MDNews - Mid Hudson

Dr. Carroll most commonly sees arterial disease, for which he implements catheter-based procedures, including angioplasty, stenting, atherectomy or bypass, depending on the occlusion's location in the extremity. "The more proximal — into the pelvic level, the iliac arteries — the occlusion is, the more likely angiography or stenting are more anatomically suitable," Dr. Carroll explains. "Shorter segment blockages or incomplete blockages are more appropriate for less invasive procedures, while long segments of occluded vessels can sometimes be treated by catheter-based therapies, but often require bypass." After Dr. Carroll restores blood flow to the affected extremity, he then assesses the appropriateness of HBOT. Vascularization is a critical component to wound healing, and no matter what innovative therapies physicians incorporate into the treatment plan, a wound will not heal if an extremity has reduced blood flow. Dr. Brooks emphasizes the importance of collaborating with vascular surgeons for comprehensive wound care. "If you don't treat the underlying problem, patients will continue to deal with the recurrent wounds," Dr. Brooks says. "They'll keep coming back. In the Health Quest system, we partner with the vascular surgeons and a multidisciplinary team of specialists to heal wounds. Our healing rates exceed national benchmarks." Dr. Brooks once treated a patient whose chronic leg wound had been grafted and closed numerous times but persistently re-opened following such treatments. The patient sought help from Dr. Brooks, who examined her and sent her to a Health Quest vascular surgeon, who found an occlusion. After the blockage was removed and normal blood flow restored, the patient's wound began to heal and the pain caused by her ischemic artery disappeared. "Without these approaches, patients wouldn't heal," Dr. Brooks notes. "If patients don't have adequate blood flow, they're not going to get better." Ablating venous Deficiency Patients may also present with pain and swelling, open ulcers, or varicose veins in their legs. These people may have venous reflux disease, which can contribute to forming chronic wounds. For this condition, Dr. Carroll provides venous ablation — a much less invasive alternative to traditional vein ligation and stripping. "As medicine moves to less invasive methods, we've replaced traditional, more invasive techniques with ablation," Dr. Carroll says. "Instead of making a series of moderate-sized incisions, we identify the culprit vein — usually the greater or lesser saphenous vein — by ultrasound and treat it percutaneously with ablation." During the outpatient procedure, Dr. Carroll enters the diseased vein with a needle and, under ultrasound guidance, passes a catheter with an energy source at the tip through the vein. Using either laser or radiofrequency energy, Dr. Carroll burns the vein from the inside and collapses it, achieving the same result — essentially removing the vein and improving venous blood flow — as ligation and stripping without many of the drawbacks. "The procedure has an extremely low complication rate and requires no hospitalization," Dr. Carroll says. "Patients return to normal activities the day of the procedure, as opposed to ligation and stripping, which is a much bigger operation that requires hospitalization." negative Pressure, Positive results Whether patients suffer from diabetic ulcers, surgical wounds, brown recluse spider bites, burns, ostomy wounds or a litany of other chronic wounds, the network of wound care centers in the health Quest system offers the complete spectrum of treatments for complex conditions. Francine h. Brooks, mD, FaCEP, interim medical Director at Vassar Brothers medical Center's Wound Care and hyperbaric medicine Center, says, "We use negative pressure wound therapy to treat both acute and chronic wounds. negative pressure wound therapy applies mechanical forces to the wound to create an environment that promotes healing by reducing edema, promoting perfusion and removing exudate." Dr. Brooks says physicians work closely with experienced nurses and technicians who have received advanced training, many of whom are nationally certified in wound care and hyperbarics. A key Participant Healing wounds is the primary focus of wound care, but another aspect that proves extremely beneficial to patients and referring physicians alike is the holistic nature of care as practiced by physicians within the Health Quest system. Primary care providers, charged with the complex task of managing underlying diseases, such as diabetes, often lack the time required to provide comprehensive wound care, so physicians at Health Quest wound care centers take on that responsibility. "We tend to wounds regularly," Dr. Hatter says. "All our capabilities aside, this is one of the most important aspects of wound care. Our patients are seen weekly until their wounds are healed. We provide intense therapy. Because of their frequent contact with patients, wound care physicians are able to devote appropriate time for wound adam semegran, mD, FaCs, associate medical Director of the Center for Wound healing at Putnam hospital Center, reviews a patient's history. mDNEWS.COm ■ MD News Mid Hudson |9

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