UCLA-Gonda (Goldschmeid) Wound Treatment Center
The UCLA-Gonda (Goldschmeid) Wound Treatment Center is a multidisciplinary program of treatment and support services for the management of acute and chronic wounds. We offer the full spectrum of wound care including both wound assessment and the most advanced treatment technology.
Since problem wounds are often associated with underlying medical conditions, our program is designed to integrate wound care with comprehensive medical care. We coordinate wound treatment plans with the patient's primary care and specialty care physicians to ensure that each patient's needs are met.
Types of Wounds Treated:
Our Center treats all acute and chronic wounds. Acute wounds may include burns, traumatic wounds, wounds from tumor removal and surgical wound problems. Chronic wounds typically represent diabetic ulcers, venous ulcers, radiation wounds, wounds due to poor blood flow, pressure sores or wounds which will not heal from nutritional deficiencies or medication use.
Wound Treatment Technologies:
Individualized wound treatment is dependent upon the type and severity of the wound. Based on the reason for the wound, we selectively employ the following treatments:
Advanced Wound Dressings
Hyperbaric (High-pressure) Oxygen Treatment
Surgery Including Microvascular Surgery
Home Nursing Care
Negative Pressure Wound Therapy (VAC)
Making an Appointment:
Patients may directly contact us, or be referred by physicians and other caregivers. Please contact us at (310) 206-6294 so that a patient coordinator can schedule an initial assessment. We are located on the UCLA Campus on the 5th floor of the UCLA 200 Medical Plaza Building, Westwood, CA.
Factors Affecting Wound Healing
There are several local factors that impede the healing process. These factors all occur at the site of the wound.
Pressure on the body's soft tissue, when it is compressed for prolonged periods of time between a bony prominence and an external surface, can cause pressure ulcers and/or inhibit wound healing.
Wounds kept in a moist environment heal three to five times faster, with less pain, than wounds exposed to a dry environment.
Trauma and Edema
Wounds that are repeatedly traumatized or reinjured heal very slowly or perhaps not at all. Likewise, edema (tissue swelling) hinders the supply of oxygen and nutrients to the wound site and impedes healing.
An infection, either local to the wound site or systemic within the body, can delay or impair the healing process.
The inability to control bowel and bladder function can interfere with the wound healing process requiring proactive management.
Local tissue necrosis (death) interferes with the healing process. Therefore, necrotic tissue must be removed from the wound site to promote healing.
Systemic factors are those that broadly affect the body. Similar to local factors, these can also impede healing at the wound site.
The elderly are at higher risk for developing problem wounds for a variety of reasons including improper nutrition.
Patients at both ends of the spectrum are at greater risk for problematic wounds. Wound healing in the obese may be compromised by poor blood supply due to fat tissue. Thin or emaciated patients may be compromised due to poor nutritional supplies and a lack of oxygen.
Diabetes Mellitus (insulin dependent diabetes) greatly affects the wound healing process if serum glucose levels are not effectively managed with appropriate dosages of insulin.
Regular nutritional assessment is very important. Monitoring of total protein, serum albumin and hematocrit to ensure adequate body nutrition to facilitate wound healing is imperative.
Poor Blood Flow
Peripheral vascular disease causes poor circulation and insufficient blood supply. This often leads to problem wounds of the lower extremities, such as feet and ankles.
The wound healing process is adversely affected by a suppressed immune system due to disease or medication.
Radiation therapy may cause ulcerations for a significant period of time after treatment has been completed due to loss of blood flow.
Our Step-Wise Approach to Wound Healing
1. Wound Assessment
We provide an extensive assessment of the wound site as well as the patient health factors that may be affecting the wound healing process.
2. Treatment Plans
Our multidisciplinary team develops individualized treatment plans that include wound care management and appropriate adjunctive therapies. All patient care is coordinated with primary care and specialty care providers to ensure a fully integrated treatment plan for the patient's overall well-being. The treatment team reviews all of the needs of patients including wound care products, assist devices and at-home wound care. Detailed patient instructions are provided along with a plan for ongoing follow-up.
Patients and caregivers are provided with education on wound care at home and lifestyle adjustments to facilitate the healing process. Effective management techniques for underlying medical conditions are also taught with emphasis given to proper patient compliance.
The treatment team has advanced training in the techniques of thorough wound debridement (removal of dead tissue). Foreign material and dead tissue must be removed so that underlying healthy tissue can regenerate.
5. Nutritional Support
Patients are assessed for nutritional status and regularly monitored by the team to ensure adequate levels of nutrients to promote healing. Patient treatment plans include individualized dietary plans.
6. Support Surface
Patients with pressure wounds are assessed to determine their risk for developing additional wounds as well as relieving pressure on existing wounds. Appropriate support surfaces such as special beds, mattresses, seat cushions or appropriate footwear are prescribed to reduce or relieve pressure on existing wounds and areas if weakened tissue.
7. Infection Management
Appropriate wound and blood cultures or biopsies are performed to identify cause(s) of infection. A detailed assessment is then made to determine the optimum antibiotic management program.
8. Compression Therapy
Compression therapy may be used on wounds located in lower extremities. Elastic stockings or bandages are applied to increase venous blood return, prevent blood pooling and decrease edema. Other forms of compression therapy may also be used.
9. Hyperbaric Oxygen Therapy
Hyperbaric (high pressure) oxygen therapy is available and administered to patients in specially designed hyperbaric oxygen chambers. Breathing pure oxygen increases the level of oxygen in the bloodstream to promote wound healing by stimulating new vascular growth and facilitating the "normal" wound healing process in the compromised patient.
Hyperbaric oxygen therapy also plays an important role in treating acute and traumatic wounds such as necrotizing fascists, clostridial myonecrosis, crush injuries and surgical complications. We have a large hyperbaric chamber in our center for patients requiring this type of treatment.
10. Occupational, Physical and Speech Therapy
When needed, patients have the support of occupational and physical therapists for rehabilitation, as well as speech therapists to assess swallowing ability.
UCLA GONDA (Goldschmeid) VASCULAR CENTER & DIVISION OF PLASTIC SURGERY
SPECIFIC WOUND CARE INSTRUCTIONS (FOR PATIENTS ONLY)
In order to ensure the best possible care and most rapid healing of your wound, we have put together these instructions for our patients. These instructions are meant as general guidelines and reminders for you and your home health care nurse to follow during the care of your wound.
General information based on your diagnosis
Chronic wounds typically arise from either one or a combination of specific causes: diabetes mellitus (high blood sugar), poor blood or lymph flow out of or into the wounded area, poor nutrition, radiation exposure, a rheumatologic disease or steroid usage. The best treatment of the wound depends not only on the cause of the wound but the location of the wound and the other health factors that may negatively impair wound healing.
Diabetes mellitus: It is important in diabetic wounds that the blood sugar be tightly controlled. Your internist or other general medical provider can help with this. If the wound resides on the leg or area where the sensation is decreased, it is important to avoid trauma to this area.
Venous status disease or poor blood or lymph flow out of a wounded area or extremity can also impair wound healing. The poor flow from the wound can cause fluid to back up and the extremity to swell such that oxygen cannot get to the tissue. It is important in these cases to keep the area involved elevated as much as possible or wrapped otherwise the wound will not heal or heal very slowly.
Patients with poor blood flow from the heart to the wound or extremity also have a difficulty healing wounds because oxygen and nutrients cannot get to the wound. It is important in this case to optimize the blood flow by taking medication which makes the blood flow better or the heart pump better. Also a vascular surgeon may be needed to discuss the possibility of a bypass graft to the wounded area.
Poor nutrition. Appropriate nutrition is essential to good wound healing. This includes good caloric intake everyday as well as a good protein source in ones diet. If you are not eating well or have a disorder which prevents your nutrition from being absorbed in your gastrointestinal tract, it is important that the doctor be notified.
Radiation exposure. In many cases radiation treatment was used to eradicate cancer or treat another condition. Unfortunately, radiation decreases the amount of oxygen in the radiated area and can cause wound healing problems. It is important to note any radiation exposure to the physician.
Autoimmune or collagen vascular disorders can also impair wound healing. It is important that these disorders be managed by your rheumatologist and any medication instructions followed. Many times steroids may be given for these diseases. It is important that the wound doctor be made aware of this as steroids may dramatically affect wound healing.
Occasionally wounds become colonized or infected with bacteria or exhibit signs of pain, tenderness, redness, warmth or increased drainage. It is important that if your wound exhibits any of these findings that you alert your physician.
Nonsurgical Wound Treatment
The following represents specific information regarding treatments utilized in our wound care center for patients with chronic wounds. If you have a specific question regarding wound care, this should be discussed at the time of your visit. If you have other questions later, you may either bring these up to your home health care nurse or discuss them with the doctor at the time of your next visit or if an emergency develops call the office.
Wet to dry dressing. These dressings are applied by taking a 4" x 4" gauze pad, soaking it in sterile saline solution and squeezing it until it is only lightly moistened. This it is applied directly to cover all surfaces of the wound. On top of this, dry gauze is placed and the gauze fastened to the wound by tape or other elastic garment such as an ACE wrap. This dressing should be changed twice daily, once in the morning and once in the evening. It is generally okay to let a chronic wound be exposed to tap water a mild soap in the bathtub or shower prior to applying the dressing.
Duoderm. Duoderm is a wafer that adheres to the outside of the dressing and allows fluid and white blood cells to help clean and heal the wound. Typically Duoderm is applied every 3-5 days and changed accordingly. If the wound is particularly moist or weepy, it may be changed more often.
Sorbsan & Fibrocol. In chronic wounds that are particularly weepy or produce a lot of fluid, Sorbsan & Fibrocol, which is an absorbent material, can be placed onto the wound bed and covered by a Duoderm or multi-layer compressive dressing. This allows the fluid to be absorbed and may prevent leakage of fluid. Typically this dressing combination needs to be changed every 1-3 days based of the amount of wound fluid which is produced.
A multi-layer compression dressing is used to reduce the swelling in the limb to improve wound healing. This dressing consists of a three-layer overlaying dressing which may be placed on top of Duoderm , Regranex, Vigilon or other dressing material (see elsewhere). Generally, this dressing is applied by the doctor or the nurse but can in some instances be applied by the patient if the patient has been instructed on how to do so. Briefly, after the wound is covered, a fluffy gauze material is wrapped from the toes to just below the knee. Following this, an elastic bandage is placed in a "figure of eight" style from the toes up to the knee. Finally, a layer of Coban is placed and wrapped around and around beginning from the toes and going to the upper part of the dressing. This provides firm but regulated elastic compression to the leg to help reduce swelling and improve wound healing. Frequently this dressing must be changed after the first day because it is loosened from the initial reduction in the swelling of the leg. Thereafter, the dressing should be changed every 3-5 days based on other recommendations for care of the wound.
Regranex. Regranex is a very expensive wound care product which may help some wounds heal more quickly. Generally it is applied once daily; briefly a pea-sized amount of the material is rubbed into the wound once a day. It can then be covered with a Telfa or gauze that is then secured to the skin with tape or an elastic bandage. The wound can be washed and cleaned with water and a mild soap if necessary.
Vigilon is a water-based dressing that is particularly useful for very sensitive wounds or skin. It is generally peeled from the package and applied directly to the wound and left there for 3-5 days then changed.
Hyperbaric oxygen is a treatment we occasionally use to improve the oxygen delivery to the wound to make it heal faster. Specific instructions related to the hyperbaric oxygen will be given by the hyperbaric personnel in the basement of the 200 Medical Plaza Building. In general, all the above noted wound dressings are used in combination with hyperbaric oxygen. These wound dressings as noted above should be continued along with the hyperbaric regime your doctor has planned for you.
The VAC device or vacuum assisted wound closure device is a new device that is useful in very deep or very weepy chronic wounds. This device suctions fluid from the wound and reduces the amount of swelling in the wound area speeding its healing. This device should be placed by your doctor or nurse initially but in some cases after instruction, the patient may change this. Briefly, the VAC sponge is placed directly onto the wound bed and then the suction tubing is placed on top of the foam and the foam is covered with a sticky watertight saran wrap like sheeting. The tubing, the tip of which is placed on top of the foam, is then hooked to a suction device that evacuates the air from the dressing and collects the fluid. This device is typically changed every 3-5 days.
Vitamin A treatment. Vitamin A has been found to reduce the effects of steroids on wounds and may speed healing. It is always important that a patient with a chronic wound who is on steroids, should have their steroid dose reduced to the minimum possible amount but only as directed by your medical physician. Then vitamin A can be taken in a dosage of 25,000 IU a day. If there is any question about the safety of the use of vitamin A with your particular condition, please check with your medical physician.
We provide comprehensive surgical treatment of wounds if nonoperative treatments fail. These include wound debridement, skin grafting, application of tissue engineered skin substitutes, as well as flap and microsurgery.