buete, MD is a Healogics Specialty Physician and Medical Director of the Manatee Memorial Wound Care Program. Transcription:
Melanie Cole (Host): Millions of people suffer needlessly from chronic non-healing wounds, such as those caused by diabetes, poor circulation, injuries, and other conditions. Most wounds can be treated successfully by a primary care physician; however, when wounds have not healed after several weeks, they may require specialized care. My guest today is Dr. Maura Buete. She's the medical director of the Wound Care and Hyperbaric Treatment Program at Manatee Memorial Hospital. Welcome to the show, Dr. Buete. Tell us about wounds and what are some of the most common reasons for wounds that will not heal?
Dr. Maura Buete, MD (Guest): Well, thank you for having me Melanie. I actually -- I often tell my patients if you think about it when you're a child, you can pretty much do whatever you wanted to. The scrape on your knee or the cut that you might receive while playing and then as you get older you start noticing that things sort of slow down -- might take a little bit longer to heal, and that's where we come in and, you know, and going from just throw a band aid on it, and it's going to do well and some of us, you know, are lucky enough or fortunate enough to still be able to have our wounds heal like that, but eventually you get to a point, and a lot of us will, that the seven to ten days it normally takes to have a wound heal almost doesn’t -- things start slowing down, and it can be from a variety of reasons. It could be poor nutrition, your other medical issues or comorbidities as we like to call them, different medicines you're on. Maybe even just a poor approach to wound healing. Venous insufficiency, diabetes -- it's very complicated, and often I tell patients the wound's not healing -- that’s a symptom of something else, and that's how we approach it. So, when you get to that point -- your wound's not healing -- you might have a consultation with your primary physician and some interventions might be made like treating an infection, but eventually you have to say -- what else is going on -- and that's what I really like about wound healing because it's a little bit of a puzzle, and everybody's different.
Melanie: How long would a person watch their wound before they say, "You know what, this isn't" and what should they look for as far as red flags around the edges or leakage from the wound? Are there some things you want them to watch out for?
Dr. Buete: Sure, in general, a person that doesn't have a history with problem wound healings, and I'm talking about patients that aren't diabetic that have been to wound care facilities before or people with very poor circulation, and generally I say if it's not going in the right direction in a week to 10 days, or you see increasing redness, increasing pain, any malodor, or change in the drainage, then it's time to get another opinion to seek help.
Melanie: And so, I’m going to ask you this before we get into some of the wound healing treatments. People are always wondering if they are self-treating a wound. Do you keep it moist? Do you keep it covered? Do you keep it dry? Do you let it air dry? What do you do for best wound care?
Dr. Buete: When I was in medical school, the dermatologists would say, “Well, if it's wet; dry it; if it's dry; wet it,” and to some degree that's true. If you are dealing with a wound at home, the best thing you can do is to just keep it covered. Bacteria can actually get through, you know, one study said 44 layers of a dressing. So, they can get through anything you’re putting on it to cause infection, but that's our best first line defense. If it's too wet, you know, you don’t keep a non-stick on it. You want to put regular gauze. If it's thick and scabby, you can use some over-the-counter ointments, but we always say, “Say no to Neosporin.” Don't use neomycin-containing antibiotics over the counter because Neosporin, while it does kill the bacteria, it's also what we call cytotoxic, meaning it kills the good cells. So, it impedes wound healing to some degree, and not only that, but about 25% of people can actually have an allergic reaction to it, and then they're hurting and impeding wound healing. So, use bacitracin, is a good over-the-counter one, and they also have Medihoney products that you can get over the counter to put that on the wound and again, that's while you're waiting to seek medical treatment -- in particular if you have other issues like diabetes, venous insufficiency, things like that because diabetes -- why wounds won't heal in a diabetic, you have poor circulation. We all know that diabetics have heart issues and eye issues and kidney issues, but it also affects small vessels to the skin, and the same ones -- the same small vessels that are affected when you have vision problems. So, diabetics might have excellent control of their blood sugars, but they still have this microvascular circulation that's keeping their wound from healing. Venous insufficiency, when you get really swollen legs that have that dark discoloration below the knees; varicosities, the veins that you can see in the skin, when your legs are swollen, your tissues are full of fluid, and the oxygen in the blood actually can't get down there to help the wound to heal. So, if the venous insufficiency -- if they're too swollen, that also impedes wound healing. That's when you get to that other aspect of problems that interfere with normal wound healing. So, before you see somebody -- no neomycin. Keep it covered, and then see a physician. Seek treatment if it's not healing in a week to ten days, or if you notice any redness or increasing pain. Pain is a very sensitive indicator of something not going on correctly.
Melanie: Ok. So, while we're talking about oxygen and wound healing, tell us about some of the treatments available for non-healing wounds such as hyperbaric oxygen therapy. What is that and what are the benefits to the patient? How does it work?
Dr. Buete: Sure! Well, when we get to the wound care center, we have a lot of modalities -- especially at a Healogics facility that we use. In addition to advanced wound care, you know, conservative treatments with different drains -- different bandages, different dressings for the wound. When you get to very complicated wounds and again most of the problems with these wounds is inadequate oxygen -- a very significant cause for poor wound healing issues is inadequate oxygen getting there. So, Medicare has 15 approved indications for using hyperbaric oxygen therapy. Hyperbaric oxygen therapy was – the hyperbaric treatments were originally used as we all are kind of familiar with them in diving accidents but now since that time, Medicare's approved 15 indications for hyperbaric oxygen for different wound healing issues, different poisonings like carbon monoxide poisoning, and different problems with fires, for instance, burns; compromised grafts are a big deal -- compromised skin grafts are a big deal for needing extra oxygen to help them heal. So, if you fall into one of those indications -- a Medicare approved indication for hyperbarics -- we are aggressive. We are on it. We are waiting. We are setting this up; we have you earmarked for once you get to a certain point, we know we’re ready to go and then we can also offer you that modality potentially.
And what hyperbarics essentially is – is when you're breathing room air, you're breathing 21% oxygen, and in the hyperbaric chamber, it's actually 100% oxygen, and we put it under pressure. So, we're essentially increasing the pressure inside the hyperbaric chamber, and what that does is it supersaturates your lung and your lungs are supersaturated with 100% oxygen so the blood coming through your lungs is essentially supercharged with this oxygen, and so then the blood will leave the lungs now supercharged with oxygen, if you will, and go into all over your body and for our case, it's important the wound that's not healing; the diabetic foot ulcer that's failed conservative wound care management. These are the issues -- these are the times that we use hyperbaric oxygen and when this supercharged red blood cells carry oxygen to this part of your body, it actually augments your immune system. Your immune system cells need oxygen to heal, to function appropriately. So, not only is it augmenting your immune system in which you need to fight off infection, it's also augmenting the other cells that are in the wound bed that require oxygen to help regenerate -- to help heal the wound, to help bring in the new granulation tissues, so you're augmenting the immune system to fight off infection. You're helping these cells that are required for wound healing, and you're also causing new blood vessel formation called angiogenesis and so when you are taking a diabetic that has poor arterial circulation, and you're exposing them to this hyperbaric oxygen, you're helping them form -- you're helping their body actually form new blood vessels and that's key because that's going to be there even after you finish the hyperbaric treatment. That doesn't go away. So, it's very exciting, and we see wonderful, wonderful results with this and not everybody is eligible to have hyperbaric oxygen, but like I mentioned, we have a lot of other advanced modalities that we're able to use to help patients heal.
Melanie: In summary, Dr. Buete, what would you like to tell people about non-healing wounds and the wound program at Manatee Memorial Hospital? And just give a brief overview including HBOT of all of the wound modalities that you use there.
Dr. Buete: Well, I don't think we have enough time to go into all the different modalities, but it’s very exciting. The Manatee Memorial Wound Care Center is a Healogics facility and the Healogics facility is very interesting because it's a national company, and we have a very standardized approach to wound care. So, if you go to a Healogics facility anywhere in the country, we all have our nine essential steps to healing that we approach with every patient, and we address all of those issues. We address, you know, optimizing their blood sugars, offloading -- meaning taking pressure off the wounds -- you know, making sure they have adequate circulation, making sure their nutrition is adequate. Making sure they have support in the home. We're always utilizing social service. So, a Healogics facility is very interesting and very exciting because it's very -- very standardized. You know what you're going to get and the doctors all go in with the same mentality, if you will. So, once we see the wound, we're ruling out infection; we're treating infection; we're debriding -- which although it sounds -- you're cutting on the patients -- we're actually removing a lot of the barriers that prevent that wound from healing. So, we'll do that and then we use various products to assist depending -- patient-dependent, of course -- what's going to work in that wound. Nobody’s the same. We can use collagen; we can use actually live cell tissue replacements that are in Petri dishes. We use frozen live cells in wounds. We use placenta products that are very exciting that we can put into the wound, and it recruits your own stem cells to come into that wound and heal. Actually, very exciting stuff we offer all of that at Manatee Memorial, and again, it's not a one-size-fit-all. It's still, even though it's a standardized approach, every patient’s different, and we're looking at the whole patient, and I'm a family physician. I'm a board certified family physician, so this is very exciting for me to look at a wound, to look the patient's medicine; I have a snapshot of who they are because I’m just not treating the wound; I’m treating all of their underlying comorbidities and seeing how they play into this and that's what you're going to get when you come to Manatee Memorial – somebody that’s looking at the whole person to help heal that wound.
Melanie: Thank you so much for such great information. This is Manatee Talk Radio with Manatee Memorial Hospital. For more information on Manatee Memorial Hospital's Wound Care and Hyperbaric Treatment Program, you can go to manateememorial.com. That's manateememorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Millions of people suffer needlessly from chronic non-healing wounds, such as those caused by diabetes, poor circulation, injuries, and other conditions. Most wounds can be treated successfully by a primary care physician; however, when wounds have not healed after several weeks, they may require specialized care. My guest today is Dr. Maura Buete. She's the medical director of the Wound Care and Hyperbaric Treatment Program at Manatee Memorial Hospital. Welcome to the show, Dr. Buete. Tell us about wounds and what are some of the most common reasons for wounds that will not heal?
Dr. Maura Buete, MD (Guest): Well, thank you for having me Melanie. I actually -- I often tell my patients if you think about it when you're a child, you can pretty much do whatever you wanted to. The scrape on your knee or the cut that you might receive while playing and then as you get older you start noticing that things sort of slow down -- might take a little bit longer to heal, and that's where we come in and, you know, and going from just throw a band aid on it, and it's going to do well and some of us, you know, are lucky enough or fortunate enough to still be able to have our wounds heal like that, but eventually you get to a point, and a lot of us will, that the seven to ten days it normally takes to have a wound heal almost doesn’t -- things start slowing down, and it can be from a variety of reasons. It could be poor nutrition, your other medical issues or comorbidities as we like to call them, different medicines you're on. Maybe even just a poor approach to wound healing. Venous insufficiency, diabetes -- it's very complicated, and often I tell patients the wound's not healing -- that’s a symptom of something else, and that's how we approach it. So, when you get to that point -- your wound's not healing -- you might have a consultation with your primary physician and some interventions might be made like treating an infection, but eventually you have to say -- what else is going on -- and that's what I really like about wound healing because it's a little bit of a puzzle, and everybody's different.
Melanie: How long would a person watch their wound before they say, "You know what, this isn't" and what should they look for as far as red flags around the edges or leakage from the wound? Are there some things you want them to watch out for?
Dr. Buete: Sure, in general, a person that doesn't have a history with problem wound healings, and I'm talking about patients that aren't diabetic that have been to wound care facilities before or people with very poor circulation, and generally I say if it's not going in the right direction in a week to 10 days, or you see increasing redness, increasing pain, any malodor, or change in the drainage, then it's time to get another opinion to seek help.
Melanie: And so, I’m going to ask you this before we get into some of the wound healing treatments. People are always wondering if they are self-treating a wound. Do you keep it moist? Do you keep it covered? Do you keep it dry? Do you let it air dry? What do you do for best wound care?
Dr. Buete: When I was in medical school, the dermatologists would say, “Well, if it's wet; dry it; if it's dry; wet it,” and to some degree that's true. If you are dealing with a wound at home, the best thing you can do is to just keep it covered. Bacteria can actually get through, you know, one study said 44 layers of a dressing. So, they can get through anything you’re putting on it to cause infection, but that's our best first line defense. If it's too wet, you know, you don’t keep a non-stick on it. You want to put regular gauze. If it's thick and scabby, you can use some over-the-counter ointments, but we always say, “Say no to Neosporin.” Don't use neomycin-containing antibiotics over the counter because Neosporin, while it does kill the bacteria, it's also what we call cytotoxic, meaning it kills the good cells. So, it impedes wound healing to some degree, and not only that, but about 25% of people can actually have an allergic reaction to it, and then they're hurting and impeding wound healing. So, use bacitracin, is a good over-the-counter one, and they also have Medihoney products that you can get over the counter to put that on the wound and again, that's while you're waiting to seek medical treatment -- in particular if you have other issues like diabetes, venous insufficiency, things like that because diabetes -- why wounds won't heal in a diabetic, you have poor circulation. We all know that diabetics have heart issues and eye issues and kidney issues, but it also affects small vessels to the skin, and the same ones -- the same small vessels that are affected when you have vision problems. So, diabetics might have excellent control of their blood sugars, but they still have this microvascular circulation that's keeping their wound from healing. Venous insufficiency, when you get really swollen legs that have that dark discoloration below the knees; varicosities, the veins that you can see in the skin, when your legs are swollen, your tissues are full of fluid, and the oxygen in the blood actually can't get down there to help the wound to heal. So, if the venous insufficiency -- if they're too swollen, that also impedes wound healing. That's when you get to that other aspect of problems that interfere with normal wound healing. So, before you see somebody -- no neomycin. Keep it covered, and then see a physician. Seek treatment if it's not healing in a week to ten days, or if you notice any redness or increasing pain. Pain is a very sensitive indicator of something not going on correctly.
Melanie: Ok. So, while we're talking about oxygen and wound healing, tell us about some of the treatments available for non-healing wounds such as hyperbaric oxygen therapy. What is that and what are the benefits to the patient? How does it work?
Dr. Buete: Sure! Well, when we get to the wound care center, we have a lot of modalities -- especially at a Healogics facility that we use. In addition to advanced wound care, you know, conservative treatments with different drains -- different bandages, different dressings for the wound. When you get to very complicated wounds and again most of the problems with these wounds is inadequate oxygen -- a very significant cause for poor wound healing issues is inadequate oxygen getting there. So, Medicare has 15 approved indications for using hyperbaric oxygen therapy. Hyperbaric oxygen therapy was – the hyperbaric treatments were originally used as we all are kind of familiar with them in diving accidents but now since that time, Medicare's approved 15 indications for hyperbaric oxygen for different wound healing issues, different poisonings like carbon monoxide poisoning, and different problems with fires, for instance, burns; compromised grafts are a big deal -- compromised skin grafts are a big deal for needing extra oxygen to help them heal. So, if you fall into one of those indications -- a Medicare approved indication for hyperbarics -- we are aggressive. We are on it. We are waiting. We are setting this up; we have you earmarked for once you get to a certain point, we know we’re ready to go and then we can also offer you that modality potentially.
And what hyperbarics essentially is – is when you're breathing room air, you're breathing 21% oxygen, and in the hyperbaric chamber, it's actually 100% oxygen, and we put it under pressure. So, we're essentially increasing the pressure inside the hyperbaric chamber, and what that does is it supersaturates your lung and your lungs are supersaturated with 100% oxygen so the blood coming through your lungs is essentially supercharged with this oxygen, and so then the blood will leave the lungs now supercharged with oxygen, if you will, and go into all over your body and for our case, it's important the wound that's not healing; the diabetic foot ulcer that's failed conservative wound care management. These are the issues -- these are the times that we use hyperbaric oxygen and when this supercharged red blood cells carry oxygen to this part of your body, it actually augments your immune system. Your immune system cells need oxygen to heal, to function appropriately. So, not only is it augmenting your immune system in which you need to fight off infection, it's also augmenting the other cells that are in the wound bed that require oxygen to help regenerate -- to help heal the wound, to help bring in the new granulation tissues, so you're augmenting the immune system to fight off infection. You're helping these cells that are required for wound healing, and you're also causing new blood vessel formation called angiogenesis and so when you are taking a diabetic that has poor arterial circulation, and you're exposing them to this hyperbaric oxygen, you're helping them form -- you're helping their body actually form new blood vessels and that's key because that's going to be there even after you finish the hyperbaric treatment. That doesn't go away. So, it's very exciting, and we see wonderful, wonderful results with this and not everybody is eligible to have hyperbaric oxygen, but like I mentioned, we have a lot of other advanced modalities that we're able to use to help patients heal.
Melanie: In summary, Dr. Buete, what would you like to tell people about non-healing wounds and the wound program at Manatee Memorial Hospital? And just give a brief overview including HBOT of all of the wound modalities that you use there.
Dr. Buete: Well, I don't think we have enough time to go into all the different modalities, but it’s very exciting. The Manatee Memorial Wound Care Center is a Healogics facility and the Healogics facility is very interesting because it's a national company, and we have a very standardized approach to wound care. So, if you go to a Healogics facility anywhere in the country, we all have our nine essential steps to healing that we approach with every patient, and we address all of those issues. We address, you know, optimizing their blood sugars, offloading -- meaning taking pressure off the wounds -- you know, making sure they have adequate circulation, making sure their nutrition is adequate. Making sure they have support in the home. We're always utilizing social service. So, a Healogics facility is very interesting and very exciting because it's very -- very standardized. You know what you're going to get and the doctors all go in with the same mentality, if you will. So, once we see the wound, we're ruling out infection; we're treating infection; we're debriding -- which although it sounds -- you're cutting on the patients -- we're actually removing a lot of the barriers that prevent that wound from healing. So, we'll do that and then we use various products to assist depending -- patient-dependent, of course -- what's going to work in that wound. Nobody’s the same. We can use collagen; we can use actually live cell tissue replacements that are in Petri dishes. We use frozen live cells in wounds. We use placenta products that are very exciting that we can put into the wound, and it recruits your own stem cells to come into that wound and heal. Actually, very exciting stuff we offer all of that at Manatee Memorial, and again, it's not a one-size-fit-all. It's still, even though it's a standardized approach, every patient’s different, and we're looking at the whole patient, and I'm a family physician. I'm a board certified family physician, so this is very exciting for me to look at a wound, to look the patient's medicine; I have a snapshot of who they are because I’m just not treating the wound; I’m treating all of their underlying comorbidities and seeing how they play into this and that's what you're going to get when you come to Manatee Memorial – somebody that’s looking at the whole person to help heal that wound.
Melanie: Thank you so much for such great information. This is Manatee Talk Radio with Manatee Memorial Hospital. For more information on Manatee Memorial Hospital's Wound Care and Hyperbaric Treatment Program, you can go to manateememorial.com. That's manateememorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.