For anyone with chronic wounds that have a hard time healing, MemorialCare Saddleback Medical Center’s Advanced Wound Healing & Hyperbaric Medicine Center in Mission Viejo offers specialized treatments that promote healing and prevent serious health risks. With over 500 patients annually, the Wound Care Center at Saddleback Medical Center treats chronic wounds caused by diabetes, poor circulation, radiation treatment, pressure injuries and other conditions, and provides a comprehensive outpatient program designed to speed healing, preserve limbs and prevent the recurrence of challenging wounds.
Treatments can range from artificial skin grafts that help stimulate healthy tissue to hyperbaric oxygen therapy to promote optimum healing for certain conditions. Anyone with a wound that has not started to heal in two weeks or is not completely healed in six weeks may be a candidate for advanced care through the Wound Care Center.
We tend to focus on the reason the wound is not healing and try to correct that or improve that to allow the body to do what it’s supposed to do. For instance, if there is a patient who has poor circulation, we address their circulation. If they have swelling that’s impeding healing, we address that.
Dr. Bill Khoury, medical director, Wound Care, Saddleback Medical Center
A large portion of the patients treated at the Wound Care Center include Laguna Woods residents, many of whom are on blood thinners and tend to develop more significant bruising, which can lead to an open wound that has a hard time healing. In cases that involve hard-to-heal open wounds, the Wound Care Center specializes in debridement, a procedure to clean the surface of a wound to allow healthy tissue to come in.
“There could be necrotic or dead tissue that’s preventing healthy tissue from coming in, so we basically clean the surface of the wound,” Dr. Khoury explains.
DEBRIDEMENT HELPS ONE VILLAGE RESIDENT
Debridement was used to help Laguna Woods Village resident and VMS board member Norman Kahn after he had a freak accident in his home one night. While in his bathroom, his right leg slipped off the top of the toilet seat while he was removing a sock from his right foot and it hit a metal, serrated waste basket nearby with so much pressure that the serrated portion of the basket acted like a knife, cutting into where his big toe bends. As he tried to lift himself up, his right arm got caught under the marble on his sink and hit the edge, removing a two-inch square area of skin from his arm.
“I had no idea of any problem at the time,” Kahn said. “When I walked away from the bathroom into my living room and looked back, I saw a trail of blood.”
The wound had been so deep that his primary care office referred him to the Wound Care Center. During his initial visit to the Wound Care Center on June 14, Kahn was pleasantly surprised upon meeting Dr. Randall Chong and hearing about the Wound Care Center’s methodology for treating wounds.
“Dr. Chong said [the center has] a completely different system,” he said. “We want the wound to heal from the inside out, which doesn’t leave a scar and would prevent sepsis or other infections. Dr. Chong said, ‘Given the depth and size of the wound that we’re dealing with, it could be a couple of months or more. I had faith in him, and I felt it was a new, modern way to go, so I said, ‘Sign me up.’”
The first few weeks, Kahn’s bandages were removed and his wounds were cleaned, numbed and medicated to ensure there was no bacteria.
“We don’t inject or anything like that, but we do have to clean and debride,” said Dr. Chong. “We use a topical anesthetic that allows us to clean the wound, because that is really important and a big part of the wound-healing process. We free it from any kind of bad bacteria. Our goal is to prevent infection.”
Later, a bacterial binding dressing—a unique dressing with special properties to attract and bind to bacteria and fungus, removing them from the wound bed and reducing the risk of infection—was used to help Kahn’s wound heal.
“We have several dermal products that are applied on wounds and provide growth factors to the wound bed, accelerating healing,” said Khoury.
During Kahn’s visits to the Wound Care Center, Chong provided instructions for what he could do at home and his wounds continued to improve. Kahn said the Saddleback team’s attention to detail, efficiency and compassion impressed him.
“Dr. Chong ran the operation on time,” Kahn said. “The nurses were spectacular. The staff was unbelievable. I understand good service and I appreciate it whether it’s in a restaurant or in a hospital. I must say that the service the center gave me was beyond spectacular. It was very personal, very warm, very friendly, informative and consistent.”
By Kahn’s final visit on July 25, his wound had healed to a point where he no longer needed to visit the Wound Care Center.
“The Wound Care Center is … something that I believe the 18,600 seniors who live in Laguna Woods Village should know about because we fall a lot,” he said. “We get cuts and we cut easily because our skin is thinner. This is a unique center and a service so different, so unique and so beneficial that the word needs to get out.”
HYPERBARIC OXYGEN THERAPY
The types of wounds Kahn incurred are among many others treated at the Wound Care Center at Saddleback Medical Center, including a variety of complex conditions that may be treated with hyperbaric oxygen (HBO) therapy. The center offers three hyperbaric oxygen chambers to improve healing capability. Radiation cystitis—a condition in which men incur damage to their bladder lining after radiation for prostate cancer—is among the conditions treated by HBO therapy.
“These patients have an internal wound in their bladder lining,” said Khoury. “We treat a number of those patients who are referred by urologists. We also receive quite a few referrals from oral surgeons for patients that develop complications related to radiation for head and neck cancer who will have a problem healing a tooth extraction for instance or an injury in their mouth where there’s a chronic infection related to previous radiation.”
HBO therapy is also used for other treatments from arterial ulcers caused by peripheral arterial disease—where there is oxygen deficiency to the lower extremities—to chronic bone infections, diabetic foot ulcers and acute hearing loss.
“We’ve treated a few patients with a rare condition where there’s acute hearing loss; not the typical one where somebody chronically loses hearing over time,” said Khoury. “There’s a specific condition where some patients lose their hearing rapidly; hyperbaric is a known treatment for that and it’s been successfully used. We’ve treated several patients with that condition. The patients are sent to us from ear, nose and throat specialists.”
SCREENING BEFORE HBO TREATMENT
Prior to HBO treatment, the Wound Care Center provides a screening to assess whether a patient would benefit from the treatment and whether they are capable of undergoing treatment safely. Typically, the center seeks to determine if a patient has had an issue related to severe heart failure or severe lung disease.
“Routinely, we’ll order a chest X-ray, an echocardiogram and an EKG, and then once we determine they can undergo treatment safely, they’re scheduled,” said Khoury.
RECEIVING HBO THERAPY
To receive HBO therapy, the patient enters the chamber on a gurney, the door is closed and 100% oxygen begins to flow into the chamber. The chamber is pressurized gradually over 10 to 15 minutes. The patient breathes the pure oxygen for approximately 90 minutes, depending on the condition being treated. After the prescribed treatment time, the flow of oxygen is stopped and the chamber is decompressed. This type of treatment is often used in conjunction with additional therapies to facilitate healing of various underlying medical conditions.
“The hyperbaric is a clear plexiglass chamber, so they can see all around them in the room,” said Khoury. “The tech is always there. There’s a speaker system, so they can speak to the tech, and there’s a flat-screen TV so they can usually watch television or watch movies or sleep throughout the treatment.”
HERE TO HELP
Many patients may not realize that the Wound Care Center at Saddleback Medical Center exists and can help their specific medical condition.
“Many patients didn’t know this center exists,” said Khoury. “Many times, patients come to us because they’re in need and they don’t have any place else to go per se and then a physician will say, ‘Go to the wound center, they specialize in that.’” For former patient Norman Kahn, visiting the Wound Care Center provided him the peace of mind that comes with knowing that he was in expert hands. “This is the best, well-kept secret in Orange County,” Kahn said. “I think people should really know about it, because it’s just unbelievable and the results are spectacular.”