Limb Preservation, Amputation service, and
Wound Care
MARK GOETCHEUS, BSN, RN, CWON, CFCN, CDE
WOUND, OSTOMY, LIMB PRESERVATION, & AMPUTEE SERVICES
HARBORVIEW MEDICAL CENTER
May 25th, 2019
CONFIDENTIAL – DO NOT DISTRIBUTE
DISCLOSUREMark Goetcheus, BSN, RN
• No relevant financial relationship reported
Wound, Ostomy, Limb Preservation, & Amputation Services
Mark Goetcheus Holly VanceNikki OertingBrandon Ibarra
Limb Preservation, Amputation service, and Wound Care
Surgical Consolation
• Salvage vs amputation
• Coordination: LP surgical service
• Vascular interventions
• Wound care plan
• Imaging, labs, ABI/TBI’s
• Infection Disease
Limb Preservation, Amputation service, and Wound Care
Amputation Education
• Physical Therapy/ Occupational Therapy
• Prosthetics & Orthotics
• Rehab Psychology
• Rehab Medicine
• Amputee Support Group
Foot care
• Nail and Callus Debridement
• Foot Care Education
Risk of ulceration Education
Fissure subcutaneous hemorrhage Callus
Onychogryphosis (ram’s horn) interdigital spaces 2/2 maceration & friction
Onychocryptosis/ Ingrown toe nail
Wound Care
• Dressing Plan
• Offloading
• Conservative Sharps Debridement
Lower Extremity Amputation Clinical Pathway (Above, Through and Below Knee)
• standardize treatment
• pre-op clinic visit to 10 weeks post-
operation
• includes trauma related procedure
• Multidiscipline approach
• Patient education