FREDERICKSBURG, Va. (Ivanhoe Newswire) -- What can start out as a small wound after surgery can lead to infections and even death. In fact, every year about 500-thousand patients in the US develop surgical site infections, which claim more than ten-thousand lives. Now, a new simple treatment for wounds can help heal them before they have a chance to kill.
Even walking short distances used to be too much for Delores Gray. “I couldn’t walk a half a block without having to stop; my leg would ache so bad,” Dolores Gray, told Ivanhoe.
She’d had surgery before for a blocked artery, but a new blockage meant another surgery. “The first time, the one side, took forever to heal,” Gray said. However, this time around doctors used a new wound healing therapy known as PICO.
Pico is a hand-held pump, which works by sealing an advanced airtight dressing around the wound. “That actually draws the exudate or the fluid from the wound away from the wound,” Doctor Victor D’Addio, MD, Vascular Surgeon at the Mary Washington Hospital and Director of the Rappahannock Wound Center, told Ivanhoe. The negative pressure also encourages blood flow, speeding up the healing process. “And so a week after their surgery, their wound is healed,” Doctor D’Addio said.
Surgical site infections cost the health care system billions of dollars a year because of longer hospital stays, readmissions, and treatment, making advances in wound care all the more important.
Victor D’Addio, MD, Vascular Surgeon at the Mary Washington Hospital and Director of the Rappahannock Wound Center, talks about a new treatment option for chronic wounds.
Can you talk about how big of a problem it is with chronic wounds?
Dr. D’Addio: The scope of chronic wounds is huge. At the wound center the wounds we deal with are diabetic foot ulceration, venous ulceration, traumatic wounds, and surgical wounds that are high risk wounds, which have opened up post operatively. It’s a major problem in this country that affects millions of patients.
Just wounds that don’t heal?
Dr. D’Addio: Wounds that don’t heal; chronic wounds.
What’s been used to try to heal these wounds? How does PICO come in?
Dr. D’Addio: Traditionally wounds have been treated with moist gauze dressings. For many years that was what we did for wounds. PICO is one of the methods we use to treat these high risks post operative wounds and even some of the more chronic wounds. Most of my experience with PICO has been in wounds that are surgical wounds; that are in high risk patients or in high risk locations on the body.
What are some of the areas that you would use this for?
Dr. D’Addio: I use it on abdominal wounds; I specifically like it for groin wounds, because there’s a lot of motion in that part of the body.
With PICO mobility is enhanced right?
Dr. D’Addio: It decreases the risk of wound infection; gets the patients up and moving that much faster. They’re able to kind of get back to their normal life with the PICO in place; due to the convenience of the device. Having your post operative patient up walking, moving is obviously a good thing.
How does it work?
Dr. D’Addio: It’s a negative pressure device so it’s a combination of the negative pressure and an advanced wound dressing in one device.
A negative pressure device; what is that?
Dr. D’Addio: A negative pressure device is placed over the wound; that actually draws the fluid from a wound away from the wound, so that the wound is not sitting bathed in the fluid from the tissues. It keeps the tissues healthy in the sense that the wound edges are not macerated or overly wet over the post operative period.
What would you say would be the recovery time for this versus traditionally just wrapping it in gauze?
Dr. D’Addio: The biggest issue especially in groin wounds or even in some abdominal wounds is your ability to avoid a chronic wound situation. These post operative wounds, in difficult patients; in difficult locations just heal right out of the box. A week after their surgery their wound is healed.
Part of that is from ACTICOAT Flex?
Dr. D’Addio: The initial layer we place on the wound post operatively is the acticoat flex product, which is a silver dressing. In many cases the silver is bacterial static, meaning it prevents proliferation of the bacteria. I like the ACTICOAT Flex, because it’s bactericidal, it kills the bacteria in the area, in the wound area. Then we place the PICO dressing on top, which is the negative pressure dressing. That works well, because the ACTICOAT Flex is porous and so allows the PICO to draw the fluid away from the wound.
The acticoat it helps prevent MRSA and some of the other bacteria?
Dr. D’Addio: There’s a broad spectrum of bacteria that it prevents including MRSA, which is one or our biggest problems in the hospitals post operatively.
How important of a breakthrough would you say this is?
Dr. D’Addio: This is a huge breakthrough for me. It’s inexpensive, simple, easy for patients to understand and it’s designed such that the patient removes the dressing themselves when they’re at home post operatively, it’s that simple. It’s light, it’s easy for the patients to carry around with them, unlike some of the other negative pressure products on the market which are bulkier, difficult for patients to carry. This is such a simple easy dressing to use; that it’s revolutionary.
What would are some other advantages then besides obviously the healing time and ease of use or maybe someone knowing that you have it on you?
Dr. D’Addio: It’s easy because it can be worn under your pants or your shirt and no one would know you actually have it on. One of the reasons this is revolutionary is many times when you use a negative pressure product it draws the fluid away from the wound in to a canister. You have to carry that canister with you, or if you’re in the hospital it’s sitting at the end of your bed. This newer technology, it’s all in the dressing; so the fluid is drawn in to the dressing, thus avoiding the use of a canister at all. That’s why it can be such a small little product that no one would even know the patient was wearing.
How does it just evaporate then?
Dr. D’Addio: There’s some evaporation and some collection within the dressing itself. I think as technology even advances from here on; those dressings will accommodate more and more fluid loads.
How much fluid is normally excreted with a wound?
Dr. D’Addio: It depends, but it holds about three to four hundred cc’s over the course of a week so it’s a product that lasts a week and then you’re done with it and you throw it out it’s completely disposable. The product itself comes in multiple sizes. There’s a silicone layer that goes on the wound that obviously is sticky to stick on the wound; this is peeled off and placed on the patient. There’s a tube that goes to a suction device that is easily connected. This is a light device; that what we do is, we just tape it to the patient’s abdomen and it’s convenient in that sense. Then to turn it on, press the orange button. There’s a little green flashing light that indicates that it’s functioning. It’s simple to use and simple to understand. The ACTICOAT Flex is the first layer and this can be cut to whatever size and it’s a porous product that just sits on the wound and the PICO goes on top.
What makes that one unique over other products?
Dr. D’Addio: A lot of the silver dressings; some are not porous so you would not be able to place this down and then put the PICO on top of it for example. The fact that this is bactericidal kills the bacteria.
What about Robert?
Dr. D’Addio: Robert Stahl has had a bypass graft on his leg in the past and had a recurrent blockage in his groin and some new blockages up above. I took him to the operating room and cleaned out the blockage in his groin; did and endarterectomy there and was able to do some angioplasty and stinting of iliac system above. Then I placed a PICO on the groin wound. His wound looks great and he’s already back in action; less than a week after surgery.
You said the groin area was particularly difficult, what would be sort of a typical healing time would you see with traditional healing time?
Dr. D’Addio: It’s common to see what we call a little wound dehiscence there where right at that groin crease where everyone has that crease. The wound opens a little; many times it’s a nuance, it may take a month or two for that to ultimately heal in. The biggest fear for a vascular surgeon is that you now have a prosthetic graft under that wound. If the wound opens enough you can develop infection in that graft. Once a foreign body is infected you have to take it out surgically. That could potentially be a disaster, even a limb threatening disaster. It’s certainly worth the small investment to invest in a good dressing like this to prevent graft infection, wound infection, or potential limb loss.
Is this something that’s covered by insurance?
Dr. D’Addio: The way it works is within the OR is there’s what’s called the DRG. The hospital charges hypothetically ten thousand dollars for it. They have that money to manage the patient so what this does typically whenever you use traditional negative pressure or tapes or gauze or whatever they’re using that kind of pulls out of that pool of cost. So if they manage a patient for five thousand dollars then that insurance comes back, that extra money kind of goes to their pool. Now with this using this prophylactically if it doesn’t avoid the patient coming back which in turn if they came back in that thirty day period or even some cases longer for different procedures it’s not reimbursed. The hospital is going to eat that cost of redoing the graft or the physicians time, the OR time. So that’s where that comes in to play for that immediate cost. It’s not like they pay for that specific product, its part and parcel of the patient’s care.
So it’s just included in the care?
Dr. D’Addio: Correct. About two or three months ago we weren’t using this in the outpatient world, because they weren’t reimbursed. So wound clinics, vascular clinics, all these different clinics it wasn’t cost effective for them to use something like this yet until they got some reimbursement on it, which we finally did get. It usually takes about a year grace period for a product to get to some sort of reimbursement through the insurance. Now they are able to bill for the application of the device and the wound care world.
When was this approved?
Dr. D'Addio: Basically it’s been a little over a year now.
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