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Wound & Lymphedema Center Offers Coordinated Care

January 5, 2006

The newest Bozeman Deaconess department—Wound and Lymphedema Center—is the only advanced multidisciplinary treatment clinic of its kind in Montana.. Come this spring, the new referral-based service will be the first in the state to have a monoplace hyperbaric chamber dedicated to wound healing.

Caryl Perdaems, OTR, CLT-LANA, is manager of the department. The Center is under the medical direction of Garth Olds, MD, and Jon Robinson, MD, who have special training in wound treatment. They both offer conservative wound care and management. “Our goal is to preserve as much function as possible,” Perdaems said. “We use a computerized documentation program that captures measurements, documents treatment results and provides courtesy referral updates to primary care physicians.” Robinson and Olds, who both continue in their own practice, oversee patient care and treatment regimens for the Wound and Lymphedema Center.

In addition to managing daily Center operations, Perdeams treats patients with lymphedema (swollen limbs caused when lymphatic pathways are damaged or from circulatory problems.) Pat O’Brien, RN, CWOCN, a nurse at Bozeman Deaconess from 1973-1994 and independent wound specialist nurse until she joined the new Center in August, is clinical coordinator. Lori Liston, RN, is the department’s wound care technician.

The new Center coordinates all aspects of wound and lymphedema evaluation in one spot (they’re housed on the 3rd floor of Highland Park 4). The team draws on the expertise of Robinson and Olds as well as dermatologists, surgeons and primary care physicians. They also partner with specialists in nutrition, prosthetic and orthotics, home health and other Bozeman Deaconess departments such as respiratory therapy and physical rehabilitation.

“Having access to our Center means patients don’t have to make multiple appointments that can delay the healing process,” said O’Brien. “We also provide extensive follow up that helps keep wounds from recurring.” Wounds treated at the Center include burns, lower extremity ulcers, diabetic foot ulcers, post operative infections, scar tissue problems, pressure ulcers and skin tears. Because the staff knows which dressing will speed healing of a particular wound and can spot edema issues or identify the need for a vascular workup, healing rates have increased. “Patient education is a big focus,” O’Brien said. “So is our connection to home health and nursing home caregivers.”

Perdaems says lymphedema is caused when lymphatic pathways are damaged during surgery for cancer. Symptoms are a heavy feeling, painful limb that is prone to repeated infections. Noninvasive treatments include manual lymph drainage, compression bandages, exercise, skincare education and scar tissue management. Circulatory disorders can also cause swelling in the legs, particularly after surgery, and the swollen tissue can split open a wound, whether traumatic or surgical.

Dressings with antimicrobials that prevent odor, growth factors to stimulate healing and skin substitutes are among new therapies offered at the Center. They also use VAC therapy, a technology that pulls excess fluid drainage away from the wound, increases blood flow and creates a welcome environment for granulation or formation of new skin. The Center also uses digital photography to monitor the size and status of each wound.

“We will have a new Trancutaneous Oximeter (TCOM) to monitor skin oxygen level of the skin and underlying tissue around a wound, or in distal areas such as toes. It can be used alone or in conjunction with the hyperbaric oxygen therapy we will soon offer,” Perdaems reports. Hyberbaric oxygen therapy (HBOT) delivers large amounts of oxygen to body tissues by applying 100% oxygen in a chamber that’s pressurized to more than atmospheric pressure. HBOT has proven to be beneficial for conditions such as chronic wounds, radiation tissue damage, skin grafts/flaps, necrotizing soft tissue infection, diabetic foot care and crush injuries.

“The chamber—that will also be available for critical care treatment of carbon monoxide poisoning—is clear acrylic enclosed, has multiple communication systems, and is fitted with a specialized gurney and stretcher,” said Perdaems. She says the Respiratory Therapy department will assist in the operation of the new hyperbaric chamber, which could in most cases, save limbs.

Another benefit of a comprehensive center is that Medicare and insurance companies pay for wound and lymphedema outpatient care and for inpatients referred through chart orders.

To date the Center has had close to 450 encounters in the outpatient location. That’s in addition to inpatient consults. “The majority of our patients have diabetic complications and circulatory disorders,” said Perdaems. “We have already treated 50 burn and frostbite cases that would otherwise have been sent out of town.”

For more information or to refer a patient contact the Center at 556-5512 or 522-1745.

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