Congrats to Dr. Rogers

[PADPM]

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Although we dont' always agree on all matters, I do believe in giving credit when justified.

I just read that Dr. Rogers is leading the way as amputation prevention medical director of Paradigm Medical Management, Inc, with the announcement that they will be opening Amputation Prevention Centers of America, which will be a multi-disciplinary approach to limb salvage which will include DPM's and/or foot/ankle orthopedists, and vascular surgeons.

Although the article was brief, my interpretation is that these centers will bring wound care centers to the "next level".

I would like to hear from Dr. Rogers to learn the requirements, specialized training, protocol, etc., that will be implemented and the geographic areas he is targeting for these centers.

Once again, congratulations for a great idea and bringing wound care to the next level.

 

[Feli]

This is a good job to get many specialists working together... that's how you can make some big saves.

 

[PMSIII]

Well said. Multidisciplinary approach is the only way we can save limbs. Vascular and foot/ankle (Pod or ortho) are the services driving the limb preservation, then you have key input from Infectious Disease, Internal medicine, and Cardiology (as needed). In addition, to the medical/surgical services, I think having access to an experienced orthotist who is familiar with foot amputations is huge.

I truly believe that none of this would be useful if you did not have a motivated patient who wants to preserve their limb and life. Let's face it, you can stent all you want and amputate at the most perfused level possible s/p vascular intervention, and even throw in every arsenal to try and get this amputated site to heal (HBO, negative pressures, etc.), but if Mr. Smith is still smoking a Pack of cigarettes every day, running his blood glucose at 300+, and his nutrition status is still horrid secondary to his poor diet, that distal foot amputation is a doomed BK.

 

[PADPM]

Wound care centers have been utilizing a multi-disciplinary approach for many years, but I'm not sure that these centers have necessarily brought it to the level that the amputation prevention levels will approach the problem.

I believe that these centers will hopefully have some protocol or algorithm when a patient is seen and also that the DPM and/or foot/ankle orthopedist will be qualified to perform any necessary reconstructive procedures. I have found that in many wound care centers (and our office is involved with two), the patient is often bounced around if the DPM is qualifed to treat wounds, but not qualified to bring it to the next level if some major reconstructive surgery is required. Hopefully, these centers will be a "one stop shop".

 

[Podfather]

Wound care centers have been utilizing a multi-disciplinary approach for many years, but I'm not sure that these centers have necessarily brought it to the level that the amputation prevention levels will approach the problem.

I believe that these centers will hopefully have some protocol or algorithm when a patient is seen and also that the DPM and/or foot/ankle orthopedist will be qualified to perform any necessary reconstructive procedures. I have found that in many wound care centers (and our office is involved with two), the patient is often bounced around if the DPM is qualifed to treat wounds, but not qualified to bring it to the next level if some major reconstructive surgery is required. Hopefully, these centers will be a "one stop shop".

We have a one stop shop and it works. I see wound care centers classified as slash and dash where everyone (unfortunately) ends up in a frame with a major reconstruction or pick and pray where people are treated with debridement after debridement and not taken to the next level. You need both of the above and actually have to heal wounds.

I also have gotten in to verbal disagreements with Dr. Rogers but also say Kudos. Now if I can only get him to say a nice word about ACFAS/ABPS.🙂

 

[diabeticfootdr]

I would like to hear from Dr. Rogers to learn the requirements, specialized training, protocol, etc., that will be implemented and the geographic areas he is targeting for these centers.

Once again, congratulations for a great idea and bringing wound care to the next level.

Wow, thanks for the props. I'm really excited about this opportunity because I feel I can effect more positive changes over a wider population of patients than just my own.

We're considering 8-12 non-competing geographic markets across the US. It would be nice to say, NYC, Miami, Dallas, Chicago, etc., but what I've found is that you have to find the right people first, because this type of center doesn't work without motivated experts. So instead of concentrating on the market first, we will concentrate on the surgeons first. Best combination is a podiatrist/vascular surgeon, although other teams will work as effectively, like a plastics/vascular/podiatry, or perhaps a F&A ortho/vascular.

We've looked at our own statistics and we have a 94% limb salvage rate with average wound healing at 53 days. We admit on average 10% of our patients every day. Our patients receive an average of 2.9 surgeries. So this is really a surgical subspecialty.

One difference from most Wound Care Centers is that an APC will have full time clinicians as opposed to the standard WCC model of half-day panels of various doctors, some of which might not have true expertise in chronic wounds (like OB/Gyn or ER).

While there is no mandatory recipe, we put guidelines in our recent paper jointly published by J Vasc Surg and JAPMA.

Rogers LC et al. Toe and flow: Essential components and structure of the amputation prevention team. J Vasc Surg 2010;52:23S-7S and JAPMA 100(5): 342-348, 2010