Winston Moncrieffe prepares for treatment in the hyperbaric oxygen chamber at Bridgeport Hospital’s Center for Wound Healing and Hyperbaric Medicine.
Wound Center helps patient take step toward healing
For Winston Moncrieffe, 36, the problems that led him to the Center for Wound Healing and Hyperbaric Medicine at Bridgeport Hospital started with a hot shower.
For most people, wound healing is a natural, uneventful process. For some individuals, however, it becomes a complex medical problem requiring specialized treatment and care. An estimated 5 million Americans suffer from chronic or non-healing wounds that are caused by a number of conditions, including diabetes, poor circulation, vein disease, trauma, surgical incisions, infections, medication (such as steroids), radiation therapy and immobility.
Moncrieffe, a former basketball star at Central High School in Bridgeport, was diagnosed with type 1 diabetes at the age of 16. Over the decades since, he has struggled to manage the complications that often result from living with diabetes. One of those symptoms is peripheral neuropathy, which is nerve damage caused by chronically high blood sugar. Because the damaged nerves cannot effectively carry messages between the brain and the body’s extremities, peripheral neuropathy can lead to numbness or loss of sensation. For people living with diabetes, this means that they may not feel heat, cold or pain in their feet, legs or hands. For Moncrieffe, that loss of sensation in his feet caused an injury that led to a cascade of complications, surgeries and treatments that consumed his life for nearly a year.
“I didn’t realize how hot the water was in my shower as I was standing in it, and I burned the bottom of my foot,” he said.
“I was out of work all of 2017 seeing doctors and nurses, going to appointments, recovering from surgery – basically, my job was taking care of my wounds,” added Moncrieffe, who works as a supervisor at UPS.
“Feet are a typical spot for burns in diabetics,” said Alisa Savetamal, MD, medical director of the Connecticut Burn Center, located at Bridgeport Hospital. “It’s not uncommon for diabetics with neuropathy to obtain scald burns as a result of shower injuries or walking on hot surfaces without shoe protection. It doesn’t have to be boiling water to do damage – it’s a function of how long the skin is exposed to the water as well.”
Moncrieffe arrived at the Center for Wound Healing and Hyperbaric Medicine in the spring of 2017 with a scald burn on the sole of his foot. The center, which has locations at Bridgeport Hospital and Park Avenue Medical Center in Trumbull, provides multidisciplinary treatment of chronic and slow-to-heal wounds. Individualized treatment plans are developed by an expert team of providers for a variety of conditions, including wounds from vascular diseases, surgeries, diabetes, ischemic wounds (caused by insufficient blood supply), pressure ulcers, animal and insect bites, burns, ostomies, chronic bone infections, cancer treatment, burn scars, and threatened skin grafts and flaps.
The team includes physicians, physician assistants, surgeons, advanced practice registered nurses (APRNs), certified hyperbaric nurses, scar management nurses, wound ostomy nurses and certified hyperbaric technicians. Physicians are board-certified in surgery, podiatry and hyperbaric medicine, with specializations in burns and critical care, as well as a passion for and expertise in wound healing. The comprehensive range of wound care services includes assessment, dressings and topical treatments, layered compression wraps, debridement (removal of damaged tissue), nutritional support, burn scar treatment, and total contact casting as needed. In addition, there are advanced therapies such as state-of-the-art dressings, antibacterial wound therapies, human skin equivalent grafting, negative pressure wound therapy and hyperbaric oxygen therapy. The Wound Center helps to coordinate the care for custom footwear, orthotics and prosthetics as well as for vascular surgery, infectious disease physicians, physical and occupational therapy and additional support services.
“We believe in integrating all the appropriate medical disciplines, both within and outside the Wound Center, through a uniform program of clinical pathways and protocols,” said William Butler, MD, medical director and general surgeon for the Wound Center. “This structured multidisciplinary approach to care enables us to determine root causes of obstacles to healing and achieve resolution through an individualized patient care plan that optimizes clinical outcomes in a cost-effective manner.”
Initial treatment of Moncrieffe’s foot included wound dressings and compression wraps. Within a week, however, it became apparent that the burn was not progressing toward healing, so Moncrieffe was admitted to the hospital’s burn unit for debridement surgery. During wound healing, the affected area can become overrun with necrotic (dead) tissue. Debridement involves the removal of the necrotic tissue from the wound to promote speedy and efficient healing, and also creates a neat wound edge to decrease scarring.
Approximately six weeks later, another debridement surgery was needed, followed by a skin graft. The donor site for Moncrieffe’s graft was his thigh. For some patients, however, a bioengineered skin substitute may be the best option and this can often be done in the Wound Center.
“For many diabetics, it’s a delicate balance to keep feet healthy. In addition to the neuropathy, they are prone to dry, cracked skin that can allow infection to get in, and a minor injury can lead to trauma. Some of these problems are inherent with the disease, and it becomes a real challenge,” said Dr. Butler.
After his skin graft showed signs of rejection, Moncrieffe was referred for hyperbaric oxygen therapy (HBOT). HBOT is a medical treatment in which patients breathe 100 percent pure oxygen inside a pressurized chamber. When pure oxygen is inhaled at an increased pressure, it promotes the healing process of specific chronic wounds, increases the effects of some antibiotics and activates white blood cells to fight certain infections. The hyperbaric oxygen chamber at the Wound Center is the only hospital-based multi-place hyperbaric chamber in the state.
“Multi-place chambers have advantages compared with single chambers,” said Dr. Butler. “Our chamber can accommodate up to six people comfortably, so patients can relax, read, watch television – all with a certified hyperbaric technician who remains with the patient throughout his or her treatment.”
Today, nearly a year after that hot shower, Moncrieffe is back on his feet and able to resume the activities he enjoys. He still plays basketball recreationally, and participates in other athletic pursuits, such as running and snowboarding.
“The important thing about wound care is to treat the whole person – not just the wound. We have a holistic approach to treatment,” Dr. Butler added. “We provide the support that the patient needs in a way that works for him or her as an individual. When you are dealing with a chronic wound, your entire lifestyle is affected. Patients feel that they have lost control over their life. We try to fit the treatment to meet our patients’ expectations and help them regain their sense of purpose and dignity.”
“I couldn’t have gotten through this as smoothly as I did without the help of my mother, father, sister and niece, who provided assistance and help while I was recuperating. And throughout the entire process, the staff at the Center for Wound Healing and Hyperbaric Medicine were like family to me as well. They were all concerned with getting me on the right path and doing the right things,” said Moncrieffe. “They gave me what I needed at the specific time I needed it, and made sure I stayed on top of my care. They helped me every step along the way.”
For more information visit the Center for Wound Healing and Hyperbaric Medicine at Bridgeport Hospital.
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