wound care

Dr. Baxter specializes and is certified in wound care from diabetic ulcer, vascular/gangrene, trauma and mechanical blisters, calluses, corns.

Types of wounds

Diabetic ulcer

An open sore or wound that most commonly occurs on the foot
Causes:

Elevated blood glucose
Neuropathy
Uncontrolled blood pressure
Poor nutrition
Prolonged pressure

Vascular/Gangrene

Gangrene occurs when tissue dies (necrosis) because its blood supply is interrupted. Gangrene may be caused by an infection or injury, or be a complication of a long-term condition that restricts blood circulation.

Trama

High-velocity blunt trauma
Low-velocity blunt trauma
High-velocity penetrating trauma
Low-velocity penetrating trauma
Thermal/Chemical injuries

Mechanical–blisters, corns, calluses

Treatments

Nutritional support - Protein deficiency is a major factor in the healing of ulcers.
Protein is necessary for fibroblast proliferation, new blood vessel formation, and collagen production.
Depending on the severity of the wound, protein consumption should range from 0.55 to 0.84 grams per pound of body weight per day. Vitamin A–Increases collagen synthesis and wound tensile strength along with lymphocyte activation. Vitamin C–Increases skin strength and fibroblastic content of scar tissue. Vitamin E –Anti-inflammatory action decreases the production of prostaglandins - Enhances the immune response and breaking strength of post-operative wounds. Zinc–Stimulates wound healing and increases collagen tensile strength
Debridement - Goals of debridement: 1. Remove potential pathogens 2. Remove necrotic and fibrous infiltrates. Forms of Debridement - “Cold steel”–scalpel, curette, rongeur, tissue nippers, mechanical–wet to dry dressings, pulse lavage, and enzymatic
Orthotic supports
Off-loading
Wound V.A.C. system - Goals of V.A.C. System: Promote granulation and tissue perfusion, remove infectious material, draw wound edges together. Applications: Diabetic wounds, Pressure ulcers, Skin grafts, Infected wounds
Skin grafts (autografts and allografts) - Traditional Skin Graft: Tissue usually removed from the thigh, leg, or buttocks on the same person. Glabrous Skin Graft: Tissue usually removed from the medial arch of the foot
Flowable soft tissue scaffold
Topical wound-healing agents