Conflicts of Interest Foot Care and Amputation Prevention: Vascular - - PowerPoint PPT Presentation

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The “Toe and Flow” Team Model of Diabetic Foot Care and Amputation Prevention: Vascular Surgery and Podiatry

Joseph L. Mills, Sr., MD Professor of Surgery Chief of Vascular Surgery and Endovascular Therapy Michael E DeBakey Department of Surgery Baylor College of Medicine Houston, Texas

Conflicts of Interest

• NONE
• Research support:
• PCORI P2P Award –Improving delivery of care for

patients with diabetic foot ulcers (BCM-PI)

• Bayer (National CO-PI, Voyager Study, BCM)
• Cesca Therapeutics (Steering Committee; BCM Site CO-

PI)

• Anges (Steering Committee; BCM Site PI)

3 4

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Relationship of DFU, neuropathy and ischemia (PAD) to outcome

Barshes et al. Diabetic Foot and Ankle 2013

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BUT: Flow is only one component

• What about prevention clinics?
• Routine foot care?
• Foot screening?
• High-risk patient monitoring?
• Off-loading (shoes and surgery)?
• Prophylactic/reconstructive/complex foot surgery?

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Components of Complete DF Care

• Screening and Prevention
• Gait analysis, biomechanics
• Risk stratification (ADA Foot Risk Class)
• Pressure reduction and offloading
• Vascular assessment and revascularization
• Surgical debridement, drainage complex infection
• Postoperative monitoring of high risk foot
• “Metabolic know”

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D.G. Armstrong, J.L. Mills / Wound Medicine 1 (2013) 13–14

“Toe and Flow” Philosophy

Toe and Flow Process

• Every consult seen by Podiatry and Vascular Surgery
• WIfI staging at baseline and after every intervention
• Drainable infection has highest priority
• Then ischemia is addressed based on WIfI rubric
• Plan for wound care, preparation, closure
• Reassess, restage if healing stalls
• At BCM, we are adding q 2 week review of C and S

results and antbiotics prescribed with designated ID physicians (In and outpatient components)

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Baylor St. Luke’s Hospital Harris Health System – Ben Taub Hospital

Harris Health

• No clear pathway or algorithm
• Cultural shift: amputation inevitable versus
• ften avoidable
• Monthly meetings with Admin, Wound Clinic,

Internal Medicine, ID, General Surgery and Vascular Surgery

• WIfI staging for all DFUs in ED and soon for
• utpatients
• Expansion of clinic to include VS

Vascular Surgery and Podiatry Outpatient Clinic

4/8/2017 6 SALSA 5-year experience

64% Endo First

1/3 of DFU patients over 4 yrs required REVASC

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Who needs a Team? You do. More importantly. Your patients do!

TEAMS win games. Patient care is a team sport