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Via Christi 50+ Lunch & LearnVia Christi 50+ Lunch & Learn
Veins, trains and automobilesVeins, trains and automobiles
Marilee McBoyle, MD, FACS
Medical Director
Via Christi Wound Healing and Hyperbaric Therapy1
2
Today’s discussionToday’s discussion
 PART 1: Veins – legs and ankles
 PART 2: Diabetes – feet
 PART 3: Trauma – legs
 PART 4: Hyperbaric oxygen therapy
3
But first…But first…
 A little bit about…
Via Christi
Wound Healing & Hyperbaric Therapy
 848 N. St. Francis, on the Via Christi Hospital St. Francis campus
Via ChristiVia Christi
Wound Healing & Hyperbaric TherapyWound Healing & Hyperbaric Therapy
 Our staff
4
5
Via ChristiVia Christi
Wound Healing & Hyperbaric TherapyWound Healing & Hyperbaric Therapy
 Our facility
6
PART 1: Venous (vein) ulcersPART 1: Venous (vein) ulcers
 Lower leg discomfort, swelling and ulcer
development
 Causes
 Prevention
 Treatment
7
Interesting factsInteresting facts
 Venous (vein) ulcers are the most frequent
cause of leg ulcers
 Leg ulcers are slow to heal and fast to recur
 Chronic vein issues affect 1/3 of the adult
population
8
PART 1: CausesPART 1: Causes
 Stasis (blood pooling)
 Insufficiency
 Varicose veins
Venous (vein) ulcersVenous (vein) ulcers
 Varicose veins
9
CEAP scale for varicose veinsCEAP scale for varicose veins
10
C2
C3
C4
C5-6
Swelling
V. veins
Skin
Changes
Ulcers
C1
Causes of venous (vein) ulcersCauses of venous (vein) ulcers
 Malfunctioning valves
 Blood pools
 Hemosiderin staining
11
Causes of venous (vein) ulcersCauses of venous (vein) ulcers
12
 Malfunctioning valves
Causes of venous (veins) ulcersCauses of venous (veins) ulcers
 Hemosiderin staining
13
Lower leg
Prevention of venous (vein) ulcersPrevention of venous (vein) ulcers
 Muscle calf pump
 Compression hose
 Avoid long periods of standing
14
Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers
 Debridement
 Compression
 Skin substitutes
 Minimally invasive procedures
15
Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers
 Debridement
16
Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers
 Compression: 2-layer or 4-layer wraps
17
Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers
 Skin substitutes
18
Ankle: Before
Ankle: After
We want to avoid this!We want to avoid this!
19
Lower leg
Ankle
Part 2: Diabetic UlcersPart 2: Diabetic Ulcers
CAUTION:
 40-70% of all lower extremity amputations are
related to diabetes.
 85% of diabetic-related amputations are
preceded by a diabetic foot ulcer.
20
PART 2: Diabetic ulcers, causesPART 2: Diabetic ulcers, causes
 Injury to blood vessels
 Neuropathic (can’t feel your feet)
 Charcot foot
21
Causes of diabetic ulcerCauses of diabetic ulcer
 Neuropathic (can’t feel your feet)
22
Causes of diabetic ulcersCauses of diabetic ulcers
 Charcot foot
23
Prevention of diabetic ulcersPrevention of diabetic ulcers
 Blood sugar control / Hb A1C
 Correct shoes
 Checking feet every day (Including the sides
and bottom of feet, and in between the toes)
24
Treatment of diabetic ulcersTreatment of diabetic ulcers
 Debridement
 Culture
 Blood sugar control
 Off-loading
25
Treatment of diabetic ulcersTreatment of diabetic ulcers
 Debridement
26
Bottom of foot: Before
Bottom of foot: After
Treatment of diabetic ulcersTreatment of diabetic ulcers
 Diabetic education – for blood sugar control
27
Treatment of diabetic ulcersTreatment of diabetic ulcers
 Off-loading
28
Bottom of foot
Lower leg cast
PART 3: Traumatic woundsPART 3: Traumatic wounds
29
Traumatic woundsTraumatic wounds
30
Ankle
Shin
PART 4:PART 4:
Hyperbaric Oxygen (HBO) therapyHyperbaric Oxygen (HBO) therapy
31
What is Hyperbaric Oxygen therapy?What is Hyperbaric Oxygen therapy?
 100 percent oxygen given with increased
pressure
32
Who is a candidate for HBO?Who is a candidate for HBO?
Most frequent indications
 Deep diabetic foot ulcers
 Radiation induced soft tissue injury
 Chronic refractory Osteomyelitis
33
What to expect with HBOWhat to expect with HBO
 Hyperbaric oxygen therapy treatments take
about two hours
 You may feel pressure in your ears, similar to
traveling on a plane
 Glass windows are built into the hyperbaric
chamber, so you can watch TV or a movie
 In case of claustrophobia, medication can be
prescribed
 Treatment schedules vary, based on your
progress
34
Celebrating wound healingCelebrating wound healing
“Let the rest of
your life be the
best of your life”
35
Summary and questionsSummary and questions
Marilee McBoyle, MD, FACS
Medical Director
Via Christi Wound Healing and Hyperbaric Therapy
848 N. St. Francis, Suite 1900
Wichita, KS 67214
316.268.5881
viachristi.org/wound
36

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Veins, trains and automobiles

  • 1. Via Christi 50+ Lunch & LearnVia Christi 50+ Lunch & Learn Veins, trains and automobilesVeins, trains and automobiles Marilee McBoyle, MD, FACS Medical Director Via Christi Wound Healing and Hyperbaric Therapy1
  • 2. 2 Today’s discussionToday’s discussion  PART 1: Veins – legs and ankles  PART 2: Diabetes – feet  PART 3: Trauma – legs  PART 4: Hyperbaric oxygen therapy
  • 3. 3 But first…But first…  A little bit about… Via Christi Wound Healing & Hyperbaric Therapy  848 N. St. Francis, on the Via Christi Hospital St. Francis campus
  • 4. Via ChristiVia Christi Wound Healing & Hyperbaric TherapyWound Healing & Hyperbaric Therapy  Our staff 4
  • 5. 5 Via ChristiVia Christi Wound Healing & Hyperbaric TherapyWound Healing & Hyperbaric Therapy  Our facility
  • 6. 6 PART 1: Venous (vein) ulcersPART 1: Venous (vein) ulcers  Lower leg discomfort, swelling and ulcer development  Causes  Prevention  Treatment
  • 7. 7 Interesting factsInteresting facts  Venous (vein) ulcers are the most frequent cause of leg ulcers  Leg ulcers are slow to heal and fast to recur  Chronic vein issues affect 1/3 of the adult population
  • 8. 8 PART 1: CausesPART 1: Causes  Stasis (blood pooling)  Insufficiency  Varicose veins
  • 9. Venous (vein) ulcersVenous (vein) ulcers  Varicose veins 9
  • 10. CEAP scale for varicose veinsCEAP scale for varicose veins 10 C2 C3 C4 C5-6 Swelling V. veins Skin Changes Ulcers C1
  • 11. Causes of venous (vein) ulcersCauses of venous (vein) ulcers  Malfunctioning valves  Blood pools  Hemosiderin staining 11
  • 12. Causes of venous (vein) ulcersCauses of venous (vein) ulcers 12  Malfunctioning valves
  • 13. Causes of venous (veins) ulcersCauses of venous (veins) ulcers  Hemosiderin staining 13 Lower leg
  • 14. Prevention of venous (vein) ulcersPrevention of venous (vein) ulcers  Muscle calf pump  Compression hose  Avoid long periods of standing 14
  • 15. Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers  Debridement  Compression  Skin substitutes  Minimally invasive procedures 15
  • 16. Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers  Debridement 16
  • 17. Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers  Compression: 2-layer or 4-layer wraps 17
  • 18. Treatment of venous (vein) ulcersTreatment of venous (vein) ulcers  Skin substitutes 18 Ankle: Before Ankle: After
  • 19. We want to avoid this!We want to avoid this! 19 Lower leg Ankle
  • 20. Part 2: Diabetic UlcersPart 2: Diabetic Ulcers CAUTION:  40-70% of all lower extremity amputations are related to diabetes.  85% of diabetic-related amputations are preceded by a diabetic foot ulcer. 20
  • 21. PART 2: Diabetic ulcers, causesPART 2: Diabetic ulcers, causes  Injury to blood vessels  Neuropathic (can’t feel your feet)  Charcot foot 21
  • 22. Causes of diabetic ulcerCauses of diabetic ulcer  Neuropathic (can’t feel your feet) 22
  • 23. Causes of diabetic ulcersCauses of diabetic ulcers  Charcot foot 23
  • 24. Prevention of diabetic ulcersPrevention of diabetic ulcers  Blood sugar control / Hb A1C  Correct shoes  Checking feet every day (Including the sides and bottom of feet, and in between the toes) 24
  • 25. Treatment of diabetic ulcersTreatment of diabetic ulcers  Debridement  Culture  Blood sugar control  Off-loading 25
  • 26. Treatment of diabetic ulcersTreatment of diabetic ulcers  Debridement 26 Bottom of foot: Before Bottom of foot: After
  • 27. Treatment of diabetic ulcersTreatment of diabetic ulcers  Diabetic education – for blood sugar control 27
  • 28. Treatment of diabetic ulcersTreatment of diabetic ulcers  Off-loading 28 Bottom of foot Lower leg cast
  • 29. PART 3: Traumatic woundsPART 3: Traumatic wounds 29
  • 31. PART 4:PART 4: Hyperbaric Oxygen (HBO) therapyHyperbaric Oxygen (HBO) therapy 31
  • 32. What is Hyperbaric Oxygen therapy?What is Hyperbaric Oxygen therapy?  100 percent oxygen given with increased pressure 32
  • 33. Who is a candidate for HBO?Who is a candidate for HBO? Most frequent indications  Deep diabetic foot ulcers  Radiation induced soft tissue injury  Chronic refractory Osteomyelitis 33
  • 34. What to expect with HBOWhat to expect with HBO  Hyperbaric oxygen therapy treatments take about two hours  You may feel pressure in your ears, similar to traveling on a plane  Glass windows are built into the hyperbaric chamber, so you can watch TV or a movie  In case of claustrophobia, medication can be prescribed  Treatment schedules vary, based on your progress 34
  • 35. Celebrating wound healingCelebrating wound healing “Let the rest of your life be the best of your life” 35
  • 36. Summary and questionsSummary and questions Marilee McBoyle, MD, FACS Medical Director Via Christi Wound Healing and Hyperbaric Therapy 848 N. St. Francis, Suite 1900 Wichita, KS 67214 316.268.5881 viachristi.org/wound 36

Notas del editor

  1. Total prep time: 2 hrs (as of 6/28/14)