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>> The diabetic foot and wound service started
in 2012, in response to the increasing number
of diabetic patients coming in with foot ulcers
who are at risk for amputations.
And basically when we started this program,
what we found was that we were able
to take care of patients in the hospital,
but once they were discharged and
they needed follow-up, it was exceedingly
difficult for the patients to see all
the different providers that were necessary.
So what we did was we created one single
multidisciplinary clinic and service
that combines vascular surgery,
surgical pediatry and endocrinology.
That works on both the inpatient
and the outpatient side.
On the outpatient side,
basically patients come and they see
all three providers at a single visit.
So they're not going to one visit
with the pediatrist, one visit
with the vascular surgeon and one
with the endocrinologist.
They see us all at every single visit.
At those visits we also have a certified wound nurse
as well as a PA who helps us in our clinic
coordinating care on the outpatient side.
>> On the inpatient side all patients
are evaluated by all members of our team.
They are provided a vascular assessment
with revascularization of their legs whenever needed.
When patients have blockages in their arteries
we can help open them up to improve
their wound healing and help save their limbs.
The surgical pediatrist works with the patient
to provide a wound care plan and wound
bereavements whenever necessary.
Our wound care nurse sees the patients daily
and helps with daily wound care changes.
Our endocrinologist is involved in blood sugar control
and helps to get the patients to a manageable level
to improve their wound healing potential.
Finally our infectious decease doctors work
with us to provide antibiotic recommendations
so that we can reduce infections
and help save patients lives.
>> The philosophy of care is relatively simple.
Patients with diabetic foot ulcers
are a risk for losing their legs,
or major amputation.
And the idea is that, diabetic patients
have multiple risk factors.
They may have high glucose levels
called hyperglycemia.
They may have peripheral vascular decease,
which is also blockages of the arteries,
or they may have neuropathy of the feet,
where they can't feel their feet,
and so they're at risk for developing ulcers.
The idea is that if we address each of these factors,
that we're more likely to help a patient heal their wound,
and prevent a major amputation.
>> We provide many cutting edge treatments
in our diabetic foot and wound service.
As vascular surgeons, we can treat patients
using minimally invasive techniques
or open surgery depending on what is needed
based on the patients anatomy.
We used balloons, drug coated balloons
and drug coated stents for minimally invasive techniques.
We also can do open CABG bypasses when
that's important or necessary.
Our wound care nurse and surgical pediatrist
have cutting edge wound care treatments
that are not used elsewhere in the country.
They're constantly using different
elements for wound care,
and these have results in excellent wound healing
rates compared to other programs across the country.
>> What's completely different about our program
compared to other places around the country,
is that we follow our outcomes.
We do an extensive amount of research
and we've published on this.
you can see it on our website,
that looks at major amputation rates,
depending on what stage a patient comes in
with their foot ulcer and their risk
of amputation for that limb.
And if you compare stage four patients
across the country, we have one of the lowest,
if not the lowest major amputation rate in the country.
>> The most important aspect of our research
is the long term outcomes of the patients
that we treat.
We've been treating patients with the diabetic
foot and wound service since 2012,
so we have more than five years worth of outcomes.
Majority of our patients follow up with us long-term
and we track their outcomes including wound
healing time, major amputation and recurring
ulcers over time.
This allows us to tailor the patient's
individual care, as well as to learn about
the treatments that we've provided in the past
and understand what treatments might
be better in the future.
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