At the Vascular & Diabetic Foot Center at Baylor Scott & White The Heart Hospital – Plano, the focus is both to treat foot and ankle wounds and to prevent those wounds from occurring in the first place. As the only coordinated outpatient and inpatient program in North Texas with comprehensive care for the diabetic and vascular conditions affecting the foot, the Center takes a holistic approach to care.
“We don’t just treat the foot; we treat the whole person,” said David S. Bastawros, DPM, medical director of the Vascular & Diabetic Foot Center. “A wound is a failure of the skin – the largest organ in the body. We try to figure out why that skin organ has failed and address the underlying problem in an organized manner.”
With its comprehensive care model, patients have access to complete care in one place – from those newly diagnosed with diabetes all the way to those with late complications who may need surgery. The center’s team includes a podiatric surgeon specializing specifically in the treatment of the diabetic and vascular conditions of the foot and a team of experienced vascular surgeons.
“We follow the toe and flow model,” Dr. Bastawros said. “The podiatric surgeon takes care of the toe and vascular surgeons take care of the flow. It’s a collaborative effort, and we work closely together with all specialists as well as the primary care doctor for the patient.”
The American Diabetes Association recommends that every person with diabetes undergo a complete foot exam at least once a year. Through this comprehensive exam, the center is able to identify and proactively address potential areas of concern – from circulation problems to loss of sensation to areas of pressure on the foot to potential ulcerations.
Along with addressing underlying problems, the center offers a variety of advanced therapies if additional treatment is needed, such as skin substitutes, wound VACs, plastic surgery closures, true total contact casting and advanced wound dressings. Patients also have access to a dietitian for nutritional counseling, lab services for blood work, vascular testing and clinical trials, when appropriate.
“The first line is always addressing the primary problem. However, if we address the problem, and don’t see a 50 percent reduction in the wound after 30 days, then we look at advanced therapies,” Dr. Bastawros said. “That’s our second line. Most of the time when a wound isn’t healing, there’s something missing or something that hasn’t been addressed.”
As a result of the center’s comprehensive approach to care, it continues to see quality outcomes. The national average days to heal for arterial, diabetic and neuropathic ulcers is 67 days. The center’s average for all ulcers is 47 days, which is 20 days less than the national average.
Its focus on preventing wounds and complications fits into the overall movement of healthcare away from pay for service to outcomes-based care. It also addresses the economic burden of diabetes in the United States. According to the American Diabetes Association, approximately 7 percent of total Medicare budget is spend on the care and complications of the diabetic foot.
“There has been a shift in the way healthcare is managed – outcomes and prevention are more important,” Dr. Bastawros said. “More than 80 percent of the time, ulcers are preventable. If we catch them early on, we’re saving time in the hospital, avoiding time in the OR, reducing loss of productivity, and keeping patients mobile and active.”