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1. Wound Management; A multidisciplinary approach with continuity Joel Aronowitz, MD Natalya Stepansky, PA-C Olympia Wound Care and Hyperbaric Treatment Center

2. Chronic Wounds; An Age Old Problem “ Miracle of the black leg” performed by Saints Cosmas and Damian 1462 A.D.

11. Diabetic (Neuropathic) Foot Ulcers

13. Chronic Sacral Pressure Ulcer -- Undermining eliminated with VAC therapy

15. Hydradenitis Suppurativa of Breasts

16. Post Op; debride, breast reduction

24. （１） Venous Ulcer （ 2 ） Arterial Ulcer （ 3 ） Pressure Ulcer （ 4 ） DM foot Ulcer

25. WOUND CARE are we up to date?

27. V.A.C. ® Therapy Systems V.A.C. System ATS V.A.C. System Freedom Source: V.A.C. ® Therapy Clinical Guidelines, p.8 Slide 28, Rev 06/04 Courtesy of KCI, San Antonio, TX 06/04

30. Sources: Mintel Group; National Center for Health Statistics Obesity in the U.S.

31. Obesity and Diabetes in the US. 1991  2001 (Mokdad et al. JAMA 2003)

33. Life Shortening Effect of DM = 13 years. (Manuel et al. Diacare 2004)

34. We keep up with wound care, reconstructive surgery and hyperbaric medicine… So you don’t have to…

39. BEFORE AFTER 3mo F/U

41. Initial Presentation

42. B/L Anterior Legs Lacerations + Burn wounds

43. HBOT + Surgical Debridements

44. Week 1 -- Topical Papain/Urea for escharectomy

45. Week 2 – VAC Started on R foot

46. Week 3 – VAC continued on R foot

47. Week 4 – d/c VAC, Silver Alginate + Collagen ORC

48. Week 1  1 Month Later

49. First Visit 1 month Later w/ VAC+HBO

50. 2 Month Later

51. HEALED 3 month Later

52. First Visit HEALED

54. Left Breast Dehiscence  Treated with VAC + HBO

56. Upperback dehiscence  Treated with VAC + HBO

59. BEFORE and AFTER

61. Wound VAC, HBO Started

62. Followed up in my office, Once a week

63. Continue to Improve in Depth & Size

67. OR: Debridement + Primary Closure

68. 1 wk Post-op

70. THANK YOU!