I am a wound care provider and every day I see new patients suffering from, “I have a hole in my leg and it just won’t heal.” Chronic (nonhealing) leg wounds are a major source of patient morbidity. Two million patients present annually in the United States with a chronic leg wound. The two most common reasons for the nonhealing of a leg wound are chronic leg swelling (edema) and repetitive trauma to the wound (diabetic foot wounds).
Treatment of a chronic leg wound in the setting of leg edema consists of: encouraging the patient to walk; elevation of the leg when sitting; primary wound dressings that maintain a moist wound care environment by wicking wound drainage away from the wound; and secondary wound dressings consisting of multilayer compression bandages that compress the swollen leg.
Chronic foot wounds occur in diabetics due to diabetic neuropathy that prevents the patient from sensing pain from the wound located on the plantar aspect of the foot, allowing them to repetitively traumatize the wound when walking. Treatment of a chronic diabetic foot wound consists of, in addition to primary wound dressings, an offloading device such as a total contact cast or offloading boot to limit plantar pressure and thus limit trauma to the wound with walking.
Even with proper treatment, healing a chronic leg wound is a prolonged process often taking 3 to 6 months or longer, require a 25 to 50 visits to a wound care provider for dressing changes.
The dilemma of the wound care provider is determining which of the many primary/secondary dressings or offloading devices are the best for the patient and the patient’s wound and when next to schedule the patient for dressing change. A recent study looking at primary wound dressings found that 45% of primary dressing changes were performed without failure of the primary dressing (UNNECESSARY DRESSING CHANGE) and 26% of primary dressings remained in place on the patient in the home despite already have failed (primary dressing saturated) and were no longer providing therapeutic wound moisture balance (FAILED DRESSING).
In addition to primary dressings, chronic leg wounds in the setting of leg edema require adequate compression of the leg with a secondary dressing of a multilayer compression bandage. The compression bandages can fail while in place on the patient in the home and slip down the leg (especially when the leg swelling decreases). Another key to reducing leg edema and speed wound healing is to encourage patients to walk and elevate when sitting. However, during the time between wound care appointments, objective data regarding patient compliance with walking and leg elevation and the status of the wound dressings or offloading device is not available.
SuraMedical has built a low profile wearable - Endema - placed by the wound care provider on the posterior calf between the layers of the compression bandage at the time of dressing changes. Endema will record the number of hours of patient walking and leg elevation in the home and a report will be generated for review at the time of dressing appointments. More importantly, Endema will detect with disposable moisture sensors placed on the outer aspect of the primary dressings if the primary dressing becomes soaked and detect using a pressure sensor within the device on the posterior calf if the compression bandage becomes loose (or the patient is not wearing the offloading boot when walking). Endema will alert twice a day via bluetooth to the patient's smartphone (or smartphone provided to the patient) and alerts will be communicated to a monitoring center that will coordinate dressing changes within 24 hours if an alert is detected.
No longer will patients have FAILED dressings remaining in place in the home. No longer will patients undergo UNNECESSARY dressing changes when the wound dressings are still therapeutic.
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