Premier Wound Care
A unique wound care service for patients who are home bound, in nursing homes, skilled nursing facilities and other long term healthcare facilities. We offer free instructive seminars every Wednesday at 10am!
Call Us: (800) 321-1593
At Premier Wound Care Of Southern California, we eliminate the need for regular office or hospital visits for wound care.
Treating Patients Where They Are!
Premier Wound Care of Southern California is an experienced and innovative wound care program, specializing in Complex and Surgical wounds.
We provide personalized and convenient wound care at your home or facilities located within San Bernardino, Riverside, Orange County and Los Angeles County (see a map of the areas we work in).
PATIENT EDUCATION
Patient education is an important component to a successful healing process. Patients that learn about their condition and treatment are better able to care for themselves, assist in the healing treatment and prevent future recurrences. Below is some basic information about wounds and wound care treatment. We encourage all patients to learn about their conditions and the treatments they are receiving. Please ask your nurse or doctor any questions you may have.
ACUTE VS. CHRONIC WOUNDS
Acute: These are wounds that heal uneventfully and within an expected time frame, although there can be complications that require prompt medical attention
Chronic : These are wounds that do not heal in the standard time frame and may last for weeks, months or even years. Typically there are not complications with these wounds other than slow healing.
TYPES OF WOUNDS
Pressure Ulcers: Also known as bedsores or decubiti, these wounds involve an area were localized tissue necrosis (death) has occurred. They are caused by pressure on a bony area against a surface, which causes a decrease in blood supply to the area that eventually leads to cell death.
Arterial Leg Ulcers: These are also known as ischemic ulcers and are caused by a lack of adequate blood supply to an organ, usually due to a blocked artery. These wounds are often seen on the tips of the toes. To properly treat arterial ulcers, blood flow must be assessed.
Neuropathic / Diabetic Ulcers: These wounds are associated with diabetes and result from damage to the nerves to the foot. These ulcers are typically located on the the foot.
Venous Wounds/Leg Ulcers: These wounds result when there is a failure of the valves in the veins, creating swelling in the lower legs. The valves become damaged and cannot effectively return blood from the lower extremities to the heart. These wounds are typically located from the ankle to the mid calf.
PRESSURE ULCER STAGING
Stage I: Non-blanchable erythema
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons.
Stage II: Partial thickness
Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister.Presents as a shiny or dry shallow ulcer without slough or bruising*. This category should not be used to describe skin tears, tape burns, incontinence associated dermatitis, maceration or excoriation.
*Bruising indicates deep tissue injury.
Stage III: Full thickness skin loss
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category/Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Stage III pressure ulcers. Bone/tendon is not visible or directly palpable.
Stage IV: Full thickness tissue loss
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Stage IV pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Stage IV ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.
Unstageable/Unclassified: Full thickness skin or tissue loss – depth unknown
Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth cannot be determined; but it will be either a Category/Stage III or IV. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.
(From the National Pressure Ulcer Advisory Panel, http://www.npuap.org)
WOUND CARE CORE PRINCIPLES
1. Wound type and documentation
2. Risk assessment and prevention
3. Identification & modification of barriers to healing including vascular impairment
4. Relieve pressure and mechanical forces
5. Control infection & bioburden
6. Debride necrotic tissue
7. Maintain a moist wound healing environment
8. Absorb exudate
9. Eliminate dead space
10. Support nutrition
11. Control pain
12. Appropriate Dressing
13. Consider adjunctive therapy such as HBO (Hyperbaric Oxygen Therapy)
DEFINITIONS
Pressure Ulcers:
Pressure ulcers, also called “decubitus ulcers,” “bed sores,” or “pressure sores” are defined as lesions caused by unrelieved pressure or shear resulting in damage of underlying tissue. These wounds often occur over bony prominences. Prolonged pressure causes ischemia, which leads to tissue necrosis that typically first occurs in the tissue closest to the bone.
- Stage 1: A persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved.
- Stage 2: A partial thickness is lost and may appear as an abrasion, blister, or shallow crater.
- Stage 3: A full thickness is lost, exposing the subcutaneous tissues – presents as a deep crater with or without undermining adjacent tissue.
- Stage 4: A full thickness of skin and subcutaneous tissues are lost, exposing muscle or bone.
Individuals at higher risk to Pressure ulcers:
- Recent Weigh Loss: Individual had weight loss of 5% or more during the past 30 days or 10% or more during the past 180 days.
- High Immobility: Individual requiring extensive assistance or were totally dependent in regard to bed mobility (how individual moves to and from lying position, turns side to side, and positions body while in bed) and transfer (how individual moves between surfaces – to and from: bed, chair, wheelchair, and standing position).
- Recent Incontinence: Individual in incontinent at least 2 to 3 times a week or more.
Park-Lee E, Caffrey C. Pressure ulcers among nursing home residents: United States, 2004. NCHS data brief, no 14. National Center for Health Statistics. 2009.
Business Hours
Premier Wound Care Offices:
1550 E. Washington St. Ste. 101, Colton, CA 92324
(800) 321-1593 Fax# (909) 370-4405
Patient had a pressure ulcer on his left ankle, nectrotic and blackish in color.
“Excellent care… the wound is gone and the ankle is good. Wonderful nurses. I can’t complain about anything.” -Billie C.
Patient had an abdominal abscess requiring surgical debridement and home wound care.
“10 out of 10. The wound healed. They took care of everything, from the surgery to the end it was great. I will recommend to other patients.”
Patient had sacral decubitus ulcer requiring surgical debridement and home wound care.
“I could hardly move because of the pain. It is a lot better now. Premier Wound Care did a great job.”
ANCEL J. ROGERS, MD, FACS
Dr. Rogers, a Southern California native, holds a Bachelor of Science degree in Physics from Stanford University and an M.D. degree from Harvard. Following medical school, Doctor Rogers completed a general surgery residency at the University of Texas, Houston, a cardiothoracic surgery
residency at the University of Pittsburgh and was later appointed Senior Cardiac Surgery Registrar at the Royal Brompton National Heart and Lung
Hospital in London, England.
Dr. Rogers has extensive research experience in transplantation immunology, has made numerous scientific presentations, and published many articles in the surgical literature. Dr. Rogers has been certified by the American Board of Surgery, the American Board of Cardiothoracic Surgery,
and is a Fellow of the American College of Surgeons.
Dr. Rogers has received several educational awards and held academic surgical teaching posts at the University of Texas, the University of Illinois, Champaign, and currently holds dual appointments as an Associate Clinical Professor of Surgery at UCLA and UC Riverside.
Dr. Rogers is a Harvard Medical School Benjamin Waterhouse Fellow and a member of the Dean’s Council. He serves as the local National Medical Association Foundation president and is the Orange County Vice president of the Harvard Club of Southern California.