• Gleneagles Medical Centre, 6 Napier Road, #08-08, S258499
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First Consultation (within 30 min)

$195.00 and above

Long First Consultation (within 30 - 60 min)

$295.00 and above

Follow-up Consultation (within 30 min)

$120.00 and above

Long Follow-up Consultation (within 30-60 min)

$195.00 and above

Emergency Consultation (W/IN 30 min)

$350.00 and above

Emergency Long Consultation (W/IN 30-60 min)

$500.00 and above

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Home|Chronic Wounds

Chronic Wounds

Advanced Wound Healing Therapies for Chronic Non-Healing Wounds

Chronic wounds are those that do not progress through a normal, orderly, and timely sequence of repair. Wounds that do not heal within three months are often considered chronic in nature. They are common and are often incorrectly treated. These wounds can cause patients severe emotional and physical stress and create a significant financial burden on patients. They are often painful and tender. Wounds often drain and emit odours, and applied dressings are often conspicuous. Unprotected by an intact skin envelope, these wounds can be retraumatised and may increase in size. They may develop an infection leading to systemic sepsis and potential amputation if on a limb or need for further surgical cleaning. The chance of a chronic wound to heal completely reduces the longer it is left untreated by a specialist.

Our clinic provides comprehensive, up-to-date and evidence-based wound healing management therapies. Dr Tang has been previously certified by the American Board of Wound Management (ABWM). Your hard to heal wound will be evaluated carefully and a customised individual treatment plan will be developed to optimise wound healing trajectory for you. The initial evaluation will include identifying systemic and local factors, which may contribute to the delayed wound healing process. These may include pressure, trauma, poor blood supply, swelling, infection, sugar control and poor nutrition.

Types of Chronic Wounds Managed:

  • Diabetic leg and foot ulcers
  • Ischemic/Arterial Ulcers
  • Venous leg Ulcers
  • Pressure Ulcers (such as in the sacral and heel regions)
  • Non-healing surgical wounds such as on the abdomen and leg
  • Infected Wounds
  • Traumatic wounds
  • Gangrene

Treatment options

The principles to successful wound healing include using the TIME principle: Tissue debridement, Infection control, Moisture balance, and Edges of the wound. After these general measures have been addressed, treatment is specific to the wound type. Patients with arterial ulcers should have interventions such as balloon angioplasty to improve blood supply to the region. Treatment of venous ulcers involves compression bandaging and elevation of the legs and exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area.

Other principles of successful management include:

  • Treating and preventing secondary infection of the wound.
  • Debridement by removing dead skin and tissue from the wound bed and surrounding area. This will promote wound healing by changing the wound from a chronic form to an acute one.
  • Applying appropriate dressings impregnated with medicated gels or antibiotics to treat and prevent infection.
  • Atypical non-healing wounds will be biopsied to check if there is an underlying malignancy.
  • Optimising blood sugar control in patients with diabetes.
  • Regular monitoring and dressings of the wound.
  • Topical pain management –There is a strong need for better pain treatment in chronic wounds. Local treatment with sustained release local anaesthetic is showing promise. Particularly in the patients with severe wound pain, any treatment that would eliminate or delay the need for systemic opioids would be very beneficial.

Advanced wound dressings

The VEC utilises a wide range of advanced wound dressings and wound healing devices. These include silver- based dressings, collagen-based dressings and Negative Pressure Wound Therapy (NPWT). Wounds require different dressings at different stages of wound healing to provide an optimal wound environment for regeneration. Advanced wound dressings are designed to treat complex wounds. They have the ability to:
  • Maintain the wound in a moist environment, optimal for the healing process
  • Protect peri-wound skin from maceration and pressure injury
  • Promote growth of new tissue in the wound bed
  • Treat infected wound with topical antibiotics and maintain a clean wound bed for healing
Advantages of using advanced wound dressings:
  • Faster healing time
  • Reduced super reinfection risk
  • Decreased frequency of dressing changes therefore saving cost

Negative Pressure Wound Therapy (NPWT)

NPWT is a special wound management device used for complex larger open wounds. It uses gentle suction (negative pressure) via a wound dressing and a small electrical pump to help wounds to heal faster.

NPWT helps wounds to heal by:
  • Maintaining a moist wound environment
  • Removing excess fluid and infectious material
  • Reducing swelling
  • Promoting blood supply to the wound
  • Promoting healthy tissue to grow

Hyperbaric Oxygen Therapy (HBOT) and Topical Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen at an ambient pressure within a special chamber. It has been recommended as a useful adjunct for patients with wounds that fail to respond to standard wound care. HBOT has been shown to be effective in improving wound healing and against severe infection, especially in the setting of diabetic foot ulcers. In diabetics the small vessels within the foot are sometimes too small to open with balloon angioplasty and therefore if the blood cannot reach those areas near the toes, oxygen from outside down a pressure gradient can sometimes be an effective substitute.

Natrox™ topical oxygen therapy (Inotec AMD Ltd, Hertfordshire, UK) employs a small battery-powered “oxygen generator” to concentrate atmospheric oxygen and feeds pure, moist, oxygen through a fine, soft tube to a dressing-like “oxygen distribution system”, which is placed over the wound and is held in place by a conventional dressing. This has proved highly satisfactory from the patient perspective and has helped reduce time to complete healing with some difficult diabetic foot wounds from our OTONAL study data from Singapore. This may be used instead of HBOT, when some patients cannot tolerate the pressure within the oxygen chamber.

VEC-Photos-3

Granulox Topical Oxygen Spray

Granulox is designed to provide wound bases with supplemental oxygen through facilitated diffusion (Figure 1). Granulox aims to provide topical, and hence extrinsic, oxygen supply via diffusion to promote healing. It has been shown to overcome the amount of exudate that chronic wounds make when applied to the wound bed directly after cleaning.

granulox

Blue Light Therapy (EMOLED)

Photobiomodulation therapy involves the use of photons from specific frequencies of the visible light spectrum to stimulate the wound healing process. The use of blue light (wavelength 400-450 nm) in particular has been shown to have anti-inflammatory properties, reducing bacterial load and promoting the tissue regeneration process particularly in venous leg ulcers.

Blue-light

Geko Therapy

This technology stimulates the motor neurones within the nerve bundle, that carry signals to the muscle fibres to cause contraction within the leg muscles causing the veins in the leg to empty intermittently. This has been shown to be effectively to heal some chronic venous leg ulcers  and diabetic foot wounds.

Geko

Split Skin Grafting

Split-thickness skin grafting is sometime carried out to cover wounds with a large defect. It is a surgical procedure which involves removing the top layer of skin from one area of the body, usually the thigh, and moving it to cover the wound defect. The top layer from the donor site normally heals without an issue as the skin graft taken is very thin in nature. Skin grafting has been shown to increase the healing rate of diabetic foot ulcer and minimise complications such as major lower limb amputation.

Split-skin-grafting

Our Screening Packages (Non-insurance)

Varicose veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • $588 + GST

Spider veins screening package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • 1 session laser treatment – (additional session $450 + GST)
  • $588 + GST

Varicose veins and spider veins package (single leg)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check distribution and anatomy plus to assess skin problem
  • Ultrasound reflux scan – to check for venous insufficiency (two legs add $450 + GST)
  • 1 session spider vein laser treatment (additional session 450 + GST)
  • $988 + GST (two legs – add $400 + GST)

Diabetic foot screening (basic)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
  • $388 + GST

Diabetic foot screening (extensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – to check circulation, biomechanics of foot arch, sensory loss
  • Ankle brachial pressure index (lab) – to check blood flow in legs
  • Blood test – to check average sugar levels in 3 months
  • Single leg arterial duplex – to identify specific artery problem (additional leg scan $400 + GST)
  • X-ray one foot – to check bone infection
  • $888 + GST

Cardiovascular screening (normal)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • Echocardiogram – to identify heart muscle function
  • $1098 + GST

Cardiovascular screening (comprehensive)

  • Consultation & Review – assess history, risk factors, life style, symptoms
  • Examination – full cardiovascular examination including the heart and limb arteries
  • Ankle brachial pressure index (lab) – this is a marker for longevity and cardiovascular health
  • Blood tests (lipids) – to check all the types of cholesterol
  • Carotid scan – to identify block artery to the brain hence stroke
  • CT coronary Angiogram plus calcium score – gold standard to identify block heart arteries
  • $2098 + GST

Our Doctors

Senior Vascular & General Surgeon
Senior Vascular & General Surgeon