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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY June 2013 | Archived Issues

Surgery Department News

Kira Chaiboonma, BS, Donald C. Dafoe, MD, Seth Felder, MD, Heidi A. Hotz, RN, Silvia Kurtovic, MD, Douglas Liou, MD, Scott Short, MD, Ryan Spurrier, MD, and Dodanim Talavera, MD, MS, PhD are highlighted.


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By Treating Open Wounds, Podiatrists Help Preserve Limbs

By Kazu Suzuki, DPM, CWS
and Jeffrey A. Klemes, DPM

Many practitioners consult podiatrists to fix a bunion, straighten a crooked toe, help the runner with heel pain, treat a sprained ankle, fix a broken bone, or treat the stubborn, infected ingrown toenail.

But podiatrists also preserve toes, feet and limbs through their tireless work with wound care, amputation prevention and limb salvage. This is the area where podiatrists are truly integrated in the multidisciplinary team approach, working hand in hand with internists, endocrinologists, infectious disease, vascular and plastic surgery to help optimize diabetic control, unplug or bypass diseased arteries, choose the optimal antibiotic, or apply the rotational or skin graft.

From the beginning of time, mankind has been troubled by open wounds. An Egyptian papyrus scroll (B.C. 580) says that "open wounds shall be treated with a mixture of honey, grease and lint." In modern surgical history, open wounds have been treated with "wet to dry" saline gauze dressings. Did you know this is now passé? The concept of "moist wound healing" was discovered in the 1970s when an animal study found that a moist wound heals more quickly than a dry one.

Fast forward to 2013, and there are a few thousand high-tech wound dressings available. With the sole purpose of healing the wound as quickly as possible, we also utilize "advanced wound care" products, including bioengineered human skin grafts (created from neonatal foreskin cells) and a recombinant PDGF human growth factor gels.

In our wound care center, a typical patient is scanned with a laser Doppler device to measure his or her skin perfusion pressure, a prediction of the patient's ability to heal. Next, the wound is cleaned with a low-frequency ultrasound debridement device that disinfects the wound bed. This wound may be dressed with a nano-silver-based antimicrobial dressing and multilayer compression bandages. A wound VAC suction device may be incorporated for large or deep tissue defects. If osteomyelitis, radiation injury or deep diabetic foot ulcers (Wagner grade 3 or 4) are present, hyperbaric oxygen therapy is recommended. Once the wound heals, we prescribe custom-molded shoe gear as well as physical therapy to prevent recurrence.

We always aim for the fastest wound closure for preservation of the limb. After a leg amputation, a patient becomes bed-ridden, which often results in formation of pressure ulcers, deterioration of cardiovascular function and premature death. Statistics show that the five-year mortality rate of diabetes mellitus patients after leg amputations is as high as 80 percent, rivaling that of stage four lung cancer or pancreatic cancer.

"Limb preservation" is a treatment concept to preserve the lower legs and the ability to ambulate, and it takes aggressive screening and treatment of peripheral arterial disease, open wounds, and osteomyelitis that may affect limb survival. As a specialist of lower extremity diseases, a doctor of podiatric medicine (DPM) is uniquely trained to treat any foot and ankle disorders, including complex open wounds and osteomyelitis.

Cedars-Sinai Medical Center has a three-year Podiatric Medicine and Surgery Residency Program. Our residents are at the front line, being consulted for diabetic foot wounds and infections, supervised by attending surgeons in the Podiatric Surgery Division of the Department of Surgery.

Kazu Suzuki is an ABWM board-certified wound care specialist at Tower Wound Care Center, Cedars-Sinai Medical Towers. He can be reached at Kazu.Suzuki@cshs.org.

Jeffrey A. Klemes is certified by ACFAS and is director of the Cedars-Sinai Podiatric Medicine and Surgery Residency Program. He can be reached at Jeffrey.Klemes@cshs.org.

A limb-threatening, infected DM leg ulcer

A healed leg ulcer after wound debridement, skin grafting and wound VAC application