Better Treatment for Wound Care and Chronic Wounds
From the Show: Highland Medical P.C.
Summary:
Air Date: 6/1/20
Duration: 10 Minutes
Dr. Giacomo Vinces discusses better treatment options for wound care and chronic wounds in accordance with Wound Care Awareness Month.
Transcription:
Prakash Chandran (Host): Have you ever had a wound that seemed to take a long time to heal? The Wound Care Center at Montefiore Nyack Hospital is a comprehensive outpatient center designed to treat wounds that resist traditional treatments for months or even years. So, what do you need to know about chronic wounds? We’re going to learn about it today with Dr. Giacomo Vinces, a Board Certified Physician and Medical Director of the Wound Care Center at Montefiore Nyack Hospital.
This is Health Track, the podcast from Montefiore Nyack Hospital. I’m Prakash Chandran. So, Dr. Vinces, I’m curious as to what exactly a wound care center does.
Giacomo Vinces, DO, MBI, CWSP (Guest): We’re mainly concerned about dealing with chronic non-healing wounds. So, these are the wounds that are taking longer to heal. Sometimes the wounds are not going through normal.
Host: Yes, so these are you said chronic non-healing wounds. And I’m curious as to what type of wounds those are because for example, I think a lot of people that are listening to this might think of a wound as when they get a cut or a serious bruise. But maybe talk to us about the difference between those types of wounds and a non-healing one.
Dr. Vinces: A chronic wound is essentially a wound that is taking longer to heal. Unlike most other wounds which go through their normal process, a chronic wound is going to be taking about several weeks to heal. It is not going through the normal stages of healing.
Host: I see and what are the most common types of chronic wounds?
Dr. Vinces: There are several types of chronic wounds. But the most common ones are the vascular type of wounds which would be either venous or arterial, the second are the diabetic ulcers and also pressure ulcers or pressure wounds.
Host: I see. And with these chronic wounds, do they seem to manifest in certain demographics over other? You mentioned diabetics. I imagine that these pressure wounds also potentially happen when someone is elderly. Maybe talk a little bit about the types of people that get these chronic wounds.
Dr. Vinces: Right. So, not all the wounds are the same. So, vascular wounds are going to be mainly found on patients that have decreased circulation to the lower extremities. Diabetic wounds will be seen in patients that have diabetes but also may have some vascular issues. And pressure wounds are commonly seen in patients that are unable to turn by themselves or to move by themselves.
Host: Let me ask a lay question here. When you say vascular, what exactly does that mean? Does that mean it’s heart related? Does that mean that it is the veins that are close to the skin like talk to us a little bit about what that means.
Dr. Vinces: So, a vascular wound could be of two different types. It could be a wound that is caused primarily by the issues with blood going into the lower extremities or the second type of vascular wounds are those that are caused when there are issues with the blood returning from the lower extremity into the heart. So, arterial has to do with blood going into the feet whereas venous has issues with blood returning back into the heart.
Host: I see. So, if I’m understanding this correctly, you are at a wound care center and you really want to go to see a wound care specialist at the wound care center when you have one of these wounds that are what you say are chronic. They take a really long time to heal. And there’s the arterial and then the vascular types of wounds. Right and I think another thing that you mentioned is it’s normally potentially elderly people and diabetics that you see most often.
Dr. Vinces: That’s correct. So, early treatment of the wounds is important and that’s why it’s important to come to the wound care center as soon as you notice that the wound is taking longer to heal. If we identify those wounds quickly, there’s a higher chances of using advanced therapies faster and speeding up the healing process. Now also if we are able to recognize these wounds, we could identify any possible infection.
Host: So, what actually causes these wounds to happen in the first place and what can people do when they notice that it’s taking a couple of weeks to heal?
Dr. Vinces: So, different wounds will be treated differently. For instance, if we talked about venous ulcers, they are mainly caused when there is accumulation of the fluid in the lower extremities, in the feet, in the calves or swelling of the feet and the calves. The treatment for this type of ulcer is mainly compression. So, you need to use compression stockings to reduce that edema and facilitate the fluid returning back into the heart.
In the case of diabetic ulcers, these ulcers are mainly caused by what’s called neuropathy. What that means is that the sensation in the feet is decreased on these patients. And they need to pay special attention to the sole of their feet because that’s where most of their ulcers will develop. And a way of preventing these ulcers from forming is checking regularly. Foot exams daily and also being examined by their primary care doctor regularly to see and evaluate any possible ulcers that are starting.
And in the last case, the pressure ulcers we need regular repositioning of these patients that are unable to turn by themselves. So, repositioning for these patients is key and usually you want to do this every hour or every two hours.
Host: I see. So, when you talk about pressure ulcers, that sounds like when pressure is applied to the skin over time. So, maybe that’s when someone is wearing a shoe that might be too tight or maybe some of these wounds are caused by someone sitting in place for too long. I’m assuming that’s right. Can you maybe confirm that and maybe talk about some of the other reasons people get these wounds?
Dr. Vinces: Right so, the pressure ulcers or pressure wounds as we know them are usually the ones that occur on patients that are bedridden most of the time. Patients that are in one position or sitting in one position it could also be lying down in one position. But they stay in one position for a few hours at a time. Unlike other wounds or ulcers that happen just from ill fitting shoes.
Host: Okay. Yeah, that helps. And so you talked about the importance of addressing the wounds early. I’m curious as to for example, when a patient notices on themselves that they have a wound, before they go to the wound care center, I’m curious as to if water or antiseptic should be used to cleanse it first?
Dr. Vinces: If there is any signs of infection then an antiseptic could be used. But if there is no signs of infection, the patient can just wash the wound with clean water and that should be enough to at least remove some of the debris or any kind of superficial bacteria that’s present on top of the wound.
Host: And how do you know when a wound is infected? What does it look like?
Dr. Vinces: The typical signs of a wound infection are going to be redness around the edges of the wound, increased tenderness, warmth on the edges of the wound also. If the patient develops fever and chills or a purulent discharge, those are going to be late findings of an infection.
Host: We talked about some of the more advanced treatment options that you can actually do to treat these wounds if you see them early. And one of those is hyperbaric oxygen therapy. And I know that’s something that the Montefiore Nyack Hospital has and has seen pretty amazing results with. So, maybe talk a little bit about why hyperbaric oxygen therapy is and how it has helped you at Montefiore Nyack.
Dr. Vinces: Hyperbaric oxygen therapy is the treatment of wounds in a pressurize chamber at high levels of oxygen. We usually use this treatment for patients that present with infected diabetic foot ulcers or also as a result of a chronic osteomyelitis or a non-healing wound that has resulted from radiation therapy.
Host: What is the concept of how it works? Like for example, we think that today, the most common way to heal a wound is to just let it heal on its own over time. But I am thinking or what I’m suspecting is that with this hyperbaric oxygen therapy, it somehow accelerates that process. Is that correct?
Dr. Vinces: The hyperbaric oxygen treatment is very specific. There is a very specific indication for the treatment. So, its affect is seen mostly on a diabetic foot ulcer, on chronic refractory or infection of the bone or patients that have the effects of radiation. So, we use it very specifically for certain types of wounds. We don’t use it for all types of wounds.
Host: I see, and you’ve had actually quite a bit of success using this therapy for those specific types of wounds, haven’t you?
Dr. Vinces: Yes, we have several patients that have done very well, that presented initially with an infection of the bone in their feet and that were treated with the high concentration of oxygen and their infections actually were controlled and the wounds resolved.
Host: Yeah. That’s pretty amazing. Just as we wrap up here, I wanted to ask if there’s anything you wanted to share with our audience around what they should know about non-healing wounds or the Wound Care Center at Montefiore Nyack?
Dr. Vinces: It’s important for patients as I mentioned earlier is to not just when the wound is developing and try to identify it earlier but to pay attention to these wounds early on because when they come to the Wound Care Center, we can help out speeding up the healing and also preventing these wounds from lingering and taking longer to heal.
Host: Okay. Yeah, that’s fantastic Dr. Vinces. Well it’s really been a pleasure learning a little bit more about wound care with you today. that’s Dr. Giacomo Vinces, a Board Certified Physician and Medical Director of the Wound Care Center at Montefiore Nyack Hospital. Thanks for checking out this episode of Health Track. For more information or to schedule a consultation or appointment please call 845-348-7600. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Prakash Chandran (Host): Have you ever had a wound that seemed to take a long time to heal? The Wound Care Center at Montefiore Nyack Hospital is a comprehensive outpatient center designed to treat wounds that resist traditional treatments for months or even years. So, what do you need to know about chronic wounds? We’re going to learn about it today with Dr. Giacomo Vinces, a Board Certified Physician and Medical Director of the Wound Care Center at Montefiore Nyack Hospital.
This is Health Track, the podcast from Montefiore Nyack Hospital. I’m Prakash Chandran. So, Dr. Vinces, I’m curious as to what exactly a wound care center does.
Giacomo Vinces, DO, MBI, CWSP (Guest): We’re mainly concerned about dealing with chronic non-healing wounds. So, these are the wounds that are taking longer to heal. Sometimes the wounds are not going through normal.
Host: Yes, so these are you said chronic non-healing wounds. And I’m curious as to what type of wounds those are because for example, I think a lot of people that are listening to this might think of a wound as when they get a cut or a serious bruise. But maybe talk to us about the difference between those types of wounds and a non-healing one.
Dr. Vinces: A chronic wound is essentially a wound that is taking longer to heal. Unlike most other wounds which go through their normal process, a chronic wound is going to be taking about several weeks to heal. It is not going through the normal stages of healing.
Host: I see and what are the most common types of chronic wounds?
Dr. Vinces: There are several types of chronic wounds. But the most common ones are the vascular type of wounds which would be either venous or arterial, the second are the diabetic ulcers and also pressure ulcers or pressure wounds.
Host: I see. And with these chronic wounds, do they seem to manifest in certain demographics over other? You mentioned diabetics. I imagine that these pressure wounds also potentially happen when someone is elderly. Maybe talk a little bit about the types of people that get these chronic wounds.
Dr. Vinces: Right. So, not all the wounds are the same. So, vascular wounds are going to be mainly found on patients that have decreased circulation to the lower extremities. Diabetic wounds will be seen in patients that have diabetes but also may have some vascular issues. And pressure wounds are commonly seen in patients that are unable to turn by themselves or to move by themselves.
Host: Let me ask a lay question here. When you say vascular, what exactly does that mean? Does that mean it’s heart related? Does that mean that it is the veins that are close to the skin like talk to us a little bit about what that means.
Dr. Vinces: So, a vascular wound could be of two different types. It could be a wound that is caused primarily by the issues with blood going into the lower extremities or the second type of vascular wounds are those that are caused when there are issues with the blood returning from the lower extremity into the heart. So, arterial has to do with blood going into the feet whereas venous has issues with blood returning back into the heart.
Host: I see. So, if I’m understanding this correctly, you are at a wound care center and you really want to go to see a wound care specialist at the wound care center when you have one of these wounds that are what you say are chronic. They take a really long time to heal. And there’s the arterial and then the vascular types of wounds. Right and I think another thing that you mentioned is it’s normally potentially elderly people and diabetics that you see most often.
Dr. Vinces: That’s correct. So, early treatment of the wounds is important and that’s why it’s important to come to the wound care center as soon as you notice that the wound is taking longer to heal. If we identify those wounds quickly, there’s a higher chances of using advanced therapies faster and speeding up the healing process. Now also if we are able to recognize these wounds, we could identify any possible infection.
Host: So, what actually causes these wounds to happen in the first place and what can people do when they notice that it’s taking a couple of weeks to heal?
Dr. Vinces: So, different wounds will be treated differently. For instance, if we talked about venous ulcers, they are mainly caused when there is accumulation of the fluid in the lower extremities, in the feet, in the calves or swelling of the feet and the calves. The treatment for this type of ulcer is mainly compression. So, you need to use compression stockings to reduce that edema and facilitate the fluid returning back into the heart.
In the case of diabetic ulcers, these ulcers are mainly caused by what’s called neuropathy. What that means is that the sensation in the feet is decreased on these patients. And they need to pay special attention to the sole of their feet because that’s where most of their ulcers will develop. And a way of preventing these ulcers from forming is checking regularly. Foot exams daily and also being examined by their primary care doctor regularly to see and evaluate any possible ulcers that are starting.
And in the last case, the pressure ulcers we need regular repositioning of these patients that are unable to turn by themselves. So, repositioning for these patients is key and usually you want to do this every hour or every two hours.
Host: I see. So, when you talk about pressure ulcers, that sounds like when pressure is applied to the skin over time. So, maybe that’s when someone is wearing a shoe that might be too tight or maybe some of these wounds are caused by someone sitting in place for too long. I’m assuming that’s right. Can you maybe confirm that and maybe talk about some of the other reasons people get these wounds?
Dr. Vinces: Right so, the pressure ulcers or pressure wounds as we know them are usually the ones that occur on patients that are bedridden most of the time. Patients that are in one position or sitting in one position it could also be lying down in one position. But they stay in one position for a few hours at a time. Unlike other wounds or ulcers that happen just from ill fitting shoes.
Host: Okay. Yeah, that helps. And so you talked about the importance of addressing the wounds early. I’m curious as to for example, when a patient notices on themselves that they have a wound, before they go to the wound care center, I’m curious as to if water or antiseptic should be used to cleanse it first?
Dr. Vinces: If there is any signs of infection then an antiseptic could be used. But if there is no signs of infection, the patient can just wash the wound with clean water and that should be enough to at least remove some of the debris or any kind of superficial bacteria that’s present on top of the wound.
Host: And how do you know when a wound is infected? What does it look like?
Dr. Vinces: The typical signs of a wound infection are going to be redness around the edges of the wound, increased tenderness, warmth on the edges of the wound also. If the patient develops fever and chills or a purulent discharge, those are going to be late findings of an infection.
Host: We talked about some of the more advanced treatment options that you can actually do to treat these wounds if you see them early. And one of those is hyperbaric oxygen therapy. And I know that’s something that the Montefiore Nyack Hospital has and has seen pretty amazing results with. So, maybe talk a little bit about why hyperbaric oxygen therapy is and how it has helped you at Montefiore Nyack.
Dr. Vinces: Hyperbaric oxygen therapy is the treatment of wounds in a pressurize chamber at high levels of oxygen. We usually use this treatment for patients that present with infected diabetic foot ulcers or also as a result of a chronic osteomyelitis or a non-healing wound that has resulted from radiation therapy.
Host: What is the concept of how it works? Like for example, we think that today, the most common way to heal a wound is to just let it heal on its own over time. But I am thinking or what I’m suspecting is that with this hyperbaric oxygen therapy, it somehow accelerates that process. Is that correct?
Dr. Vinces: The hyperbaric oxygen treatment is very specific. There is a very specific indication for the treatment. So, its affect is seen mostly on a diabetic foot ulcer, on chronic refractory or infection of the bone or patients that have the effects of radiation. So, we use it very specifically for certain types of wounds. We don’t use it for all types of wounds.
Host: I see, and you’ve had actually quite a bit of success using this therapy for those specific types of wounds, haven’t you?
Dr. Vinces: Yes, we have several patients that have done very well, that presented initially with an infection of the bone in their feet and that were treated with the high concentration of oxygen and their infections actually were controlled and the wounds resolved.
Host: Yeah. That’s pretty amazing. Just as we wrap up here, I wanted to ask if there’s anything you wanted to share with our audience around what they should know about non-healing wounds or the Wound Care Center at Montefiore Nyack?
Dr. Vinces: It’s important for patients as I mentioned earlier is to not just when the wound is developing and try to identify it earlier but to pay attention to these wounds early on because when they come to the Wound Care Center, we can help out speeding up the healing and also preventing these wounds from lingering and taking longer to heal.
Host: Okay. Yeah, that’s fantastic Dr. Vinces. Well it’s really been a pleasure learning a little bit more about wound care with you today. that’s Dr. Giacomo Vinces, a Board Certified Physician and Medical Director of the Wound Care Center at Montefiore Nyack Hospital. Thanks for checking out this episode of Health Track. For more information or to schedule a consultation or appointment please call 845-348-7600. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
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