ASK THE EXPERT: DR. BRIAN LEPOW
ASK THE EXPERT
Brian D. Lepow, DPM, DABPM, FACPM is a board-certified podiatric surgeon practicing in Houston, Texas specializing in Diabetic Foot Amputation Prevention and Limb Salvage. He maintains staff privileges at all major medical institutions in the Houston area. Dr. Lepow holds dual academic appointments in the departments of Internal Medicine and Cardiovascular Surgery at McGovern School of Medicine in Houston Texas as well as at the Baylor College of Medicine in the Division of Vascular Surgery and Endovascular Therapy. Dr. Lepow is a member of the Board of Directors of the American Board of Podiatric Medicine and is the Founding Treasurer of the American Limb Preservation Society.
If "time is tissue", how does SnapshotNIR help you to triage patients for critical limb-threatening ischemia (CLTI)?
For every patient that enters our clinic, each one receives a diagnostic screening. This means that an initial assessment for oxygenation and perfusion of the extremity is performed at the first clinical visit. Using Kent’s Snapshot device, in addition to other physical exam findings, decisions are made as to which patients are determined to be in a more critical state. Typically, images of concern found with SnapshotNIR will be confirmed by immediate vascular ultrasound ABI and toe pressures. Snapshot is lightweight and handheld which allows our team to easily assess multiple patients in a very timely manner.
Can you share how SnapshotNIR assists you in optimizing debridement and preparing peri-wound for the successful application of cellular tissue products?
In my practice, Kent Imaging’s SnapshotNIR is used in all aspects of wound care. One common example is the utilization of the device in a pre- and post-debridement setting. Evaluation of both oxygenation of the wound bed, as well as the periwound space, helps to guide treatment for application of various skin substitutes including Medline’s Hyalomatrix product. Both visual assessment and confirmatory images from SnapshotNIR help to confirm that the wound bed is optimal for graft application, ensuring the graft is taking appropriately and that the wound is moving towards ultimate healing. Additionally, SnapshotNIR is used to confirm that other products, like Medline's PluroGel for example, are performing effective debridements by removing biofilm and thus improving oxygenation at the wound bed level.
Can you speak to the importance of tracking the progress of wound healing and how SnapshotNIR supports you in this documentation journey?
The importance of tracking the progress of wounds throughout the continuum of care is an extremely important factor to reduce complications and improve outcomes for patients. Serial tracking allows for a clear evaluation of the wound site and indicates improvements. If improvement is not noted, this is generally a strong indicator that other factors may be limiting the healing process. This could include the need for additional endovascular intervention and more invasive vascular assessments, broadening and/or tightening of antibiotic coverage, the need for additional surgical debridements, and/or a possible change of plan altogether.
Tracking the progress of wound healing is also extremely important for physician reimbursement. Without adequate documentation of wound improvement, reimbursement can become difficult to achieve in managing this patient population. Images captured with SnapshotNIR allow us to confirm and at times better evaluate both the wound bed and periwound space by viewing serial images throughout the treatment pathway. When treating a particular patient, comparing the tissue oxygenation (StO2) images week after week is critical in determining if there are any significant changes.
GAME CHANGERS: If you would like to share your experience with SnapshotNIR through an Ask the Expert Interview, fill out this form.