Hillcrest Medical Center offers an outpatient Wound Care Clinic for patients with acute wounds or chronic wounds that won’t heal on their own. Many patients have diabetic foot and leg ulcers, which when they become so severe, amputation may be the final course of action. However, recent data is encouraging for these patients, as foot and leg amputation has decreased 65 percent in recent years. Contributing factors include improved treatment of foot wounds and diabetes management, along addressing cardiovascular issues in these patients. Treating and preventing cardiovascular disease can dramatically impact the healing process by improving oxygenation in the vascular system, critical for cell metabolism, which promotes wound contraction.
Oklahoma Heart Institute assists in the treatment of Wound Care patients when indicated, a unique relationship that attributes to faster healing and reduces the rate of amputation. Dr. Raj Chandwaney works closely with the Wound Care Clinic. “Many patients who suffer from non-healing wounds in their feet actually have blockages in the blood vessels that feed their legs,” he explains. “These blockages impair the delivery of nutrient and oxygen rich blood to the wounded extremity. Without the delivery of this nutrient and oxygen rich blood, the foot wounds are unlikely to heal and this problem can lead to an amputation of the affected limb.”
Dr. Chandwaney says not all patients are fortunate to benefit from the relationship between Hillcrest and Oklahoma Heart Institute. “A recently published study reveals that more than 54 percent of patients who underwent an amputation in the United States during a single year were never referred for any evaluation to examine the blood flow to their feet prior to their amputation,” he says. “The endovascular specialists at Oklahoma Heart Institute are committed to correcting this problem in our community. By working closely with our colleagues at the Hillcrest Wound Care Clinic we have piloted the Oklahoma Heart Institute Critical Limb Clinic.”
“We have very successfully integrated Oklahoma Heart Institute’s vascular intervention team with our wound center's operation,” says Wound Care Clinic Charge Nurse, Samantha Kuplicki, RN, BSN, CWS. Kuplicki says because of this relationship, she has told patients they may have an option besides amputation, when they were told previously there was nothing that could be done.
“We refer at-risk lower extremity wound patients from the wound center to Oklahoma Heart Institute’s Critical Limb Ischemia Clinic, or CLIC,” she explains. “After the patient is referred, a vascular specialist will evaluate the patient and determine the need for intervention to address lower extremity circulation problems. This partnership has increased patient satisfaction, and it has been a huge asset to wound healing rates.”
The Oklahoma Heart Institute Critical Limb Clinic was developed to fast track patients with poorly healing wounds so that any blockages in the blood vessels that feed the wounded leg can be promptly diagnosed and treated. Patients referred to the Oklahoma Heart Institute Critical Limb Clinic will be seen by a specially trained health care provider within one week of the referral. If appropriate, patients can be scheduled for an angiogram within two weeks of the referral.
Due to the need for such services that exists in Oklahoma, the endovascular specialists at Oklahoma Heart Institute have elected to expand the availability of the Critical Limb Clinic. Podiatrists and wound care clinics located throughout northeastern Oklahoma may now refer patients to the Oklahoma Heart Institute Critical Limb Clinic.
“By promptly evaluating and treating the underlying blockages present in these patients' blood vessels, we are finding that our colleagues at the Hillcrest Wound Care Clinic are achieving higher rates of wound healing,” says Dr. Chandwaney. “We hope to reduce the need for amputation in many of these patients.”