Wound Offloading Orthotic Products

March 1, 2010 — Matthew Livingston R.N. C.W.S.

Total Contact Cast ( MedE-Kast, Instant Total Contact Cast, Custom TCC):

This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot  and heel wounds.

Removable Cast Walker/ Walking Boots
1. Charcot Restraint Orthotic Walker  (CROW) boot:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot,  and heel wounds.
2. DH Walker (also known as Active Offloading Walker):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, charcot midfoot,  and heel wounds.
3. Prefabricated Walker (any premade walking boot):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, ankle, and heel wounds.
4. Patella Tendon Bearing (PTB) brace:
This product is indicated for heel wounds.

Wedge Shoes
1. IPOS or Darco Wedge Shoe:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, and lateral metatarsal wounds.
2. Ortho Wedge Shoe:
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal, and lateral metatarsal wounds.
3. Reverse IPOS:
This product is indicated for offloading heel wounds (no longer manufactured)

Multipodus Splint / Boot (Prafo, L’nard, Bend-a-boot, Multiboot):
This product is indicated for offloading heel and ankle wounds.

Surgical Shoes or Shoes with Pressure relief Insoles
1. Post op shoe (e.g. the Darco med-surg shoe with “peg assist”):
This product is indicated for offloading dorsal digit wounds.
2. DH Pressure Relief shoe (also the DH offloading post-op shoe):
This product is indicated for offloading planter digit, planter metatarsal, medial metatarsal,  lateral metatarsal wounds, and ankle wounds.
3. Plastizote Healing Shoe:
This product is indicated for offloading the dorsal digit, planter digit, planter metatarsal, medial metatarsal, lateral metatarsal, and heel wounds.

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Twitter and Wound Clinics a Unique Combination

January 5, 2010 — Matthew Livingston R.N. C.W.S.

Take a look at my article in Today’s Wound Clinic on how Twitter can help your Wound Clinic communicate more effectively. http://www.todayswoundclinic.com/twitter

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Wound Care Tool Kit (Stoma Paste)

December 19, 2009 — Matthew Livingston R.N. C.W.S.

Stoma Paste is a very useful tool when trying to provide a uniform surface for the placement of wound VAC drape over uneven surfaces. Uneven surfaces include skin folds, incision line deformations, or anatomical irregularities related to surgery or trauma. There are many brands of stoma paste available, but I have had good luck with Convatec and Hollister Brands. I recommend using the following process to prevent the paste from doing what it does best – sticking to everything.

1. Prewarm the past in a tray of warm water for a few minutes to make the paste less thick

2. Squeeze a little paste out on the clean side of the opened VAC kit package (let it sit for about a minute).

3. Pour a little water or normal saline into an appropriate container.

4. Dip into the water with a wood depressor or the back of the 10 blade scalpel (that you are using to cut the VAC foam)

5. Take up the stoma paste with the moist utensil surface and place it into the uneven surface. Leaving the top of the stoma paste even with the corresponding topside tissue. If you need to add more paste remember to re-moisten the utensil or else it will stick fast to the applicator.

6. Smooth out the paste between the inserted stoma paste with the corresponding topsided tissue by re-wetting the utensil and gently moving across it surface.

7. Wait a few minutes for the paste to firm and then apply the VAC drape over it. If you don’t wait for the stoma paste to firm up the VAC suction could pull it in, which could loose the seal.

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Twitter Article

December 12, 2009 — Matthew Livingston R.N. C.W.S.

I am currently writing an article on Twitter and the use of social media for wound physicians and  clinics. Please let me know if you are having success with social media as a marketing tool for your practice.

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Unique Wound Etiologies

December 12, 2009 — Matthew Livingston R.N. C.W.S.

This is a partial list of unique types of wounds. Typically these wounds are identified after a wound has failed to heal over several weeks of standard wound care or if there is a rapid appearance and/or deterioration of the wound. It is important to seek the care of a wound care specialist for these types of wounds.

AUTOIMMUNE DISORDER ULCERS

Clinical disorders lead to abnormal coagulation that triggers a primary thrombus in normal blood vessels leading to red cell blood clots, causing soft tissue cell death and ulceration.

CALCIPHYLAXIS

Condition associated with high levels of calcium phosphate. This leads to calcification of the small arteries (at the tunica media of the vessel). This is associated with intimal fibrosis and thrombus formation.

HEMATOLOGICAL ABNORMALITIES

Abnormal blood components lead to non flowing red blood cells and trigger blood clots.

LYMPHATIC OBSTRUCTION/ LYMPHEDEMA

Caused by a condition called lymphedema which typically doesn’t cause ulcerations (usually caused by trauma to the extremity), but the condition can keep wounds from closing.

MALIGNANCIES OF THE SKIN

More commonly related to (but not limited to) squamous cell carcinoma, basal cell carcinoma, and melanoma.

NECROBIOSIS LIPOIDICA

Associated with diabetes, which leads to collagen degeneration related to inflammation.

PYODERMA GANGRENOSUM

Pyoderma gangrenosum is an uncommon noninfectious neutrophilic dermatosis that is of an unknown cause.

RHEUMATOID ARTHRITIS ULCERS

Rheumatoid arthritis is a systemic autoimmune disorder of unknown etiology.

SCLERODERMA

Condition related to the occlusion of finger (digital) blood vessels related to excess collagen deposition inside the vessels

SICKLE CELL ULCERS

Related to the condition of sickle cell anemia. Unique sickle formed red blood cell clot and therefore, prevents appropriate capillary flow and tissue perfusion.

VASCULITIS/VASCULOPATHY

With vasculitis abnormal blood vessels activate a red blood cell clot.

WARFARIN (COUMADIN®) NECROSIS

Related to starting warfarin therapy. This condition is related to a protein C deficiency with anti-vitamin K anticoagulants leading to a hypercoagulable condition that results in a blood clot of skin (dermal) vessels.

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